Coffee and Migraine Headaches: Benefits and Drawbacks

The incredible appeal of coffee.

Coffee is a potent drug, and migraineurs have an especially tricky relationship with it. Coffee constricts blood vessels and thereby alleviates headache symptoms. There’s a good reason why caffeine is added as a key ingredient in some NSAID migraine meds like Excedrin: caffeine lowers adenosine levels (but like all other migraine meds as well as coffee itself, Excedrin also causes rebound headache). Coffee actually has a lot of great health benefits, some of them particularly relevant to those with migraine, which is probably one reason why so many with migraine are so dependent on it.  All of us also know that coffee consumption has some drawbacks as well – causing us to either feel physically or psychologically bad for drinking coffee when we do. So are coffee and migraine headaches incompatible, or complimentary?

Quite a few of us yo-yo between these two states: going through phases of intense coffee use and then denial, back and forth.  Others have wholeheartedly and without reservation accepted their coffee obsession, without any qualms.  A few lone souls have actually managed to completely stop drinking coffee.

Coffee is just too delicious and too sacred a ritual for the majority of my clients to give up with any ease.  Usually I will recommend that people NOT try to give up coffee in the early weeks of implementing the SimplyWell Migraine Relief Protocol because I think it is often unrealistic and too challenging to expect people to start drastically new dietary and lifetsyle habits while also going through withdrawal from their favorite drink.

But when we recognize we’ve reached a place where we are truly ready to do anything to heal, the time comes to really take stock of what we consume regularly, ESPECIALLY if our use of it is chronic, addictive, or we feel we literally can’t function without it.  That’s a sign that the substance offers substantial benefits but is also probably being misused.

Evidence for both benefits and drawbacks of coffee consumption for those with migraine

Above all, my intention here is simply to share some of the research that I’ve found on both the positives and negatives of coffee and migraine headaches and how I personally choose to interface with coffee.  My intention here is neither to demonize or glorify coffee.  It’s a food grown from a plant, and you know how I adore plants.  I believe we need to be able to integrate food into our life while being very mindful and educated about each food’s properties, and then check in with our inner body wisdom and experience to make the final call about how much to incorporate that food into our life.

Coffee and caffeine’s affects on us are complex and vast. The most thorough and balanced article on coffee’s benefits and drawbacks that I was able to find concludes that much of the research on coffee is conflicting at best, because:

. . . most research studies observe and measure the effects of a single dose of caffeine rather than the effects of chronic ingestion. Yet most coffee drinkers drink coffee daily. As a number of studies have shown, single-dose experiments don’t necessarily reflect the effects of our regular routines. . .  [But what is clear is that] caffeine impacts whether certain chemicals are available; how receptive our brains are to them; and whether we’re even making those chemicals in the first place (Source).

Coffee benefits for those with migraine

Coffee imparts certain benefits to those with migraine especially.  The question is whether these short-term benefits are worth the drawbacks. So first, what’s so fabulous about coffee, above and beyond the taste and the ritual, specifically for those with migraine? Here are the highlights that I find intriguing:

• “Chronic caffeine intake has been shown to increase the receptors of serotonin (26-30% increase), GABA (65% increase), and acetylcholine (40-50%). This may contribute to the elevated mood and perceived increase in energy we feel after a coffee.” (Source)
  Why this is relevant: Migraineurs tend to have lower levels of most neurotransmitters, including serotonin and acetylcholine, but more receptor sites for them (presumably because their levels are so low, they need more receptors to benefit from the few that are available). Coffee inadvertently increases receptivity to serotonin, GABA, and acetylcholine BECAUSE it depletes our bodies of them (maybe not such a good thing, but the initial effects of increased receptivity feel good). “In the human body, when neurotransmitter receptors . . . increase their sensitivity, it generally suggests a reduction in functional capacity and activity of neurons associated with those receptors. Either the brain needs more chemicals to do the job, or the neurons involved aren’t working as hard. This might mean that a certain neurotransmitter is in short supply, or that its activity needs to increase.” (Source)
  
• Caffeine inhibits blood platelet aggregation (it does so by inhibiting the release of serotonin). Why this is relevant: Migraineurs generally have thick, sticky blood.
  
• Caffeine synergizes with progesterone, and increases its concentration in blood and tissues. (Source)  Why this is relevant: progesterone is a glutamate scavenger.  It is also essential for the production of cortisol, which puts the brakes on histamine.  Progesterone offsets estrogen, an excessive amount of which contributes to histamine overload and interferes with proper signaling in your thyroid gland.  Increased progesterone can improve liver and thyroid function as well.  All of these are good things for those with migraine.
  
• Coffee contains magnesium and potassium. Other vitamins and minerals found in coffee include vitamin K, riboflavin, niacin, folate, pantothenic acid, choline, calcium, phosphorus and manganese, but these are not present in dosages high enough to warrant drinking it. Why this is relevant: Migraineurs get migraines due in part to deficiencies in essential vitamins and electrolytes.
• Caffeic acid, found in coffee as well as other plants like celery and the herb Danshen, lowers CGRP levels.  Why this is relevant: CGRP, an inflammatory neuropeptide, has shown to exist in higher levels in those with migraine.
• Coffee raises blood pressure.  This is perhaps the greatest benefit of coffee, and explains why it can get rid of a headache once in awhile.  Coffee raises blood pressure by way of stimulating adrenaline. Why this is relevant:  those with migraine generally have low blood pressure, so raising it and thereby getting rid of the headache is a huge relief. The blood vessel constriction and raising of blood pressure results in reduced blood flow to the brain.  Check out these before and after images of the brain after coffee consumption.
• “Caffeine affects the activity of a naturally occurring and necessary brain substance called adenosine. Adenosine levels in the blood go up during migraine attacks. Furthermore, adenosine when injected into a vein can trigger migraine attacks. Adenosine is widely available in the brain, and can produce many effects including less brain electrical activity, temporary widening of blood vessels, and control of some aspects of sleep and movement. Adenosine acts by sticking to specific receptor molecules on the surfaces of some brain cells. Caffeine can block the action of these receptors, and, thereby, stop the effects of adenosine. We do not know how these effects of caffeine result in acute anti-migraine and pain control actions.” (Source)
•  Caffeine shows promise as a means to reduce β-amyloid levels which cause lesions in the brains of migraineurs and those with Alzheimer’s. So far, this has been demonstrated in transgenic mice.
• Coffee is high in niacin.  One cup of coffee contains about 40 mg of niacin. Niacin helps to lower glutamate and increase blood flow in small capillaries of the body.

Coffee drawbacks for those with migraine

• Despite increasing receptor sites for serotonin, caffeine inhibits the release of serotonin. Why this is relevant: low serotonin is a major cause of migraine, and elevating serotonin’s levels also serves to stop the overproduction of inflammatory brain chemicals like glutamate and CGRP. While lower serotonin levels result in increased receptor sites (as discussed in the benefits section), low serotonin is not a good thing for migraineurs.  Changes in serotonin levels from coffee consumption lead to the “characteristic withdrawal symptoms (such as agitation and irritability) when coffee intake is stopped. The brain has come to expect more action in its serotonin receptors, and when its abundant supply of happy chemicals is abruptly cut off, it gets crabby. . . .” (Source) To help with migraine symptoms, we want to increase serotonin, not inhibit it.
  
• “Caffeine produces its stimulant effects by inhibiting the release of GABA and thereby allowing the increase of excitatory neurotransmitters. The less GABA, the more nerve transmissions occur. Think what too much coffee feels like: that is the sensation of glutamate without enough GABA.” (Source) Why this is relevant: migraineurs need to increase their GABA.  They can do so through improved gut health and consumption of prebiotics as outlined in the SimplyWell Migraine Relief Protocol.  Inhibited GABA is not desirable for migraineurs, because it leads to excess glutamate (which in turn leads to excess CGRP, an excitatory neurotransmitter elevated in those with migraine).
  
• Coffee inhibits the absorption of iron, as well as vitamin B6 and thiamine.  This is true even in the case of decaf coffee, because the nutrient depletion happens not by way of caffeine, but by way of the tannins in the coffee that bind to these minerals and vitamins.  For this reason, tannins in tea are also problematic and steal B vitamins.  Why this is relevant: Iron and B6 are both involved with the synthesis of serotonin, dopamine, and GABA. B6 is also needed to create Diamine Oxidase (DAO), the enzyme that breaks down histamine. Thiamine is important for the creation of acetylcholine, which is needed for proper vagal tone and to keep inflammation in the body down. Migraineurs are generally anemic and low in these vitamins already.  They need the constituents necessary to produce serotonin, DAO, dopamine, GABA and especially acetylcholine.
  
• Increased alertness (or anxiety) due to caffeine may be mainly due to blockage of adenosine receptors which normally inhibit glutamate release. Why this is relevant: migraineurs have high levels of glutamate, which causes excitotoxicity in the brain.  We need our adenosine receptors to be working properly so as to prevent an excessive buildup of glutamate. Glutamate released into synapses is normally reabsorbed back into neurons by the ion-exchange transport system, or soaked-up by astrocytes which convert the glutamate into glutamine (a molecule which cannot cause excitotoxicity). However part of the pathology of migraine is imbalanced electrolyte levels which impact the effectiveness of ion-exchange.
• Caffeine increases cortisol, adrenaline, and epinephrine, mimicking a state of acute stress. Why this is relevant: stress increases histamine and inflammation, which we all have enough of already.
• Caffeine is metabolized more slowly in women, especially those on oral contraceptives or postmenopausal hormone replacement therapy, due to the fact that it is detoxified using the same enzyme used to metabolize estrogen. Why this is relevant: more women than men get migraines and many women are on hormone replacement therapy or oral contraceptives.
• Chronic coffee consumption increases insulin resistance. This typically occurs with a diet high in refined sugars and starches, and many people consume their coffee with pastries or refined carbs. This horrible combination creates inflammation and neurotransmitter imbalances. Why this is relevant: Migraineurs already have imbalanced sugar metabolism and low blood sugar.  We don’t need more.
• Caffeine decreases vitamin D receptor protein expression (Source).  Why this is relevant: Vitamin D is essential for lowering inflammation, proper digestion, deep sleep, and for serotonin production.
• Coffee is a diuretic, ie, dehydrating. Why this is relevant: As migraineurs, our kidneys and adrenals are already stressed out from the constant inflammation in our system.  Due to their compromised status, we already excrete important vitamins and minerals like sodium, magnesium, and the B vitamins faster than most people.  And we are already dehydrated.
• Coffee is acidifying. Why this is relevant: due to having compromised kidney function, most migraineurs also have compromised pH balance (ie, are already acidic).
  
• Coffee consumption causes dependency and uncomfortable withdrawal symptoms. “Studies of caffeine dependency and tolerance show that daily caffeine users are actually more motivated to consume it to avoid withdrawal symptoms, than to experience the lift that its stimulant properties may provide.” (Source)
• “Research has shown that some conditions, such as long-term antibiotic use or excessive consumption of alcohol or caffein can deplete inositol stores. Suboptimal levels of inositol can negatively impact brain function, and memory loss may be an indication of inositol deficiency.” (Source)

The healthiest coffee

The healthiest coffee to drink is cold-brewed, organic water-pressed decaffeinated coffee.  Conventional processes used to decaffeinate coffee use a lot of harmful chemicals.  Decaf coffee contains some caffeine.  And it is still acidifying for the body.  Once you have bought your water-pressed decaf coffee, you can cold brew it according to these instructions here.

Alternately, you can make an herbal “coffee” substitute using healing herbs that actually support digestion, liver health, and adrenal function.  Check out my chicory, dandelion, and chaga “coffee” recipe here.

What does your bodywisdom say about your coffee consumption?

I’ve learned over the years that I actually don’t love coffee.  I love the flavor and ritual of coffee.  And there is something about the joy of doing something that I tell myself I shouldn’t just because it’s fun to live a little, to indulge in life’s pleasures and to counterbalance any tendency towards strict denial in life.  But ultimately I’d rather have a clear head, healthy kidneys, and a happy stomach.  So I only drink coffee about twice a month to remind myself that I don’t actually enjoy the feeling coffee gives me, even while I love the taste.

So what’s the takehome?

Is the occasional cup of coffee going to counterbalance all your efforts to get rid of your migraines?  No. Will occasional cups of coffee actually be supportive to you as someone with migraines?  Yes.  Is the consumption of daily cups of coffee, even decaf coffee, going to undermine all of your other good lifestyle habits?  If you are consuming coffee in excess out of stress, depletion, and a deep sense of fatigue – absolutely. We may want to keep in mind that caffeine is a defensive toxin designed by various plants to repel herbivores from its the berries and seeds. On the other hand, humans evolved eating small amounts of toxic substances which stimulate the liver.

What do the neurologists say about caffeine consumption if you have migraine?

It is important to emphasize that caffeine consumption is rarely the sole “cause” of frequent headaches including migraine. However, it is a modifiable risk factor, unlike many other unavoidable migraine triggers. Caffeine is often a significant and overlooked contributor to the problem of frequent and chronic daily headache. Migraine sufferers should use caffeine less frequently or remove it entirely as one component of a program of therapies for success, and it requires no prescription. (Source)