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Caffeine Withdrawal

Caffeine Withdrawals

Caffeine withdrawal belongs to the group of caffeine related disorder and presents with unpleasant signs and symptoms experienced by the individual upon withdrawal of caffeine. The symptoms can get so severe at times, that it is considered to be a disorder.


Presentation

Researchers have identified the major symptoms associated with caffeine withdrawal. These begin with headache, followed by drowsiness or fatigue, irritability, difficulty in concentrating, muscle pain, nausea accompanied by vomiting. All these symptoms interfere with the ability to work and cause distress and depression among the individuals [7].

Symptoms usually show effect within 12 – 24 hours of withdrawal of caffeine. The intensity peaks within 1 – 2 days and the symptom lasts for as long as 2 – 9 days. It was also postulated that the severity of symptoms would heavily depend on the dosage of caffeine the individual was accustomed to. However, it has been noticed that those consuming as less as 100 mg of caffeine per day also suffered from symptoms upon its withdrawal [8].

Research studies have also underlined that, in order to avoid caffeine withdrawal symptoms, subjects have to go back to their daily cup of coffee. With inclusion of caffeine containing products, the negative effects of withdrawal just vanishes and they could get the perceived benefits of their morning cup of coffee.

Dry Eyes
  • It is possible that you developed dry eye symptoms off caffeine but this is speculation. My feeling is that your vision and your caffeine use are unrelated and coincidental.[aao.org]
Suggestibility
  • RATIONALE: It has been suggested that caffeine is most likely to benefit mood and performance when alertness is low.[ncbi.nlm.nih.gov]
  • These findings suggest that acute caffeine withdrawal during prolonged sleep deprivation has an adverse effect on abstract reasoning and concept formation.[ncbi.nlm.nih.gov]
  • We suggest that this possibility should be considered in clinical management of affected patients.[ncbi.nlm.nih.gov]
  • Logistic regression analysis of trend between headache and caffeine consumption suggested that with each 100-mg increase in caffeine consumption, there was a 12% increase in the odds of headache developing in the immediate preoperative period (P less[ncbi.nlm.nih.gov]
  • Survey data suggest that 9% to 30% percent of caffeine consumers may be caffeine dependent according to DSM-IV criteria.[ncbi.nlm.nih.gov]
Headache
  • Coffee seemed to abate the headache. This frequency (0.4%) should, clearly, be regarded as a minimum figure. Caffeine-withdrawal headache at the grassroots level may be a rather rare, generally vague, symptom-poor headache.[ncbi.nlm.nih.gov]
  • No relationship was found between headache and the patients' age, sex, usual frequency of headache, consumption of alcohol or nicotine, or the anesthetic agents or adjuvants used.[ncbi.nlm.nih.gov]
  • Abstract Caffeine consumption may cause headache, particularly migraine. Its withdrawal also produces headaches and may be related to weekend migraine attacks.[ncbi.nlm.nih.gov]
  • This is further explained by the fact that upon administration of coffee the headaches gets eventually resolved. It occurs due to the ability of caffeine to constrict the blood vessels that is causing the headache.[symptoma.com]
  • The males amongst these were all migraine patients, but 23% of the women suffered from tension- type headache.[ncbi.nlm.nih.gov]
Tonic-Clonic Seizure
  • On the third day after discontinuation a withdrawal syndrome characterized by headache and a generalized tonic-clonic seizure occurred.[ncbi.nlm.nih.gov]
Clumsiness
  • When you skip your usual stimulant high, you might feel down, drowsy, sluggish, clumsy, and irritable. You may also experience headaches , and a drop in blood pressure.[health.com]

Workup

Caffeine withdrawal is now listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental disorders and lately has been defined as mental disorder since it significantly impairs the individual’s ability to optimally perform his/her daily activities.

Researchers suggest that in order to be diagnosed with caffeine withdrawal, an individual must experience at least 3 out of 5 symptoms within 24 hours from the elimination of the stimulant. The symptoms include: headache, drowsiness / fatigue, irritability / depressed mood, poor concentration and flu-like symptoms. These are some of the most common symptoms experienced by all; however, if these worsen to such an extent to be able to cause distress and interfere with the individual's daily work, an intervention might be needed.

The speed with which caffeine is metabolized and removed from the system varies from one individual to another. For some it takes as long as 8 hours to metabolize caffeine, whereas in some it takes just about 2 hours [9].

Diagnosis can be made based on the individual’s history of caffeine intake from all possible sources.

Treatment

Individuals who wish to remove that caffeine from life are advised to follow gradual elimination. This can be done by gradually decreasing the amount of caffeine they add to their regular cup. This can be mixed with decaffeinated coffee and eventually the proportion of caffeine can be reduced. During the withdrawal phase, support from family and friends would also be of great help.

Prognosis

Prognosis of the condition will depend on how long caffeine has been withdrawn from the daily diet. In initial stages, individuals would experience mild headache which gradually gets better once the stimulant is taken. However, in many instances, symptoms can even get worse and necessary medical intervention becomes mandatory.

Etiology

Symptoms of caffeine withdrawal occur when individuals either reduce or eliminate the caffeine stimulant from their daily routine. For individuals addicted to consume coffee on daily basis, even a slight change or reduction in the amount can give rise to mild headache or discomfort. It has been seen that individuals who do not maintain their amount of caffeine consumption per day are at an increased risk of suffering from the unpleasant symptoms. Individuals who are on the point of detoxifying their body from caffeine are also potential candidates of experiencing symptoms of caffeine withdrawal [2].

Epidemiology

It has been estimated that about 90% of individuals across the globe consume coffee on a daily basis. About 400 mg of caffeine has been found to be safe for adult population. Caffeine withdrawal symptoms are experienced by almost 50% of individuals who decide to stay away from the stimulant [3].

Studies have shown that about 280 mg of caffeine is daily consumed by individuals in USA, with a higher intake reported amongst the European population. Caffeine is not ingested from coffee alone, but from tea, caffeinated energy and soft drinks as well [3].

Sex distribution
Age distribution

Pathophysiology

Side effect of caffeine withdrawal is most commonly presented by development of headaches in individuals who actually want to avoid it. Onset of headache upon withdrawal of caffeine occurs as a result of enhanced response of adenosine to neurotransmitter in brain. Large amounts of adenosine causes the blood vessels to dilate and in turn causes sudden drop in blood pressure.

Therefore, there is a strong association between dilation of blood vessels due to increased levels of adenosine upon caffeine withdrawal. This is further explained by the fact that upon administration of coffee the headaches gets eventually resolved. It occurs due to the ability of caffeine to constrict the blood vessels that is causing the headache [5].

Caffeine has structure similar to that of adenosine, which binds with the nerve receptors and inhibits their transmission, thus acting as a stimulant. In such situations, the body produces more adenosine to carry out its normal functioning. Therefore, when caffeine is eliminated, more number of receptors is available to bind to adenosine which in turn gives rise to unpleasant symptoms [6].

Prevention

The best way to prevent caffeine withdrawal symptoms is to avoid going cold turkey. Gradual reduction of caffeine either by reducing the volume or by substituting caffeine with decaffeinated powder would help in easy elimination [10].

Summary

According to several research trials conducted on coffee consumption, it was postulated that occurrence of headache or uneasiness for not getting the regular cup of coffee in the morning can be a sign of caffeine withdrawal – a disorder in making. Excessive consumption of caffeine has been significantly linked to development of bladder cancer. Several risks have been associated with consumption of coffee. However, the beverage has various protective effects as well [1].

Patient Information

Definition: Caffeine withdrawal is a condition wherein individuals wish to eliminate caffeine from their diet. Recently, it has been considered  a form of mental condition, as during the elimination period several unpleasant symptoms are experienced that significantly hamper the individual’s ability to participate properly in their work.

Cause: Symptoms of caffeine withdrawal occur when individuals withdraw caffeine from their diet. Even a slight change or reduction in amount of caffeine can give rise to various unpleasant symptoms.

Symptoms: Individuals who practice caffeine withdrawal suffer from headache, nausea, vomiting, irritability, poor / decreased concentration and flu-like symptoms.

Diagnosis: Diagnosis is made based on the patient’s pattern of caffeine consumption. A careful history is gathered followed by study of signs and symptoms.

Treatment: Clinicians suggest staged reduction of caffeine on a gradual basis instead of adopting the sudden strategy. Staged reduction would allow an absolute elimination of caffeine after a few days.

References

Article

  1. Lieberman HR, Stavinoha T, McGraw S, et al. Caffeine use among active duty US Army soldiers. J Acad Nutr Diet 2012; 112:902.
  2. Herz RS. Caffeine effects on mood and memory. Behav Res Ther. Sep 1999;37(9):869-79.
  3. Grigg D. The worlds of tea and coffee: Patterns of consumption. Geojournal 2002; 57:283.
  4. Reissig CJ, Strain EC, Griffiths RR. Caffeinated energy drinks--a growing problem. Drug Alcohol Depend 2009; 99:1.
  5. Strain EC, Mumford GK, Silverman K, Griffiths RR. Caffeine dependence syndrome. Evidence from case histories and experimental evaluations. JAMA. Oct 5 1994;272(13):1043-8.
  6. Di W, Shi X, Zhu Y et al. Overuse of paracetamol caffeine aspirin powders affects cerebral glucose metabolism in chronic migraine patients. Eur J Neurol. Apr 2013;20(4):655-62.
  7. Smith A, SturgessW, Gallagher J. Effects of a low dose of caffeine given in different drinks on mood and performance. Hum Psychopharmacol Clin Exp 1999; 14:473.
  8. Heckman MA, Weil J, Gonzalez de Mejia E. Caffeine (1, 3, 7-trimethylxanthine) in foods: a comprehensive review on consumption, functionality, safety, and regulatory matters. J Food Sci 2010; 75:R77.
  9. Kamimori GH, Johnson D, Thorne D, Belenky G. Multiple caffeine doses maintain vigilance during early morning operations. Aviat Space Environ Med 2005; 76:1046.
  10. Childs E, de Wit H. Subjective, behavioral, and physiological effects of acute caffeine in light, nondependent caffeine users. Psychopharmacology (Berl) 2006; 185:514.

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Last updated: 2018-06-22 04:27