Prevalence, characteristics, and factors associated with caffeine‐withdrawal headache during the first day of Ramadan

• Published in: Headache Vol. 63; no. 3; pp. 360 - 367
• Main Authors: Magdy, Rehab, El Desouky, Eman D., Hammad, El‐Sayed Mah, Salem, Marwa Rashad, Mahfouz, Noha A., Fathy, Wael, Al‐Azayem, Salsabil Abo, Naguib, Esraa M., Hussein, Mona
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2023
• Subjects: Body mass; Body mass index; Body size; Body Weight; Caffeine; Caffeine - adverse effects; caffeine use disorder; caffeine‐withdrawal headache; Confidence intervals; Consumers; Cross-Sectional Studies; food frequency questionnaire; Headache; Headache - chemically induced; Headache - epidemiology; Headaches; Humans; Prevalence; Ramadan; Ramadan fasting; Substance Withdrawal Syndrome - epidemiology; caffeine-withdrawal headache; food frequency questionnaire; Ramadan fasting; caffeine use disorder
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/head.14483

Background Data regarding prevalence, characteristics, and factors associated with caffeine‐withdrawal headache are lacking. This work aimed to study the prevalence of caffeine‐withdrawal headache among caffeine consumers during Ramadan's first day and describe its characteristics and associated factors. Methods This analytical cross‐sectional study targeted 755 caffeine consumers eligible to fast on the first day of Ramadan. Two methodological approaches were followed: an online open survey and a face‐to‐face interview. Using an adjusted form of food frequency questionnaire, eligible participants were requested to report their intake of caffeine‐containing products during the last week of Shaaban month, the month preceding Ramadan. Results The prevalence of caffeine‐withdrawal headache on the first day of Ramadan was 419 (55.5%), with 95% confidence interval (CI; 51.9–59.0%). The headache in the majority of the participants was throbbing in character (249/419, 59.4%), diffuse (146/419, 34.8%), and moderate in intensity (227/419, 54.2%). Participants who developed caffeine‐withdrawal headache had significantly higher body mass index (27.2 ± 5.1 vs. 26.3 ± 5 [mean ± standard deviation], p‐value = 0.012), daily caffeine intake, mg (316 [185.2–537.8] vs. 144.4 [60.0–312.4] [median interquartile range (IQR)], p‐value < 0.001), and caffeine intake mg/kg body weight (4.7 [2.6–7.2] vs. 1.9 [0.8–4.4] [median (IQR)], p‐value < 0.001) than participants who did not develop it. Mild, moderate, and severe caffeine use disorder were found to have adjusted associations with developing caffeine‐withdrawal headache. They increased the odds of headache by 5.3 (95% CI = 3.40–8.3), 10.2 (95% CI = 5.9–17.5), and 15.5 (95% CI = 9.0–26.8) times, respectively. The optimal cut‐off value of daily caffeine intake/Kg body weight was determined at 1.97 mg/kg with an area under the curve of 0.722 and sensitivity and specificity of 85.1% and 50.2%, respectively. Conclusion Daily caffeine intake/kg body weight and caffeine use disorder are significantly associated with a caffeine‐withdrawal headache.