Migraine and caffeine has long been a complicated relationship. While caffeine has been used to treat acute migraine, there is also evidence that too much of it can be a bad thing for migraine patients. More studies have been done to further complicate this issue.

A recent study suggests abstinence from caffeine can lead to more effective acute treatment.

An observational study conducted by the Department of Neurology at Samsung Medical Center in Seoul, South Korea looked at migraine patients with daily consumption of caffeine. Patients were evaluated using the headache impact test (HIT-6), then instructed to stop consuming caffeine. Patients were also tested for anxiety and depression.

Abortive medications for migraine, which included triptans and antiemetics, were prescribed by the patient’s physician. At least two weeks after the initial test, patients were reevaluated using the HIT-6 and the migraine assessment of current therapy (migraine-ACT).

More than 72% of the participants in the group abstaining from caffeine reported excellent treatment efficacy compared to 40% of those in the non-abstinence group. The study suggests there was a trend towards improved HIT-6 scores for the abstinence group, too.

Lead author Mi Ji Lee and the rest of the study’s authors say the results of the study compare favorably to suddenly discontinuing the use of other substances.

“Our study results might indicate that migraine patients may benefit from complete abstinence of caffeine, similarly to the abrupt discontinuation of acute analgesics for detoxification in patients with medication overuse headache,” the authors said in the study published in Journal of Headache and Pain.

NHF Executive Chair Seymour Diamond, MD said it all depends on how caffeine is used.

“Caffeine for individual attacks can be of help, but overuse can lead to more headaches,” Diamond said.

Limitations of the study included that no assessment was made of headache worsening from caffeine-withdrawal. The study also did not control the setting for the prescription of triptans.