Caffeine Withdrawal Headaches: Why They Happen and How to Cope

Missing that morning cup of coffee can turn into a real headache—quite literally. While caffeine is often relied upon for that much-needed energy boost, going cold turkey on it can lead to some painful headaches. For those trying to completely give up coffee, well, the struggle can be especially tough.

Dr. Nolan Pearson, a neurologist and headache expert at Cedars-Sinai Medical Center in Los Angeles, noted, “Caffeine withdrawal headaches can be surprisingly intense. It can trigger a migraine-type headache, so it can be pulsing, pounding, and throbbing.”

Why are these withdrawal headaches so severe? Neurologists aren’t exactly clear on all the mechanisms at play, but they do have some ideas and a few tips for managing the discomfort.

Typically, caffeine withdrawal headaches develop when someone consumes over 200 milligrams of caffeine—roughly the amount in two cups of coffee—daily for more than two weeks and then suddenly stops. According to the International Classification of Headache Disorders (ICHD-3), these headaches usually manifest within 24 hours of cutting out caffeine and tend to resolve within a week or once caffeine is reintroduced.

The reasons behind the severity of these withdrawal headaches are complex. Experts aren’t able to pinpoint a single cause since caffeine affects multiple systems within the body. However, they believe that the pain is partly due to the dilation of blood vessels.

Caffeine normally constricts blood vessels, which is one reason it can sometimes alleviate headaches. When caffeine is stopped, the blood vessels dilate—leading to increased blood flow and resultant pain. Yet, Dr. Brian McGeeney, another neurologist from Brigham and Women’s Hospital in Boston, emphasized that this factor alone doesn’t explain the whole picture.

Another angle to consider involves adenosine receptors. Caffeine blocks adenosine, which is involved in various processes throughout the body. By doing so, it causes neurons to fire more rapidly and blood vessels to constrict, leading to that jittery alertness we often crave.

When caffeine is removed from the equation, the resulting buildup of adenosine can indeed contribute to those dreaded withdrawal headaches. This is also why caffeine is frequently utilized in headache relief—it prevents blood vessel dilation from the get-go, making pain relief more effective when combined with medications like ibuprofen or acetaminophen.

Dr. Pearson admits, however, that the full story behind caffeine withdrawal reactions remains to be fully understood. “We’re still working through it, but there are various theories that could explain these headaches,” he remarked.

Caffeine withdrawal can commonly occur in hospitals when patients need to abstain from coffee as part of a medical procedure. Interestingly, some studies have also observed withdrawal symptoms among individuals who fast, like during Ramadan.

As McGeeney explains, “Whenever life gets upended unexpectedly—like an emergency room visit—you see a lot of caffeine withdrawal.”

While caffeine can be safe in moderation, those looking to cut back are generally advised to do so gradually. Dr. Pearson suggests reducing caffeine intake slowly—perhaps cutting back by 25 to 50 milligrams per day, which translates to about a quarter to half a cup of coffee.

If a headache lingers beyond a week, Dr. Pearson advises seeking medical attention. It may indicate that the headache has different underlying causes unrelated to caffeine withdrawal.