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.

Q. I have been on Fioricet for 2 years. I had been taking 6 tablets a day. My physician recommended that I cut back, due to rebound headache, every 4 days. I have now cut back to 3 tablets, and I’m experiencing extreme drowsiness and agitation.  I was told it’s not a side effect. Do you have any recommendations for alternative medication(s) that I can try? Also, I would like to know if you’ve ever heard of anyone else experiencing these types of side effects.

Tension headaches are the most common form of headaches and affect more than 20% of the population. Frequently, tension headache sufferers turn to over-the-counter medications for relief. A recent study indicates that medication containing a combination of acetylsalicylic acid, (aspirin), acetaminophen, and caffeine is more effective than acetaminophen alone.

Several medications were recently deemed the most effective for treating acute migraine, including triptans, dihydroergotamine (DHE), nonsteroidal anti-inflammatory drugs (NSAIDS), butorphanol nasal spray, and the combination medication of sumatriptan/naproxen and acetaminophen/aspirin/caffein). Several other migraine medications were considered "probably effective" or "possibly effective."

Q. Is there a study about how eating chocolate can help a headache? I have never really liked eating chocolate, but recently when I had a headache and upset stomach and medication didn't fully take away the pain or the upset stomach, I tried a chocolate candy bar and started feeling better. So that's why I'm asking. I suffer from cluster migraines and have for nearly 35 years.

The first step in the nutritional management of diet-triggered headaches is eating a well-balanced diet. It is especially important to eat three meals a day with a snack at night or 6 small meals spread through out the day.  You should include a good protein source at each meal/snack (i.e. milk, meat, fish) and should avoid eating high sugar foods by themselves, especially when excessively hungry. These actions will help to prevent the "hunger headache." If you are taking an MAOI drug (i.e Nardil, Parmate) you need to follow a low-tyramine diet.

Caffeine and anti-inflammatories may be the best cure for a hangover-induced headache, particularly for migraineurs whose headaches are triggered by low doses of alcohol. Professor Michael Oshinsky, of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, induced headaches in rodents by injecting them with small doses of ethanol (about the equivalent of one alcoholic drink in humans). Like alcoholic drinks, ethanol produces acetate in the body when it is metabolized.

Q. Excedrin Extra Strength gelcaps each contain 250 mg. of acetaminophen, 250 mg. of aspirin and 65 mg. of caffeine. Excedrin Migraine caplets contain exactly the same amounts of each ingredient. However, the first product allows the use of eight gelcaps in 24 hours, whereas the latter only allows the use of two caplets in 24 hours. Why the difference in the allowable use of two pills of apparently the same medication?

It isn’t the stress of the holidays that affects me the most. In fact, I love the holidays because I get to spend time with my family. The only problem is that they live seven hours away (more if the weather is bad). So, when it comes to the holidays, it is the thought of all that traveling that does NOT leave visions of sugarplums dancing in my head. When you live in the Upper Midwest, every drive during the winter is an adventure and this holiday season promises to be no different. This year, it will mean leaving late at night after a full day of work, pounding back caffeinated beverages to stay awake while taking turns with my boyfriend at the wheel. On top of that, we’ll have two puppies traveling with us as well. It also means staring into headlights for hours on end. And it means nodding off in the most uncomfortable positions in the car.