Should you avoid taking Codeine and Caffeine for headaches?

February 21, 2008 1:45 AM

My girlfriend was told something by her doctor this morning that to my ears sounds strange, or at best misleading. He basically asserted that you should never take pills like Solpadeine and Syndol because they contain codeine and caffeine, which in the long run cause more headaches and ultimatley makes them worse.

Now, I could imagine that this might be the case if you were taking multiple doses each day every day (I used to get lots of headaches when I drank lots more coffee than I do now for example), but surely it's not the case if you are an occasional user? Like a few times a month say?
I'd be interested in knowing some facts about this. I could of course go to Google to find something that will disprove what the doctor is saying, and equally I could go to Google to prove what the doctor is saying. Basically, looking into this on Google confused me even more, so I was wondering whether the erudite members of AskMe might be able to offer some insight based on sound science?

If it helps, here's the messenger exchange that started all this:

She says:
he told me that tablets with codeine in them (including Solpadeine and Syndol, unfort) make headaches worse in the long run and actually *cause* headaches and so I should never take them, rather take paracetamol. And also, that caffeine makes headaches worse too, which is also in solpadeine and syndol and so one should never take them for headaches
He says:
With all due respect to your doctor, that sounds like pseudo science.
She says:
he said actually it is well-known. But not advertised.
and that codeine should not really be available over the counter.

Thanks, and sorry for the length of the question.

posted by chill to health & fitness (14 comments total)

I think he's on about medication overuse headaches, which are a real problem and mean you shouldn't take painkillers constantly (see the bottom of the Wikipedia page for some journal references). Also caffeine and codeine are addictive, although probably not in the smaller doses found in OTC painkillers. But a few doses a month maybe, if you get headaches? I think he's taken the whole rebound headache thing to heart a bit too much. Paracetamol is linked with rebound headaches as well so I'm not sure why he thinks taking that is OK.
posted by terrynutkins at 2:12 AM on February 21, 2008

he told me that tablets with codeine in them (including Solpadeine and Syndol, unfort) make headaches worse in the long run and actually *cause* headaches and so I should never take them, rather take paracetamol. And also, that caffeine makes headaches worse too

This is all true and verified--but true primarily for people with headaches or migraines as an ongoing medical condition. Most likely, a large part of the population with natural resistance to headaches has no problem. Look at the lines in your local joe slinger, or Starbucks--most of these people are not migraine-impaired.

So, the question is, does your girlfriend suffer from headaches. If the answer's "yes," the doc's advice is a good recommendation for her. If it's "no," she can ignore it.

Even for people with headaches or migraines, an occasional use of codeine is considered okay. This book defines occasional as "twice a month."
posted by Gordion Knott at 3:03 AM on February 21, 2008

Google analgesic induced, rebound, or maintained headache for more info.
posted by Wilder at 4:00 AM on February 21, 2008

IANAD, but a quick pass through a drug interaction database (LexiComp) indicates that there are no known interactions between those two agents, or either of their respective classes of drug. So that seems like a strange value for 'widely known.'

However, anecdotally, I can tell you that the migraines that I started getting last spring became progressively worse and worse as I stepped up the dosage of Excedrin to try to stay ahead of them; when the neurologist had me cut the acetaminophen out entirely, most of the problem went away in the space of about two months. I think terrynutkins has it exactly right on the analysis--as long as it's just an occasional dose, I think the bigger factor is the OTC painkillers, rather than the codeine.
posted by Mayor West at 5:06 AM on February 21, 2008

Thanks all, that's some useful perspective.
posted by chill at 6:33 AM on February 21, 2008

Bad headaches is part of caffeine withdrawal. So it could be that patients take these drugs and no one warns them about this. Once they've built a tolerance they might stop without tapering and suddenly get a pretty nasty headache out of nowhere. This happens to normal people. I am uncertain on how this might affect someone already prone to headaches.
posted by damn dirty ape at 7:17 AM on February 21, 2008

Caffeine is a diuretic, and many headaches are caused by dehydration. Could this be the tenuous link that the doctor is grasping at?
posted by explosion at 7:20 AM on February 21, 2008

Very true. I get migraines and cluster headaches and codeine or caffeine tablets will give me a nasty headache as they wear off. So do most OTC painkillers like ibuprofen, acetimophen but only if taken for a number of days in a row.

Interestingly stronger opiate painkillers like Percocet do not give me headaches, nor does coffee in reasonable amounts (one to two cups per day).
posted by fshgrl at 8:04 AM on February 21, 2008

I've pushed the book before, because it's changed my life. In this case, i'm not recommending that you (or your girlfriend) follow his plan, because it doesn't sound like headaches are a chronic problem for you. However, the book also contains a ton of info about headaches in general, and the various treatments, and especially about what is called 'rebound headaches', which is what I think the doc here is referring to.
Heal Your Headache, by David Buchholz.

On preview - this is the same book linked to in an above post... but it's worth repeating anyway.
posted by cgg at 8:50 AM on February 21, 2008

I had serious weekly migraines for years. I was really sick of taking serious medicines to prevent and treat them, so I thought I'd follow the advice of this guy, even though I thought he was an exaggerating quack.

Everyone's headaches vary, but in my case, he was totally right. Caffeine was my trigger, but not right away--the withdrawal 24 hours later. This was true even with small amounts.

So for me, taking caffeine for what turned out to be a caffeine-withdrawal triggered headache would actually prolong the agony the next day, even though it solved the problem in the short term.
posted by umbú at 10:05 AM on February 21, 2008

I am totally not a doctor, but I always avoid caffeine when I've a headache because it's a vasoconstrictor.
posted by hot soup girl at 12:32 PM on February 21, 2008

When I take Tylenol, I get no relief.
When I take an equivalent dose of acetaminophen in Excedrin, which also contains caffeine, I get relief.
In fact, Excedrin is the only thing that helps when I have a headache. (Ibuprofen is useless.)
Therefore, Excedrin is my friend.
posted by loiseau at 5:04 PM on February 21, 2008

I agree with the doctor too, with some of the same caveats others have mentioned.

Tylenol and naproxin sodium does nothing for me, but ibuprophen and ketoprofen do me right. But they do give me rebound headaches.

When my head is pounding like a freight train, caffeine doesn't help. But a different vasoconstrictor (Sudafed) works just fine.

(And I'm totally jealous that you can get Codeine over the counter.)
posted by gjc at 7:43 PM on February 21, 2008

Well, I found this online: Caffeine and migraine

Caffeine is contained in many food products (cola, tea, chocolates, coffee) and OTC analgesics. Caffeine in low doses can increase alertness and energy, but caffeine in high doses can cause insomnia, irritability, anxiety, and headaches. The over-use of caffeine-containing analgesics causes rebound headaches. Furthermore, individuals who consume high levels of caffeine regularly are more prone to develop withdrawal headaches when caffeine is stopped abruptly.

Personally, I get Migraines and can confirm that if I take a constant amount of Caffeine, they don't bother me. However, if I stop getting the Caffeine, I get headaches. My doctor told me that it has to do with thinning the blood - or something like that. However, Caffeine is also used to stop headaches. Advil Migraine is simply Ibuprofen plus Caffeine. So there is a relationship between Migraines and Caffeine. The issue here is that after you take the meds, you risk another Caffeine headache.

If your girlfriend gets headaches on a regular basis, send her to a neurologist for a migraine screen. There is plenty of effective migraine treatment out there and just knowing your triggers makes a huge difference. If they are common, she can take a prophylactic to prevent them. If they are less common, there is specific meds that target migraines and have no side effects. However, everyone reacts differently to all these meds so the best advise in this case is what works.

Hope that helps!
posted by joshfeingold at 5:18 AM on February 22, 2008