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Practice Masterclass for GPs


BMJ 2007; 334 doi: (Published 01 February 2007) Cite this as: BMJ 2007;334:254

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Caffeine withdrawal causes weekend headaches

Headache is common and trigger factors for migraine are mostly well
known. However, the specific trigger of erratic coffee / tea consumption
leading to caffeine withdrawal headache deserves a mention. As huge
numbers of people drink tea and coffee it is likely to be very common, and
its importance is that it is contrary to the perception most doctors seem
to have that triggers act positively to induce migraine rather than
causing it by taking the trigger away.

For years I put up with inevitable migraines almost every time I was
off work at a weekend or on holiday. Weekend headaches were so
predictable my wife thought they were an indication that our marriage was
more stressful than my job.

Casual discussions at work with GPs and neurologists suggested all
sorts of treatments, none of which made a great deal of difference, but it
took a pathologist colleague who had suffered the same symptoms to
identify the cause. Every day at work I was drinking several cups of
filter coffee, then during the weekends I had only decaffeinated coffee
and fruit juice. The headaches coincided with caffeine withdrawal.

Since then just having a couple of cups of strong tea or coffee on
days off has kept me pretty well migraine free and my family no longer
think I hate them.

This is not just a nice anecdote. It is also supported by evidence
published in the BMJ:

BMJ. 1990 June 16; 300(6739): 1558–1559.

Headache caused by caffeine withdrawal among moderate coffee drinkers
switched from ordinary to decaffeinated coffee: a 12 week double blind
M van Dusseldorp and M B Katan

So, as a cured sufferer of caffeine withdrawal headache, I would
suggest anyone taking a headache history should start with a cup of

Competing interests:
None declared

Competing interests: No competing interests

02 February 2007
Derek E Roskell
Consultant Pathologist & Assistant Medical Director (Education)
John Radcliffe Hospital, Oxford OX3 9DU