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It is a well known fact that non-steady caffeine intake — caffeine withdrawal more precisely — can lead to headache. However, the question of whether or not such a headache can trigger a migraine is still debated by some.

What is a migraine?

A migraine is a very bad headache that tends to recur. Migraines may be classified into three types:

• Migraine with aura (old term: classic migraine)
• Migraine without aura (old term: common migraine)
• Migraine variants (retinal migraine, ophthalmoplegic migraine, familial hemiplegic migraine)

The pain is usually on one side of your head and you may be very sensitive to bright lights and noises. Moving around can make the headache feel worse. Many people that have migraines are not aware of their condition, not knowing what a migraine is. A common misconception is that a migraine is a headache that comes and goes more often than usual.

Common migraine

The common migraine is not preceded by an aura. During the headache phase of a common migraine a patient usually has nausea and sometimes vomiting. Migraine can be triggered by:

• an alteration of sleep-wake cycle;
• missing or delaying a meal;
• insufficient fluid intake;
• physical exhaustion;
• bright lights, sunlight, fluorescent lights, TV and movie viewing;
• certain foods (sweets); and
• excessive noise.

Stress is an important trigger factor too.

Migraine affects individuals and society

Migraine has an enormous impact on society. Recent US studies have evaluated the indirect and direct costs of migraine. Indirect costs include the aggregate effects of migraine on productivity at work (paid employment), in performance of household work, and in other roles. Hu and associates estimated that productivity losses due to migraine cost American employers $13 billion per year. These issues were more recently reviewed in detail by Lipton and colleagues.

Migraine also has a marked impact on healthcare utilization. The National Ambulatory Medical Care Survey, conducted from 1976 to 1977, found that 4% of all visits to physicians’ offices (>10 million visits per year) were for headaches. Migraine also results in high utilization of emergency rooms and urgent care centers. Vast quantities of prescription and over-the-counter (OTC) medications are taken for headache-related disorders. OTC sales of pain medication in the United States (for all conditions) were estimated at $3.2 billion in 1999, and headache accounted for approximately one third of OTC analgesic use.

Migraine and caffeine

Approximately 96% of migraineurs use medication for migraine relief, and more than 90% use non-prescription medication. Caffeine is already widely used in a number of migraine medications, and paracetamol and aspirin are recommended for acute treatment of migraine. Controlled trials suggest that alcohol and caffeine withdrawal are the most important nutritional precipitating factors of migraine. Both caffeine withdrawal and migraine are accompanied by vasodilation in the head and neck. Both caffeine withdrawal and migraine are commonplace and irregularly episodic. Both are, in many cases, relieved by administration of caffeine. Does caffeine withdrawal cause, influence, or merely resemble migraine? To find the answers, studies of primary headache and headache treatments should control for caffeine withdrawal, a demonstrated cause of headache.