Habitual caffeinated beverage consumption and headaches among adults with episodic migraine: A prospective cohort study

Abstract Objective To examine the relationship between habitual caffeinated beverage consumption and headache frequency, duration, and intensity in a prospective cohort of adults with episodic migraine. Background Caffeine is a commonly ascribed headache trigger in adults with migraine and clinicians may counsel patients to avoid caffeinated beverages; however, few studies have examined this association. Methods From March 2016 to August 2017, 101 adults with physician‐confirmed episodic migraine completed baseline questionnaires, including information about caffeinated beverage consumption. For 6 weeks, they reported headache onset, duration, and pain intensity (scale 0–100) on twice‐daily electronic diaries. Ninety‐seven participants completed data collection. We examined associations between self‐reported habitual caffeinated beverage consumption at baseline and headache outcomes prospectively captured over the following 6 weeks, adjusting for age, sex, and oral contraceptive use. Results The adjusted mean headache days per month was similar among the 20 participants reporting no habitual intake (7.1 days, 95% confidence interval [CI] 5.1–9.2), the 65 participants reporting 1–2 servings/day (7.4 days, 95% CI 6.1–8.7), and the 12 participants reporting 3–4 servings/day (5.9 days, 95% CI 3.3–8.4). Similarly, mean headache duration (no servings/day: 8.6 h, 95% CI 3.8–13.3; 1–2 servings/day: 8.5 h, 95% CI 5.5–11.5; 3–4 servings/day: 8.8 h, 95% CI 2.3–14.9) and intensity (no servings/day: 43.8, 95% CI 37.0–50.5; 1–2 servings/day: 43.1, 95% CI 38.9–47.4; 3–4 servings/day: 46.5, 95% CI 37.8–55.3) did not differ across levels of caffeinated beverage intake, though estimates were imprecise. Conclusions We found no association between habitual caffeinated beverage intake and headache frequency, duration, or intensity. These data do not support a recommendation that patients with episodic migraine should avoid consuming caffeine. Further research is needed to understand whether deviating from usual caffeine intake may trigger migraine attacks.