Why do drug companies put caffeine in headache remedies?

I noticed that this week’s copy of the British Medical Journal included a ‘Masterclass for GPs’ on the subject of headaches [1]. This took, as expected, a pharmaceutical-based approach to the problem. What I found more interesting was an electronic response to this review by a doctor wishing to draw attention to a cause of headache not mentioned in the article ” caffeine withdrawal [2]. The author of this letter describes his past experience of getting headaches at the weekend and when on holiday, which turned out to be the result of him not getting the normal caffeine ‘fix’ he was having during the working week.

I can say from my experience that caffeine withdrawal headaches are surprisingly common. They, as the letter in the BMJ points out, will commonly manifest at the weekend. Over the years, I have seen a string of patients with weekend headaches, all of whom turned out to have them as a result of caffeine withdrawal. Some of these individuals had been extensively investigated for the cause of their headaches. One patient, I remember, had had sophisticated allergy testing for pollen to be found in and around the golf course he frequented on a Saturday morning!

Those suffering from caffeine withdrawal headaches at the weekend have two main options open to them. One of these is to abruptly or gradually withdraw from caffeine. Obviously, going ‘cold turkey’ is likely to bring on a headache. Usually, this sort of headache will last from between 2 and 4 days. Gradual reduction over some days/weeks might allow withdrawers to circumvent this.

The other option, of course, is to make sure that some caffeine is had each day, including over the weekend. Nutritionally, I’m not completely averse to this tactic, on the basis that coffee and tea are both associated with protection from chronic disease.

One approach to caffeine withdrawal headaches I don’t recommend is just to pop a painkiller. My preferred approach to bodily ailments, including headaches, is to attempt to identify and resolve their underlying cause. And headaches, after all, are not caused by, say, an aspirin or paracetamol (acetaminophen) deficiency. Not only that, but such drugs can have side-effects too. In particular, aspirin can induce bleeding in the gut while paracetamol can damage the liver.

What is curious to me is that some over-the-counter headache remedies contain, in addition to one or more analgesics, a fair whack of caffeine. Hang on a moment, though, caffeine is not believed to have explicit painkilling properties of its own, so what’s it doing there? Could it be that the manufacturers of these products know that caffeine can relieve headaches by reversing caffeine withdrawal?

After the short term relief offered by such a concoction caffeine withdrawal is inevitable. This may, of course, induce another headache which may cause someone to reach, once again, for the headache remedy. Just thinking about what appears to be a cynical ploy by drug companies to keep us popping pills is enough to give me a headache.

References:

1. Fuller G, et al. Masterclass for GPs: Headaches BMJ 2007;334:254-256

2. Roskell DE. Caffeine withdrawal causes weekend headaches
bmj.com. 2 Feb 2007

10 Responses to Why do drug companies put caffeine in headache remedies?

  1. Audrey 5 February 2007 at 12:58 pm #

    Re the formulation of over the counter medicines:- I started working in my father’s chemist’s shop over 50 years ago and Beechams Powders, Anadin , Nurse Syke’s Powders and other brands generally contained aspirin, phenacetin and caffeine. When phenacetin was withdrawn the products just left out the phenacetin or added paracetamol as a replacement.

    I think the caffeine was just added as a feel good thing. At first these products would have had secret formulae before the law changed and the ingredients had to be listed. Before my time, even though I am very old. As an analgesic OTC medicine there was only aspirin and phenacetin so everything on the market contained one or both of these ingredients. This continued until the recent addition of ibuprofen to OTC remedies.

    When I first qualified we were still writing “The Tablets”, “The Capsules”, “The Mixture” on dispensed medicines and the tablets were sent out in collapsible cardboard packets with no protection from the air or crushing.

    Pre-Valium one doctor had a rubber stamp for Mist Pot Brom & Valerian.
    Audrey

  2. Audrey 5 February 2007 at 1:40 pm #

    Sorry, it was Mist Pot Brom et Val. I am forgetting my dog Latin.

  3. Jayney Goddard 6 February 2007 at 11:31 am #

    This is a wonderful piece Dr Briffa and the addition of caffeine to analgesics is something I have long found curious. I would tend to agree with Audrey that it is probably a feel-good thing – especially if you look at the advertising going on at the moment – BlahBlah product if for people who “just get on with it”. However, the idea of caffeine withdrawal is so intriguing that it can’t be ignored and your observation is a really fascinating take on this unnecessary addition to the medicines in question.

    Jayney

  4. Dee 7 February 2007 at 10:23 am #

    I am now set to go off at a slight tangent!
    This all brings me to the herbal teas that I drank when I gave up tea and coffee a few years ago. [I am back on t & c in moderation] I found that the herbal teas made me incredibly thirsty and wonder what the salt content is in them. They don’t list much by way of ingredients.

  5. Helen Mould 9 February 2007 at 1:08 pm #

    Caffeine could shrink the cords holding the brain in the skull and reduce a headache. My daughter had a a ceasarian Dec 29th 05 and the spinal cord got a small puncture causing a leak of spinal fluid and the fluid supporting the brain to also leak. (So the anaethetist at the London hospital said) Her symptoms were extreme headache and vomitting. To help cure she was told was to lie down as much as possible and to drink lots of strong black coffee because the caffeine in the coffee shrinks the cords (I forget the technical term) holding the brain in position in the skull and therefore will lessen the headache until the pucture seals itself and the fluid around the brain is replinished

  6. deborah booth 9 February 2007 at 6:58 pm #

    Fascinating stuff, as usual.
    How about the role of dehydration in headaches? My daughter and my partner often used to reach for the pills, complaining of a headache – I suggest drink a pint or two of water and hey presto within half an hour all signs of the headache gone. Are they typical workers, out all day and rarely drink (or pee for that matter!) and wonder why they had a problem with headaches?

  7. Dr John Briffa 9 February 2007 at 7:02 pm #

    Thanks Deborah – my experience in practice is that dehydration is THE most common cause of headaches at all. And, as you may have noticed, reversing this not only often banishes the headache, but leads to a general buoying up of physical and mental energy too.

  8. Rosina 9 February 2007 at 10:06 pm #

    I dispute your basic premise. I live with fibromyalgia, and by now hardly take any painkillers, because of after-effects (more fatigue the next day, greater stupidity and less life participation at the time). But there are times I take a codeine based painkiller. I have the kind without caffeine in, because if it has it in, and I drink coffee, I get bowel spasms. So I have a coffee when I take it, and is there ever a marked difference, MUCH more effect with caffeine. I was surprised that you didn’t mention the ‘theory’ that caffeine potentiates.

  9. Helen Roberts 11 June 2008 at 8:31 pm #

    Drug companies are about PROFITS. Truth be told, they REALLY don’t want to cure your headache or ANY ailment for that matter…because they’d be out of business if they did.

Trackbacks/Pingbacks

  1. The headache pills that cause headaches | Dr Briffa's Blog - A Good Look at Good Health - 21 September 2012

    [...] Another quite-common cause of headaches, I find, is caffeine withdrawal. Anyone who has gone ‘cold turkey’ of a good coffee or tea habit is likely to know how this fells (typically the headache comes on within a day and lasts for 1-2 days before resolving – often, for good). It is interesting to note that some headache remedies contain caffeine, despite caffeine having no painkilling properties. Could it be that the manufacturers know that headaches can be caused by caffeine withdrawal and caffeine can therefore help get rid of a headache? But might they also know that putting caffeine in the medication will likely, ultimately, lead to some caffeine withdrawal and another headache requiring, yes, more medication. I have no idea but I think we should at least ask the question. I wrote about this issue some years ago here. [...]

Leave a Reply