Caffeine Withdrawal

• The incidence and prevalence of the caffeine withdrawal syndrome is not known.
• About 11% of individuals who stop caffeine use for at least 24 hours may experience a headache and some functional impairment.^[3]
• In those that attempt to permanently stop caffeine use, about 70% can experience at least one caffeine withdrawal symptom, and almost half experience headaches.

• There is a large variability between and within individuals in terms of the presentation of withdrawal symptoms.
• Caffeine withdrawal symptoms can occur after abrupt cessation of relatively low chronic daily doses of caffeine (<100 mg).^[4]
• Symptoms usually begin 12 to 24 hours after the last caffeine dose and peaks after 1 to 2 days of abstinence. The symptoms can last between 2 to 9 days, and withdrawal headaches and persist for up to 21 days.
  • These symptoms usually resolve rapidly (30 to 60 minutes) after the re-introduction of caffeine.

• Caffeine withdrawal may be associated with generalized anxiety disorder, major depressive disorder, panic disorder, antisocial personality disorder.^[5]
  • There is also an association with alcohol use disorder, cannabis, and cocaine use.^[6]

• The likelihood and severity of caffeine withdrawal increases as the dose and frequency of caffeine use increases.^[7]
• Individuals with eating disorders, smokers, incarcerated individuals and prisoners, and individuals with other substance use disorders are at increased risk.

Prolonged daily use of caffeine.

Abrupt cessation of or reduction in caffeine use, followed within 24 hours by at least 3 of the following signs or symptoms:

1. Headache
2. Marked fatigue or drowsiness
3. Dysphoric mood, depressed mood, or irritability
4. Difficulty concentrating
5. Flu-like symptoms (nausea, vomiting, or muscle pain/stiffness)

The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The signs or symptoms are not associated with the physiological effects of another medical condition (e.g. - migraine, viral illness) and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

• Headache is a hallmark (but not required) feature of caffeine withdrawal and can be diffuse, gradual, throbbing, severe, and sensitive to movement.
  • Some may describe it as “the worst headaches” ever experienced, but it is important to ensure there are no other neurological causes.
• Since caffeine use is often integrated into social customs (e.g. - coffee breaks, tea time), some individuals may be unaware of their dependence on caffeine.^[8]
• Caffeine withdrawal can also happen when individuals are required to abstain from foods and beverages before to medical procedures or when there is a change in routine (e.g. - travel).^[9]
  • Individuals may mistake and misattribute the withdrawal to other causes (e.g. - the flu, or migraine)^[10]
• There may be less motivation to work and less sociability during caffeine withdrawal.

• Other medical disorders and medical side effects
  • Caffeine withdrawal can mimic migraines and other headache disorders, viral illnesses, sinus conditions, tension, other drug withdrawal states (e.g. - from amphetamines, cocaine), and medication side effects. Caffeine withdrawal should only be diagnosed based on a careful history of the amount consumed, the interval between caffeine abstinence and onset of symptoms, and the clinical symptoms presented by the individual. A “challenge dose” of caffeine followed by quick symptom remission can be used to confirm the diagnosis of caffeine withdrawal.^[11]

Electroencephalographic (EEG) shows that caffeine withdrawal symptoms are associated with increases in theta power and decreases in beta-2 power.^[12]

• Caffeine users can decrease the incidence of caffeine withdrawal by using caffeine daily or only infrequently (e.g. - using no more than 2 days in a row).
• Gradually reducing caffeine over a period of days or weeks can also decrease the incidence and severity of caffeine withdrawal.