title: Caffeine discontinuation improves acute migraine treatment: a prospective clinic-based study.
abstract: BACKGROUND
  Caffeine has both excitatory and vasoconstrictive effects on central nervous system. Caffeine use might be associated with development and chronification of migraine. We aimed to evaluate the effect of caffeine cessation on the acute treatment of migraine.
  
  
  METHODS
  We prospectively recruited migraine patients who consumed caffeine drinks daily and instructed them to discontinue their caffeine intake. Triptans were prescribed for acute treatment. Patients were followed up after at least two weeks after screening and evaluated the efficacy of acute treatment with the migraine assessment of current therapy (Migraine-ACT) questionnaire. Excellent efficacy was defined as Migraine-ACT score of 4. Chronic migraine, body mass index, allodynia, depression, anxiety, antiemetic use, and use of prophylactic medication were included in the multivariate analysis if the univariate p < 0.2.
  
  
  RESULTS
  Among 108 patients included, 36 completely discontinued their caffeine intake (abstinence group). The efficacy of acute treatment was assessed at median 34.5 days (interquartile range, 28-89) after the screening. Twenty-six patients (72.2 %) in the abstinence group and 29 (40.3 %) in the non-abstinence group reported an excellent efficacy (p = 0.002). The abstinence group also showed a trend toward greater reduction of headache impact test-6 (HIT-6) scores (p = 0.085). Caffeine abstinence was independently associated with an excellent efficacy of acute treatment (multivariate odds ratio, 3.2; 95 % confidence interval, 1.2-8.4; p = 0.018) after controlling for covariates.
  
  
  CONCLUSIONS
  Caffeine abstinence is associated with better efficacy of acute migraine treatment. Our uncontrolled study results encourage a further confirmatory study on this issue.
authors: Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 135-710, South Korea.
authors: Mi Ji
authors: MJ
authors: Lee
authors: Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 135-710, South Korea.
authors: Hyun Ah
authors: HA
authors: Choi
authors: Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, South Korea.
authors: Hanna
authors: H
authors: Choi
authors: Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 135-710, South Korea. cspaul@naver.com.
authors: Chin-Sang
authors: CS
authors: Chung
mesh_terms: D000328:Adult; D002110:Caffeine / Q000009:adverse effects* / Q000493:pharmacokinetics; D003069:Coffee / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy / Q000503:physiopathology*; D016017:Odds Ratio; D011446:Prospective Studies; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D003069:Coffee; D002110:Caffeine
keywords: Acute treatment; Caffeine; Migraine