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Caffeine withdrawal
From WikEM
Contents
Background
- Caffeine dependence and withdrawal is very common
- Up to 52% of moderate caffeine uses have withdrawal symptoms[1]
Common Dosages by Type
| Type | Amount | Caffeine^ |
| Coffee, brewed | 1 cup | 100mg |
| Coffee, instant | 1 cup | 75mg |
| Tea | 1 cup | 50mg |
| Red Bull | 1 can | 80mg |
| Rockstar | 1 can | 160mg |
| Excedrin Migraine | 2 tabs | 130mg |
^Average caffeine content can vary[2][3]
Clinical Features
- Most common symptoms
- Headache
- Fatigue
- Decreased energy/activeness
- Decreased alertness
- Drowsiness
- Decreased contentedness
- Depressed mood
- Difficulty concentrating, irritability, and foggy/not clearheaded
- Additional symptoms
- Flu-like symptoms
- Nausea/vomiting
- Muscle pain/stiffness
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Temporal arteritis
- Idiopathic intracranial hypertension (aka Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
Others
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Varicella
- Herpes
- Enterovirus
- West Nile
- Tuberculosis
- Lyme disease
- Syphilis
- Drug induced aseptic meningitis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
- Sarcoidosis
- Vasculitis
- Connective tissues disease
Evaluation
- History should can be sufficient
- Consider further workup in ambiguous cases
Management
- OTC analgesics
- Hydration
- Rest/Sleep
Disposition
- Rule out more serious etiologies
- Timing[4]
- Onset 12–24 h after abstinence
- Peak intensity at 20–51 h
- Duration of 2–9 days
See Also
External Links
References
- ↑ Silverman K, et al. Withdrawal syndrome after the double-blind cessation of caffeine consumption. NEJM. 1992; 327(16):1109–1114.
- ↑ Food Standards Agency (2001) Statement on the Reproductive Effects of Caffeine. London: Food Standards Agency.
- ↑ Juliano LM and Griffiths RR. Caffeine. In Lowinson, J.H., Ruiz, P., Millman, R.B., Langrod, J.G. (Eds.). Substance Abuse: A Comprehensive Textbook, Fourth Edition. 2005. PP. 403-421. Baltimore: Lippincott, Williams, & Wilkins.
- ↑ Juliano LM and Griffiths RR. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features . Psychopharmacology. 2008; 176(1):1–29.
