Caffeine and Fibromyalgia
Caffeine is a naturally-occurring substance found in plants, mainly coffee beans, tea, and cocoa. It is also added to soft drinks and other beverages. It acts as a stimulant by working on the central nervous system, and its effects can last for up to six hours. Immediate physical effects of caffeine include an increase in heart rate, body temperature, and blood pressure, as well as increases in blood sugar levels, stomach acid production, and urine output. Other possible effects of caffeine include dizziness, low blood sugar, difficult breathing, muscle spasms, nausea, diarrhea, drowsiness, thirst, anxiety, insomnia, appetite changes, and blurred vision.
Caffeine and Headaches
Due to its stimulant properties, caffeine is relied on by millions to help them wake up in the morning or make it through a long drive. Caffeine is sometimes used medicinally, in particular to treat headaches; however, when it comes to headaches, caffeine can be both a help and a hindrance. It can expedite the process of symptom relief when taken alongside certain analgesics; however, it can also trigger headaches when frequent dietary consumption is abruptly ceased.
Headaches are a prominent and often-debilitating symptom for many fibromyalgia patients. The natural reaction that many people (including those without fibromyalgia) have is to immediately reach into the medicine cabinet to find something that can help. In addition to standard over-the-counter pain relievers, many products that are marketed specifically for the treatment of headaches contain caffeine as an active ingredient. The reasons for doing so lie in the fact that caffeine helps painkillers work more quickly and efficiently. In fact, pain relievers that contain caffeine additives are approximately 40% more effective than those without them. In addition, caffeine helps to speed up absorption of medications in the body, which can lead to quicker pain relief for patients. This can theoretically lead to patients requiring less medication, thereby reducing the risk for potential side effects and/ or habitual use.
Common examples of over-the-counter headache medications that contain caffeine include Excedrin and Goody’s. Fiorinal, Fioricet, Norgesic, and Migergot are examples of prescription pain relievers that contain caffeine. In addition to pharmaceutical sources, caffeine is also found in some beverages and foods. Chocolate and chocolate-containing foods products are one example (e.g., chocolate milk, chocolate chip cookies, chocolate ice cream), as well as sodas/pop, coffee, tea, and the ever-popular “energy drinks” like Red Bull and Monster Energy. Products that are labeled as “caffeine-free” or “decaffeinated” also contain trace amounts of caffeine.
Rebound headaches can occur in relation to the overuse or misuse of any headache medication (including those with and without caffeine). Individuals who use caffeine-containing headache medications and who consume considerable amounts of caffeine through their diet are at an increased risk of developing rebound headaches. The only treatment for rebound headaches is to completely cease use of all headache medications, which should only be done under the close and careful supervision of a physician.
Fibromyalgia patients should use caution when choosing a headache medicine that includes caffeine as an active ingredient, especially those patients who also consume considerable quantities of dietary caffeine. While the presence of caffeine may help to expedite the process of pain relief, the potential for rebound headaches cannot be overlooked if headache medications are overused.
Furthermore, fibromyalgia patients should also moderate caffeine consumption on the whole and ensure that their intake is within normal ranges. This is due to the fact that excessive caffeine consumption (more than 500mg per day, or five cups of coffee) can lead to troublesome withdrawal symptoms if intake is stopped abruptly. In fact, the severity of caffeine withdrawal has even been acknowledged by the global medical community, as caffeine withdrawal was classified as an official diagnosis in the World Health Organization’s International Classification of Diseases, Tenth Revision (ICD-10). Symptoms of caffeine withdrawal are wide-ranging and can include any of the following: headache, fatigue, drowsiness, depression and irritability, difficulty concentrating, nausea, vomiting, and muscle pain or stiffness. Note that many of these symptoms mirror those commonly associated with fibromyalgia, including headache. Symptoms typically occur within 12 to 24 hours after ceasing use of caffeine, peak in their intensity between one and two days after ceasing consumption, and can persist for a week or longer. Generally speaking, the incidence and severity of caffeine withdrawal symptoms tend to increase in proportion to daily dose, but some individuals have been shown to experience symptoms of withdrawal with daily doses as low as 100 mg (Juliano & Griffiths, 2004).
Caffeine and Fatigue
Similar to its relationship with headaches, caffeine can be a double-edged sword when it comes to fatigue, which is a hallmark symptom of fibromyalgia. Every day, millions of people consume caffeine in an effort to fight fatigue, to increase their alertness, and improve functioning. However, the effects of caffeine are short-lived, which often leads people to ingest more caffeine in order to maintain its desired effects on their energy level, concentration, or functioning. This can invite unwanted dependence on caffeine, which can work through negative feedback loops to actually worsen fatigue, decrease performance, and adversely impact functioning. Consider the following example: an individual consumes three cups of coffee each morning in order to “wake up” and increase their alertness. By mid-afternoon, the effects have worn off, causing them to reach for yet more coffee or soda in order to obtain more caffeine. When evening rolls around, that person finds it hard to “unwind” or settle down, and sleep becomes difficult to achieve. Ultimately that person may go on to develop insomnia if caffeine is used regularly enough and in sufficient quantities. This occurs because of the fact that caffeine interferes with the compound adenosine, which is a byproduct of nerve cells. Throughout the day, adenosine binds to nerve cells and causes them to slow down. It eventually builds up to the point that it makes you feel tired. When you consume caffeine, the caffeine competes with adenosine and binds to nerve cells in its place. This creates a lack of adenosine in the body and leads to difficulty sleeping.
Additionally, caffeine can inadvertently induce or perpetuate fatigue if consumption is abruptly stopped and withdrawal symptoms set in.
There is considerable material online and in magazine articles that suggest caffeine is a clear negative dietary factor relative to overall fibromyalgia symptoms. While this is a popular conception, there is little to no actual scientific evidence to back it up. No specific studies have been conducted that document caffeine as either a positive or negative factor relative to fibromyalgia symptoms. Many individuals with fibromyalgia experience positive benefits from moderate caffeine usage relative to treating headaches. Some fibromyalgia patients clearly experience a negative effect from caffeine. As with many potential fibromyalgia treatment options, the best approach to caffeine is to test and measure your individual response and ensure that you coordinate with your care team and pay careful attention to possible interactions with other drugs you may be taking.