Weekend Attacks in Migraine Patients: Caused by Caffeine Withdrawal?

Abstract

The principal reasons for a predominantly weekend incidence of migraine attacks are likely to be social or psychological in origin. There may be another factor. This study examines the use, and more importantly the way of use, of caffeine containing substances. We collected data by questionnaire from 151 consecutive Migraine Clinic patients with the diagnosis of migraine or tension type headache. Of the whole group, 21.9% claimed to have weekend attacks, with relatively more males than females. The males amongst these were all migraine patients, but 23% of the women suffered from tension-type headache. Patients with both a high daily caffeine intake and excessively delayed wakening at weekends (each defined as greater than the mean for the whole group) had a 69% risk of weekend headache. This compared with 4% in patients exceeding the mean in one only, and zero in those with moderate habits in both. These results support the idea that weekend attacks are linked to caffeine withdrawal. Sleeping in is not on its own a significant cause. We suggest that this possibility should be considered in clinical management of affected patients.

Reduction in perceived stress as a migraine trigger

“…These results are consistent with and extend prior research. [11][12][13][14][15][16][17][18][19][20] In aggregate, these findings and the prior literature support the let-down hypothesis, which predicts that decline in perceived stress is associated with an increased probability of migraine onset. There are at least 2 alternative mechanisms to explain this phenomenon.…”

“…Trigger factors, measurable precipitants associated with an increased probability of an attack, can include stressful events, hormonal changes, weather changes, and certain foods, although some studies demonstrate reduced odds for migraine attacks in relation to certain variables. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] In patient surveys, perceived stress was associated with migraine onset in up to 80% of respondents. [13][14][15][16] Diary studies have shown that "daily hassles" significantly increase in the 2-to 3-day period before a migraine day.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Premonitory features include changes in mood or behavior that precede the onset of an attack. Trigger factors, measurable precipitants associated with an increased probability of an attack, can include stressful events, hormonal changes, weather changes, and certain foods, although some studies demonstrate reduced odds for migraine attacks in relation to certain variables.…”

“…4 Some studies have examined the effects of reduction in stress or "let-down" as a migraine trigger factor, often focused on "weekend" headache attacks. [14][15][16][17][18][19][20][21][22] The roles of level of stress and reduction in stress as migraine triggers remain to be disentangled. Our objective was to examine the association between stress and reduction in stress on migraine attack onset in persons with migraine using electronic diaries.…”

“…Results demonstrate that electronic diaries coupled with appropriate analytic strategies provide a powerful tool for assessing headache triggers. [11][12][13][14][15][16][17][18][19][20][21][22] Random-effects logistic regression modeling provides more accurate summaries of effects both within and among participants. Methodologic issues in studying stress and relaxation after stress exemplify the problems that arise for studying provocative factors for migraine in general.…”