Acute effects of caffeine withdrawal on headache among regular caffeinated coffee drinkers.

Headaches are among the most common neurological disorders, often leading to significant disability and reduced quality of life1,2. However, much remains unknown about the triggers that precipitate headaches3. Coffee is one of the most widely consumed beverages worldwide, and coffee withdrawal is thought to be associated with headache4,5. However, research linking caffeine withdrawal to headache in healthy adult populations is largely limited to observational studies prone to confounding or single snapshot assessments prone to recall bias6-8. While small, near-term randomized trials have been conducted, these generally are done in artificial study-based settings (rather than among ambulatory individuals) and fail to capture repeated events that best represent real-life circumstances9,10. We sought to leverage a prospective, randomized, case-crossover trial to assess acute relationships between caffeine withdrawal and headaches among healthy individuals11. Here, we show that among regular caffeinated coffee consumers, caffeine avoidance likely contributes to headaches. When headaches are present, caffeine avoidance was also associated with increased headache severity. These results suggest that headache, commonly experienced by a substantial proportion of the population, may often occur as a consequence of caffeinated coffee withdrawal. Together, these findings may inform behaviors and recommendations regarding coffee consumption and minimizing headache burden on a day-to-day basis.