Scientists Use Guesswork Where Study Is Unclear

According to the World Health Organization (WHO), headache disorders are some of the most
common to affect the nervous system.
A migraine is a form of primary headache disorder. The term "primary" refers to the fact that the
underlying causes are unclear.
In the United States, 12% of the population (39 million people) experience migraines. This
includes adults and children.
The majority of migraineurs say that they are aware of at least one trigger that can bring on their
symptoms. Triggers include weather patterns, sleep, stress, hormones, drugs, exercise, and diet.
When it comes to caffeine, the amount a person drinks may be the central factor in whether or
not it is a trigger. According to the American Migraine Foundation, some people find it helpful
to use a small amount of caffeine to stop some of their migraine headaches. Others may have
more frequent migraine headaches with regular caffeine consumption.
Although there is anecdotal evidence of caffeine's potential Jekyll-and-Hyde nature, clinical data
from migraineurs is rare.
A new study paper, which now appears in The American Journal of Medicine, sheds some light
on this conundrum.
Elizabeth Mostofsky, from the Department of Epidemiology at Harvard T.H. Chan School of
Public Health in Boston, MA, is the first author of the study.
Together with her collaborators, Mostofsky set out to investigate if caffeine consumption is
linked to the onset of migraines on the same day in people living with the condition.
For her study, Mostofsky recruited 98 volunteers who experience migraine with or without aura.
The study participants filled in electronic diaries every morning and evening for 6 weeks. In
these diaries, they recorded a variety of factors, including exercise, caffeine, and alcohol
consumption, stress, sleep quality, and headaches.
Specifically, the team asked the participants about total daily caffeine intake from coffee, tea,
soda, or energy drinks.
They then compared how likely each participant was to experience migraine on a day when they
consumed caffeine with the likelihood on a day when they didn't.
Using a statistical model, the team estimated that drinking one or two caffeinated beverages did
not change the odds of experiencing a migraine headache on the same day. However, when the
volunteers consumed three or more caffeinated drinks, the odds were significantly higher.

The results were similar when the team reanalyzed the data to take alcohol intake, stress, sleep
quality, exercise, and female participants' menstrual cycles into account.
Mostofsky also looked at the potential of reverse causation, meaning that the volunteers may
have consumed more caffeine to help cope with the onset of a migraine headache.
However, the data showed that people who drank three or more caffeinated beverages had higher
odds of developing a headache on the following day, meaning that this amount of caffeine didn't
stop a migraine in its tracks.
To date, there have been few prospective studies on the immediate risk of migraine headaches
with daily changes in caffeinated beverage intake," says principal study investigator Dr. Suzanne
M. Bertisch, an assistant professor of medicine at Harvard Medical School.
In this study, there was a nonlinear association between caffeinated beverage intake and the
odds of migraine headache on that day. This suggests that high levels of caffeinated beverage
intake may be a trigger of migraine headaches on that day.
Additional research is needed to examine the potential effect of caffeine on symptom onset in
the subsequent hours and the interplay of sleep, caffeine, anxiety, environmental factors, and
migraine, the authors conclude in their paper.


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