What should I do if I get a headache without coffee?

Q: I must drink a cup of coffee in the morning to stay awake. If I don’t drink coffee, I will feel irritable and have a headache. Do I need to quit my coffee addiction?

A: Don’t worry, caffeine is not difficult to quit and you can quit it in 7 to 12 days.

People who need to drink a cup of coffee every day may have had this experience: if they don’t drink it for a day, they will feel drowsy, even have a headache and be unable to concentrate.

Michael Keane, a researcher at Dublin City University in Ireland, mentioned that wanting to drink a cup of coffee as soon as you wake up every morning is not simply a need for caffeine to wake you up, but rather a dependence on caffeine, like the caffeine "withdrawal" symptoms of addicts: after not taking caffeine for a night, you want to take caffeine immediately in the morning. "Even people who only drink a cup of tea a day may experience withdrawal symptoms when they stop after forming a habit."

In fact, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in May 2013, caffeine withdrawal was included in the diagnostic criteria for the first time. If you experience three or more of the following symptoms within 24 hours of suddenly stopping or reducing your caffeine intake, such as headache, fatigue or tiredness, depression, irritability, inability to concentrate, and some cold-like symptoms such as nausea, vomiting, muscle aches, etc., it means that you are addicted to caffeine.

But I believe that many coffee addicts are familiar with these symptoms. Chen Jingxu, director of the Chen Jingxu Clinic and a specialist in the Taiwan Psychiatric Association, also mentioned that caffeine is a central nervous system stimulant that has the same effect on the brain as amphetamines and cocaine, but the effect is not as strong as these two types of drugs. Therefore, it is rare to see cases in clinical practice where a psychiatrist is really needed to help quit addiction.

However, Roland Griffiths, a psychiatrist at Johns Hopkins University and a member of the DSM-5 working group, pointed out that among the withdrawal symptoms, caffeine withdrawal headaches accounted for the highest proportion, reaching 50%, and only 13% of people were unable to work, socialize, and live normally because of it. "But even without headache symptoms, many people still experience symptoms such as fatigue and inability to concentrate, so I think we should still remind everyone that caffeine addiction is risky," Griffiths explained.

Why is caffeine addictive like a drug?

Caffeine is actually both water-soluble and fat-soluble. When we drink coffee, it can be absorbed into the bloodstream, penetrate the cell membrane, and enter the brain.

In the brain, there is a chemical called adenosine, which is an inhibitor that helps keep many areas of the brain under control. When adenosine binds to receptors, it inhibits the release of certain neurotransmitters, creating a sedative effect. The molecular shape of caffeine is similar to that of adenosine, which means that caffeine will also bind to adenosine receptors, preventing adenosine from exerting its original effect.

The range of adenosine's effects includes the reticular activating system in the brain. When this system is controlled by adenosine, we feel sleepy and our energy gradually decreases; but when adenosine is blocked, this system becomes uncontrolled and becomes active, and the whole person enters the "on" mode.

On the other hand, the brain's own stimulants, such as dopamine, become more active when adenylate is blocked; adenylate that is not bound to receptors sends a signal to the adrenal glands, which releases adrenaline, making the body more alert. These are the stimulating effects of caffeine; and this effect can last for several hours.

Moreover, if you consume caffeine every day, your brain cells will produce more adenylate receptors to cope with the constant influx of caffeine every day; this also explains why coffee addicts gradually develop a tolerance to caffeine.

However, when you have more and more adenosine receptors, once the caffeine supply is stopped, the withdrawal symptoms will be more intense.

The good news is that caffeine is easy to quit.

Compared to other drug and alcohol addictions, caffeine withdrawal symptoms are relatively short-lived; they will gradually subside in about 7 to 12 days.

In order to make the addiction treatment process smoother, Juliano, a psychiatrist at the American University, recommends breaking the regular frequency of coffee drinking, slowly lengthening the interval between intakes, and limiting the caffeine content to 100 mg as much as possible (the standard for caffeine poisoning is 250 mg), which means you can only drink one cup of 150cc coffee a day.

Doctors suggest finding alternatives, such as low-caffeine coffee and tea, and gradually quitting.

During this period, the brain will slowly reduce the number of adenylate receptors; when the number returns to the baseline number, congratulations, you have successfully quit addiction!