Caffeine is a common component included in many headache and migraine treatments. It is  also naturally present in coffee, tea, cocoa and chocolate including chocolate related products, and is sometimes added to soft drinks. In fact, many caffeine-free and decaffeinated beverages also contain small amounts of caffeine.

The caffeine content found in various food and drinks is shown below:

COFFEE Decaffeinated instant or roasted and ground 8 oz (237ml) 5mg
Instant 8 oz (237ml) 55-105mg
Roasted and ground, percolated 8 oz (237ml) 120mg
Brewed 8 oz (237ml) 135 mg
TEA Decaffeinated 8 oz (237ml) 0mg

Instant 8 oz (237ml) 15mg
Blend 8 oz (237ml) 45mg
Leaf or Bag 8 oz (237ml) 50mg
COLA Regular Cola 12oz (355ml) (1 can) 35-45mg
Diet Cola 12oz (355ml) (1 can) 40-50mg
COCOA Milk Chocolate 1oz (28g) 5-20mg
Dark, Unsweetened Chocolate 1oz (28g) 25-60mg
Chocolate Cake 1oz (28g) 35mg
Chocolate Milk 8oz (237ml) 10mg

Similarly, the caffeine content found in medication varies significantly, for example:

OVER THE COUNTER Dristan Capsules 16 mg
Vanquish Caplets 33 mg
Excedrin Caplets 65 mg
Vivarin Tablets 200 mg
PRESCRIPTION DRUGS Norgesic Tablet 30 mg
Fiorinal Capsules 40 mg
Norgesic Forte 60 mg
Wigraine Tablets 100 mg

Caffeine Advantages

Caffeine is used in headache medication because it:

  • Acts as a vasoconstrictor – it constricts blood vessels which become dilated and inflamed during a migraine.
  • Makes pain relievers approximately 40% more effective in treating headaches.
  • Helps the body absorb headache drugs more quickly, bringing faster relief.
  • Reduces the risk for potential side effects e.g. gastrointestinal irritation and possible drug addiction due to requiring less medication.

Caffeine is an effective headache treatment for many people, either in combination with a painkiller or other medication. Benefits are usually noted after 20-30 minutes after ingestion and may last up to 5 hours. Based on current research, sensible (mild to moderate) levels of caffeine are beneficial in easing headache pain.

Caffeine Disadvantages

  • Certain migraneaurs find caffeine acts as migraine trigger even in small quantities.
  • People who are used to drinking coffee regularly (4-5+ cups a day), frequently report that coffee/caffeine withdrawal (along with possible symptoms such as fatigue, anxiety, depression, muscle tension, irritability and nausea) acts as a powerful migraine trigger. Caffeine withdrawal (not to be confused with caffeine addiction that is a compulsive craving for the drug and rare) thresholds differs from person to person and depends on a wide range of factors e.g. metabolism, age, weight and other medication being taken. These people are recommended to limit their coffee intake to one cup a day.
  • Possible side effects of caffeine include:
    • General – nausea, upset stomach, insomnia, restlessness, nervousness, tremors, headaches and light-headedness.
    • Large amounts –  muscle twitch or irritability, frequent urination,  aggravated ulcers, flushing.
    • Notify a doctor if you experience –  chest pain, palpitations, rapid breathing, dizziness, confusion or fatigue, depression.
  • Regular overuse or misuse of any headache medication, particularly in association with caffeine e.g. strong coffee or caffeine containing medication, can increase the probability of a condition termed Headache Rebound Syndrome
    • Worsening headache pain can occur with medication overuse due to it interfering with the brain centers that regulate the flow of pain to the nerves. In essence, the following cycle ensues: 
      Pain relief medication taken → Pain medication wears off → Withdrawal reaction and headache → More pain relief medication taken. 
      This cycle leads to ever-increasing levels of medication being required to alleviate headaches of increasing frequency, severity and drug tolerance.
    • The risk of Headache Rebound Syndrome and addiction is minimized by using pain relievers on a limited basis and only when necessary. Should it develop, gradual reduction and possible elimination of certain medication will be required.  This may need to be carried out under medical supervision.