PEDIATRIC HEADACHE

Caffeine is the most widely used behaviourally active substance. Excessive caffeine consumption, mostly in the form of coffee and tea, is a well‐recognized cause of headache or migraine, and withdrawal can cause headache. Nevertheless, caffeine abuse headache is not listed as a separate category in the International Headache Society classification, 1988. We report our experience with children and adolescents with daily or near‐daily headache and excessive consumption of caffeine in the form of cola drinks. Over a period of 5 years we have encountered, in a tertiary headache clinic in a general hospital, 36 children and adolescents (17 girls and 19 boys) with daily or near‐daily headache related to excessive caffeine intake in the form of cola drinks. The mean age of the subjects was 9.2 years (range 6‐18) and mean headache duration was 1.8 years (range 0.6‐5). All were heavy cola drinks consumers; at least 1.5 L of cola drinks per day (192.88 mg of caffeine daily), and an average of 11 (range 10.5‐21) L of cola drinks a week, which amounts to 1414.5 mg of caffeine (range 1350.1‐2700.3). Patients were encouraged to achieve gradual withdrawal from cola drinks, which led to complete cessation of all headaches in 33 subjects, whereas one boy and two adolescent girls continued to suffer from migraine without aura not frequent enough to justify prophylactic medication. Children and adolescents with high daily caffeine consumption in the form of cola drinks may suffer from caffeine‐induced daily headache. Gradual withdrawal can be achieved without withdrawal headache and with complete disappearance of the induced chronic daily headache. Comments: Adolescents get rebound headache, too, and elimination of caffeine is part of the necessary detoxification of medications in teens as well as in adults. I tell my patients that caffeine is just another rebound medication, and I, too, have had excellent results in patients with chronic migraine restored to episodic migraine after decaffeination. SJT I would agree. Another issue always worth exploring with these patients is the use of combination analgesic products; eg, containing caffeine and acetaminophen or aspirin to “enhance the analgesic effects.” These products have also, of course, been implicated in the development of chronic migraine if used on a daily basis. DSM