Caffeine withdrawal
Background
- Caffeine dependence and withdrawal is very common
- Up to 52% of moderate caffeine uses have withdrawal symptoms[1]
- Average caffeine content can vary[2][3]
- Coffee, 1 cup brewed – 100mg
- Coffee, 1 cup instant – 75mg
- Tea, 1 cup – 50mg
- Coffee, 1 cup brewed – 100mg
- Red bull, 1 can – 80mg
- Rockstar, 1 can – 160mg
- Excedrin Migrain, 2 tabs – 130mg
Clinical Features
- Most common symptoms
- Headache
- Fatigue
- Decreased energy/activeness
- Decreased alertness
- Drowsiness
- Decreased contentedness
- Depressed mood
- Difficulty concentrating, irritability, and foggy/not clearheaded
- Additional symptoms
- Flu-like symptoms
- Nausea/vomiting
- Muscle pain/stiffness
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Mild traumatic brain injury
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Workup
- Hx should can be sufficient
- Consider further w/u in ambiguous cases
Management
- OTC analgesics
- Hydration
- Rest/Sleep
Disposition
- R/O more serious etiologies
- Timing[4]
- Onset 12–24 h after abstinence
- Peak intensity at 20–51 h
- Duration of 2–9 days
See Also
External Links
Sources
- ↑ Silverman K, et al. Withdrawal syndrome after the double-blind cessation of caffeine consumption. NEJM. 1992; 327(16):1109–1114.
- ↑ Food Standards Agency (2001) Statement on the Reproductive Effects of Caffeine. London: Food Standards Agency.
- ↑ Juliano LM and Griffiths RR. Caffeine. In Lowinson, J.H., Ruiz, P., Millman, R.B., Langrod, J.G. (Eds.). Substance Abuse: A Comprehensive Textbook, Fourth Edition. 2005. PP. 403-421. Baltimore: Lippincott, Williams, & Wilkins.
- ↑ Juliano LM and Griffiths RR. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features . Psychopharmacology. 2008; 176(1):1–29.