Is caffeine withdrawal causing my debilitating headache?
May 11, 2018 8:20 PM   Subscribe

The last two weeks have been the most miserable of my life. Some of it is definitely the anemia I'm going through. but I'm starting to think some of my pain is caffeine withdrawal. But I would love a more knowledgeable opinion. YANAD, or even if you are, YANMD, because my doctor has been useless. Snowflake details inside.

I would never have thought I currently had a caffeine addiction. I grew up mainlining Mountain Dew, but I kicked that habit a decade ago and didn't replace it with any other caffeine. I don't recall having any side effects when I quit, but I definitely tapered off it, over months. I was drinking water, too much alcohol, and occasionally coffee. And then I got my new job 2 years ago with free fancy coffee and started having one in the mornings. I mean, it's free! But I often skip days and experience no side effects. I usually don't have any on the weekends, so I might go from Friday morning to Monday morning not having any. That said, my go to pain reliever is Excedrin, and I often get very low-grade headaches, 1-2 on the pain scale, and Excedrin has caffeine so maybe I was inadvertently dosing. I used to take Excedrin a lot, but have rarely taken it in the last 6 months.

I've had what was diagnosed as perimenopause, and while sometimes I don't bleed at all, sometimes I hemorrhage. Usually progesterone kicks the bleeding, but for the first time, two weeks ago, it didn't. I was working with my doctor, ended up in the ER, I'm on new meds, and it's finally, hopefully, calming down. But at one point, my hemoglobin was as low as a 6. Throughout all of this, my headache was so bad, I wanted to die. I assumed the headache was due to the anemia, but even after they gave me 2 units of blood, my head was the same. And this week, with the new meds starting to work and the bleeding tapering off, my head was still awful. I wasn't going in to work, so I wasn't having any coffee. The doctor gave the usual advice, drink lots of water, eat more frequently, rest, and no caffeine. I told her I didn't think caffeine withdrawal was causing the headache, because the headache was ongoing for 2 weeks and she said "Oh sure it could be. Caffeine withdrawal symptoms can last a month. But don't start drinking it again, because it can be dangerous with the high estrogen you're taking." She told me I just had to suffer through them, even though I told her they were excruciating, and she wouldn't even consider anything stronger than Tylenol. Tylenol has done nothing for 2 weeks.

Well, that made me wonder. I suffered another 2 days and then I reluctantly made a very small cup of green tea, and sure enough, that headache that made me want to die for 2 weeks was gone in an hour. About 30 hours later, the headache returned. I drank water. No help, I ate. No help. I had 1/3 a cup of green tea, gone in 45 mins.

This seems pretty conclusive to me, but people I talk to seem skeptical. They don't seem to think that having 1 latte on average 4 days a week could cause an addiction that would cause a massive headache for 2 full weeks, with no signs of slowing. I'm willing to believe the anemia made it much worse, but would love some opinions from those with medical knowledge. Is this something that can happen? Does anyone know if there is a relatively safe amount of caffeine I can take with estrogen, because I cannot function with this headache. I'm seeing my doctor on Tuesday, and would like to manage until then. Thanks, friends.
posted by greermahoney to Health & Fitness (22 answers total) 2 users marked this as a favorite
I can't comment on the caffeine thing, but for anemia, check with your doctor about intravenous iron sucrose (venofer). It isn't the right fit for everyone, but if it works for you, holy wow will you feel better.
posted by pseudostrabismus at 8:26 PM on May 11, 2018 [2 favorites]

The half life for caffeine is about 5-6 hours. Something over not that.
posted by sanka at 8:36 PM on May 11, 2018 [4 favorites]

In my experience, caffeine withdrawal happens after 1-2 days without caffeine. You get a severe headache. I've found that a small amount of caffeine (1 swallow) relieves the pain. Usually that is the end of the dependency (until you try that sweet, sweet java again).
Caffeine affects blood vessels in the brain. Caffeine, or lack of it, might be causing headaches (just a guess, I have no specific knowledge, this article is interesting).
posted by H21 at 8:50 PM on May 11, 2018 [2 favorites]

How much water are you drinking? Could be dehydration. Drink a lot more water than you normally do for about three days.

I am perimenopausal. I cut back on caffeine. Thought I was having headaches because of that. Started drinking a ton of water while doing yard work. Headaches disappeared.
posted by fluffy battle kitten at 8:52 PM on May 11, 2018 [3 favorites]

Response by poster: How much water are you drinking? Could be dehydration. Drink a lot more water than you normally do for about three days.

My doctor said I should be getting 100 oz of water a day right now. I've been getting close to that.
posted by greermahoney at 8:55 PM on May 11, 2018

I noticed the no headache thing after about three days of 100-150 oz of water. (I don't have a headache but now all I do is pee.)

Some people really are super sensitive to caffeine. I hope this gets solved for you.

I am wondering if thisis tied in to your cycle. Maybe something to do with retention/bloating? (Ugh, anything tied in to a perimenopausal cycle is annoying.)
posted by fluffy battle kitten at 8:59 PM on May 11, 2018 [1 favorite]

Hormonal fluctuations can cause monster headaches, as can blood pressure issues. If the estrogen supplement is new, maybe it's just not agreeing with you?

It's a problem that your doctor is fobbing you off when you're in pain. I think you should seek a second opinion, because this kind of suffering, whatever the cause, for two weeks is way too long. Best wishes.
posted by Iris Gambol at 9:16 PM on May 11, 2018 [1 favorite]

I got caffeine withdrawal symptoms after stopping my one-coffee-a-day habit. I never thought I was addicted because I'd sometimes skip a day with no problems. The withdrawal symptoms started after missing coffee on 2 or 3 days.
posted by whitelily at 9:47 PM on May 11, 2018 [1 favorite]

Best answer: Headaches happen when blood vessels are dilated. Caffeine is a vasoconstrictor (as H21 referenced) which is why it majorly helps with reducing headache pain. And also why it's found in products like Excedrin and Excedrin Migraine.

In my own case, I found diet is what caused my headaches. (I have PCOS.) Eating foods high in sugar (including simple carbs like white bread, potatoes, pasta, etc, which the body quickly converts to sugar) causes a spike in blood sugar. It's when blood sugar crashes, you can end up with a headache. Eating foods high in protein, healthy fats, and fiber help stabilize blood sugar levels, leading to infrequent headaches. On the days I don't follow my own advice, I hit the Excedrin Mirgraine and it's gone in like 45 - 60 minutes. ;)
posted by pdxhiker at 9:47 PM on May 11, 2018 [3 favorites]

I've gone through caffeine withdrawal a couple or more times and this doesn't sound like that. I'm not familiar with anemia, but I can tell you that I get an awful headache when I'm low on electrolytes. I've found a (beef) bone broth that I like, that I'll warm just a bit and sip like tea. To rid myself of the headache I'll have a cup every couple of hours, and it usually works by the end of the day. I don't have any medical concerns though; if it is indeed an electrolyte issue you might need a higher concentration, or a bit longer timespan for a noticeable effect. At the very least, it probably wouldn't hurt to add it into your diet to see if it makes a difference.

Again, not experienced with anemia, but between blood loss and the amount of water you are drinking you may need to increase your salt intake in general, and you may need to double up on your multivitamins, as a good portion are probably going through without being metabolized. Best to take a regular dose in the morning and a second at night (unless they contain a lot of vitamins B, which can contribute to insomnia).

Best of luck.
posted by vignettist at 9:55 PM on May 11, 2018 [2 favorites]

Dehydration is an absolutely notorious cause of headache. A hemoglobin of 6 is very, very low, like about half what an adult woman needs. Lack of oxygen can also cause headache (along with other symptoms), and oxygen is carried in the body on the hemoglobin. A transfusion should have lessened the headache because it increased the amount of oxygen your blood can carry to your brain (and all your other) tissues. This would be incidental - transfusion is for other reasons (severe anemia) not "headache". This would be an incidental finding.

I have never heard that estrogen and caffeine had any headache-risk interactions, and before I ran with what your doctor told you, I would want to see the scholarly publication that said it. I also had profuse bleeding in peri-menopause, tried several rounds of progesterone and finally was diagnosed with bleeding polyps. It didn't seem reasonable to keep taking progesterone or bleed my hemoglobin down to 7 or so. I was having trouble catching my breath when walking on flat ground, much less going up steps. Profuse bleeding requiring transfusions is not a normal symptom of menopause. After my polyp diagnosis I had a hysterectomy and my bleeding was over. During this time nobody in my academic-physician practice said anything about avoiding caffeine.

Please try to get to the bottom of why you are bleeding in the first place and insist on a solution that doesn't depend on continuously taking high hormone doses. I frankly think the headaches, while possibly hormone related may also be due to low blood volume and dehydration. Push fluids when you are bleeding or have headaches. Anything that's a liquid at body temp (98.6) is a fluid, jello, ice cream or water ice, popsicles, custard. You could include the occasional tea or coffee - it counts, too. It might make drinking a gallon of fluid a day seem less impossible.

Far less than CAUSING a headache, Caffeine may CURE your headache (totally unrelated to any caffeine addiction) when you do get a one because it's a vasoconstrictor - The Excedrin people know this. No reason to avoid caffeine at all - in this case it's your friend.
posted by citygirl at 10:39 PM on May 11, 2018 [2 favorites]

Best answer: I am a women who has had a headache for 24 years. (Not headaches. A single headache, for almost my entire adult life.) Thought it was daily, it was always mild-to-moderate, never severe. When I hit perimenopause, it worsened dramatically and stopped responding to treatment. I had a severe headache every day, and nothing helped, or, if something did, it didn't last long--including a hospitalization in a headache unit, which produced miraculous results that lasted less than two months. In addition, my headache became highly linked to my menstrual cycle in a way it hadn't before--hormones definitely play a role in some headaches.

My neurologist, whose practice is entirely treating headache patients, told me that a lot of women's headaches change at perimenopause: some get worse, and some get better. Mine got very much worse, to the point that I was debilitated for most of every day for almost four years. I am happy to report that in the past few months, when it seems I have become actually menopausal, mine has improved and begun to respond to treatment again. (Thank god.)

One of the ironies of headache medications is that many of them, like Excedrin, cause rebound headaches, so I often receive meds from my neuro with instructions to take them no more than X days/week or Y days/month in order to avoid rebounding. Caffeine in any form is very dangerous this way.

If you have been managing your headaches with over-the-counter meds, you might find it productive to consult a specialist. The state of the art in headache treatment is a process of medication trial-and-error, which can be frustrating, but there are a great many options for you.

I'd also push your regular doctor or gynecologist on the bleeding. Attempts to treat my excessive bleeding with hormones were such a disaster that it's clear I can never use exogenous hormones again (in my case, the disaster was changes in mood, not related to my headaches). I had an endometrial ablation a few years ago, and while I still had discernible hormone cycles (because I still had my ovaries), being free of the excessive bleeding was a big improvement in my life.
posted by Orlop at 11:11 PM on May 11, 2018 [1 favorite]

Response by poster: I have never heard that estrogen and caffeine had any headache-risk interactions, and before I ran with what your doctor told you, I would want to see the scholarly publication that said it.

At the risk of thread-sitting, I want to clarify that the doctor didn't say the caffeine was causing or would cause headaches. She was cautioning me not to use the caffeine as a cure for the headaches, as while on high estrogen, it might cause other health issues. But I've done some internet research and I can't seem to find what she might have been talking about. I've also now perused the drug literature, and it doesn't say anything about caffeine, so I'm starting to distrust her word.

Please try to get to the bottom of why you are bleeding in the first place and insist on a solution that doesn't depend on continuously taking high hormone doses.

Dear lord, am I trying. Everyone (my primary care, the doctors at the ER, and this clinic doctor) has been worried about putting me on the estrogen, and the effects. I'm absolutely not taking it more than 3 weeks, and I see a different doctor on Wednesday next week about my long-term options (iud, ablation, hysterectomy?) I still have biopsy results that are on the way, too.
posted by greermahoney at 11:17 PM on May 11, 2018 [1 favorite]

Just because of the timing and it being spring and everybody I know being in allergy hell: Have you ever had any allergy trouble? It might be a long shot kind of thing, but I notice that caffeine tends to help my sinus headaches sometimes, and also I notice some hormonal fluctuations there, but a sinus nasal spray has helped that a lot, so--I don't know, if you don't already use one it could at least be safe to try, or a few days of neti pot. I often get sinus headaches even without much actual drainage or anything like that. I'm not saying this is definitely it, just like... a thing to rule out, at least.
posted by Sequence at 11:38 PM on May 11, 2018 [2 favorites]

"Can't function with this headache" is definitely a thing that MUST be explored more. Use those exact words with your doctor if you haven't already.

Is there anything else that could be causing the headaches, for which the caffeine is treating it?
For example, have you checked your vision? Blood pressure? Neck pain? TMJ or other jaw pain? Dental pain like if you still have your wisdom teeth? Hormone fluctuations themselves? How's your blood sugar? Thyroid levels?

I personally had severe migraines and vertigo from going YEARS severely needing glasses. I also have POTS and Endometriosis which can trigger headaches and migraines. (I literally had a brain MRI before someone ended up checking my vision.)
posted by Crystalinne at 11:47 PM on May 11, 2018 [1 favorite]

A two week headache definitely needs investigating. Blood pressure came to mind for me too. I’m sorry all this is happening to you.

Anecdotally, every time I’ve gone off caffeine (11/12 of my largely unsuccessful pregnancies) I’ve had a headache for 1-2 weeks. After the first few days though it was manageable. I’m also prone to migraines, and when I got really serious about a fitness routine, I swear (anecdotally) that I had exercise-induced migraines. I found that a sport drink or coconut water (high potassium) helped. So you could try that while you’re experimenting.
posted by warriorqueen at 3:03 AM on May 12, 2018

Just drinking tap or spring water, even three litres per day, may not be enough to reestablish your electrolyte balance and all the fun deficiencies that can happen with heavy bleeding. I'd go for either rehydrating solution or proper mineral water. In a similar situation, I alternated between regular soda (cane/beet sugar) and mineral water high in calcium and magnesium.
posted by I claim sanctuary at 3:20 AM on May 12, 2018

Response by poster: For those of you saying tap water is not enough - probably half of the water I’ve been drinking is Smart Water. Is that good enough for electrolytes?

(Also, we asked that same doctor about electrolytes and she dismissed the idea entirely. Sigh.)
posted by greermahoney at 7:49 AM on May 12, 2018

Best answer: Composition for Smartwater is a bit hard to find, but according to this blog post it's 10 mg potassium, 10 mg calcium and 15 mg of magnesium. By European standards it would be classed as "extremely low mineral content" (under 50 mg per liter) - proper mineral water starts at 500 mg per liter of mineral ions. For comparison, I was drinking Kinga Pienińska, with 80mg calcium, 20mg magnesium, 14 mg sodium and 2mg potassium, plus various other things for a total over 500.

Honestly unless you can get your hands on water with very high mineral content like Borjomi, I'd start with some Gatorade, then a bowl of miso soup, and see if that improves things. It does wonders for my post-exercise headaches too.
posted by I claim sanctuary at 8:14 AM on May 12, 2018 [3 favorites]

Best answer: I wonder if it’s related to the estrogen? Hormones and headaches are often connected- I basically can’t take HBC because it gives me a migraine. It’s not uncommon.

Try coconut water instead of tap water. (And man, this doctor sounds so dismissive!)
posted by Countess Sandwich at 10:19 AM on May 12, 2018 [2 favorites]

Response by poster: Thanks, all! I’ve been having a small about of tea daily and the headaches have been kept at bay. In addition, I’ve been trying to drink a lot more water and eat more frequently. Fingers crossed this keeps up.

Y’all rock.
posted by greermahoney at 8:31 PM on May 13, 2018

I don't think caffiene withdrawl is causing your headaches. RAther the constriction of blood vessels in your head form the caffiene is helping them. You could try tying bags of ice around your head at the temples and see if that helps put the headache at bay. I think they make some fancy headache head wraps with ice pack inserts if you don't want to sit around like a doofus with bags of ice tied to your head with a shoelace.
posted by WeekendJen at 9:01 AM on June 4, 2018

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