The Role of Tea and Caffeine in Headaches and Migraine

The Question

You have an excruciating headache. Someone tells you to have a cup of tea. Do you want to comply or do you want to throw the kettle at them?

Well, anyone who’s had a really bad headache might try something as simple as having tea. It may, after all, alleviate the pain. But if you have migraines, you’ve undoubtedly gotten endless unsolicited advice that begins with “have you ever tried x?” —as though you and your neurologist haven’t already pondered and pursued your every option!

Still, it’s worth at least a glance at anything that may help, if only to understand why certain possible remedies are even offered. 

So today, I’m returning to the question of whether tea can help relieve a migraine, having already looked at the role of herbals (see Can Tea Relieve Migraine?). As mentioned in that earlier post, I found sources that cite green, black, and white tea as perhaps being helpful to relieve migraine. But what does science say?

Silver Needles (white tea)

The Proposed Remedy: A Cup of Tea

First off, all true tea is made from the C. sinensis plant. Controlling how much the leaves oxidize during processing determines whether you end up with white (withered only), green (slightly oxidized), oolong (partially oxidized), or black (fully oxidized) tea. (Matcha, pu-erh, and yellow tea are their own thing and not included here.)

There are certainly molecular differences between these.

When leaves are first harvested, they wither, meaning the plant cells are damaged and the leaves begin to oxidize. For white tea, that oxidation is immediately stopped. For green tea, it’s quickly stopped, allowing the polyphenols to remain largely as flavonols or catechins (which give the tea its green color and vegetal flavor).

South Korea Seogwang Sencha (green tea)

As the leaves continue to oxidize, simple polyphenols convert to more complex forms. Black tea’s theaflavins provide the characteristic bright taste, while thearubigins confer complexity.

But these differences are probably irrelevant to the question at hand, especially when sources suggest that any of these forms of tea will help relieve migraine. Therefore, looking at the factors that are common to all tea types, it’s caffeine that’s likely the acting agent as it relates to migraine and headaches.

But caffeine is actually very complicated!

As R. H. Shmerling of Harvard Health Publishing (2019) puts it:

the caffeine in coffee, tea, and other foods or drinks can help prevent a headache, treat a headache, and also trigger a headache.

Wild Caucasus Mountain (black tea)

Removing Caffeine from the Equation

Someone who suffers from headaches and/or migraines (there is a difference) may decide to completely eliminate caffeine from their diet. For tea and coffee drinkers, that means no decaf tea/coffee either, since those contain residual caffeine.

The complete cessation of caffeine consumption often results in a caffeine-withdrawal headache, as many of us have experienced(!), but after a couple of weeks, that subsides as the body adjusts. Once that point has been reached, medicines used as acute treatment for migraine (in this case, triptans) tend to work more effectively, according to a study by M. J. Lee et al (2016). These researchers found that although consuming a lower amount of caffeine also helped with medicine efficacy, ingesting no caffeine was better.

Adding Caffeine to Pain Meds—But Just the Right Amount

On an opposing line of thought, however, caffeine (often, the very same caffeine that was removed when tea and coffee were decaffeinated) is frequently added to pain medicines because it makes the medicine more effective. It does this by improving the absorption of the drugs. (Caffeine itself has 100% absorption and bioavailability in our bodies.)  

According to R. B. Lipton et al. (2017), in their review of caffeine for treatment of headache, 130 mg of caffeine improves the efficacy of over-the-counter meds for tension-type headaches, and levels over 100 mg improve the efficacy of over-the-counter meds for migraine.

However, if too much caffeine is used, or if caffeine-containing medicines are taken too often, people can experience medication over-use headache, and possibly even progress into chronic migraine. And, caffeine can adversely interfere with other therapies (Lipton et al. 2017). 

Another note: this study looked at over-the-counter meds whereas the caffeine cessation study involved prescribed triptans, a different class of meds. Still, they illustrate some of the many possible roles of caffeine.

Silver Needles

Caffeine as Headache Preventative

For those who have nightly head pain—or hypnic headaches—the treatment is caffeine, as in a strong cup of coffee before bedtime.

Also, for some people, having around the same amount of caffeine each day (and probably around the same time of day) seems to help, logically because consistency staves off any caffeine-withdrawal headache. Or, is a brain that has been altered and sensitized by migraine helped simply by constancy of caffeine levels, whether that means no caffeine, low levels of caffeine, or high amounts of caffeine? Disruptions in sleep, meals, stress, activity, and so on can trigger migraine, so is caffeine just another factor that if consistent, generally helps?

Seogwang Sencha

Caffeine as Headache Trigger

Coffee can trigger a migraine in some people, although it’s unclear whether it’s the caffeine or something else in coffee that’s to blame.

However, a 2019 study looked at the relationship between caffeine intake and developing a migraine. Shmerling (2019) summarizes the results, which suggest that consistency and moderation are beneficial:

• The odds of having a migraine increased for those drinking three or more caffeinated beverages per day, but not for those consuming one to two servings per day; the effect lasted through the day after caffeine consumption.
• It seemed to take less caffeine to trigger a headache in those who didn’t usually have much of it. Just one or two servings increased the risk of migraine in those who usually had less than one serving per day.

Caffeine for Symptom Relief

Caffeine has been used since antiquity because it helps us focus, keeps us awake, makes our minds work faster, improves reaction time, and more. For someone suffering the fogginess and brain sluggishness that often accompanies headache and migraine, caffeine may help clear some of that.

In this function, tea may be more helpful than coffee because tea also contains the amino acid L-theanine, which increases those alpha brain waves that relax us. The combination of this amino acid with caffeine, then, bestows a “calm alertness.”

Also, for some people, the benefits of consuming caffeine still outweigh any improved efficacy of medicine in the absence of caffeine, especially if that improvement was very slight.

Wild Caucasus Mountain

The Upshot

As Lipton’s team (2017) puts it:

The relationship between caffeine and headache is complex, paradoxical, and often misunderstood.

Yet articles continue to glibly suggest that if a person is suffering a migraine, they might try having a cup of tea. Such suggestions don’t do migraineurs any service. Because if only it were that simple! 

Further, such superficial advice implies that migraine is some slight ailment that readily responds to tea. For someone who is at their wits’ end and miserable with relentless migraine—which, by the way, has no known cure—such suggestions are dismissive and even cruel. Migraines have an economic cost that impacts society; over 13 billion dollars are lost annually in the U.S., largely because of “reduced work productivity,” according to J. Chawla of Medscape.

Or, is such advice born from the desire to find a simple, easily accessible, solution to this staggering problem? 

But can a cup of black—or green or white—tea mitigate a headache or migraine?

Science says: Maybe. Maybe not. Maybe this time but not the next time. Maybe if the pain isn’t so bad. Maybe when that dose of caffeine is enough to work synergistically with other meds taken. Maybe if it’s only the first or second cup of the day and the person usually has two cups per day.

It’s complicated.

Sources:
–Chawla, J., “What is the economic impact of migraine headache in the US?,” Medscape, 10/21/19.
–Lee, J. L. et al., “Caffeine discontinuation improves acute migraine treatment,” The Journal of Headache and Pain 17(1). 2016.
–Lipton, R. B., et al., “Caffeine in the management of patients with headache,” The Journal of Headache and Pain 18(1). 2017.
–Shmerling, R. H., “If you have migraines, put down your coffee and read this,” Harvard Health Publishing, 11/25/19.

Teas shown here are available at TeaHaus.