By Dr. Mark Wiley

The other day a patient emailed me complaining of the “worst headache she’d ever had.” On my recommendation she attempted to stop drinking coffee. But the day she tried, she got such a horrible headache she had to leave work and not attend a function later that evening. She asked why, if coffee was bad for you, when she stopped drinking it she became sick?

The answer is that her body responded to the lack of the daily stimulus that it was accustomed to. The headache was a rebound off the lack of coffee consumption that is was relying on for daily energy and stimulation.

What generally happens, especially with coffee drinkers, is a vicious cycle of more and more. They are tired one day and drink coffee to perk them up. Then they have a blood sugar crash and drink more coffee to “wake up.” But it keeps them up at night and they can’t wake up in the morning, so the next day or week they find themselves drinking two cups in the morning and one in the afternoon. Moreover, coffee acts as a diuretic and makes them perspire and urinate and this leads to dehydration. They become constipated and drink coffee to move the bowels. This works for a while but then their intestines dry out so much that days pass between bowel movements. During this time toxins build and spread in the body, with pain and headaches as the result.

I tell patients like this to stop drinking the coffee. And they say, “I am so tired. If I don’t drink coffee (or soda or tea or energy drinks), I have no energy. And when I don’t drink them I get a headache and can’t go to the bathroom.” They are right to a point: the caffeine is giving them energy but at the same time it is also sapping their energy.

Caffeine and sugar drinks offer the body a false or empty energy. It is not real. So when the fake energetic means of moving through the day drops out (and you feel like crashing), the body returns to its normal state. But that normal state is one that is worn out and exhausted, since its energy depleted long ago and it has been moving along on legally addictive stimulants. And along the way it cries out in pain! The body says, “I hurt. I am exhausted. My nerves are inflamed. I am dehydrated.” And you feel the pain, the throbbing, the aches the headaches that were always there but just hidden under the stimulant effects of the coffee (or soda, or drugs or cigarettes).

Rebound pain and rebound headaches are so-named because they occur as the body “rebounds” from over-consumption or withdrawal from too many analgesics or prescription medications, coffee or caffeinated soft drinks, elevated adrenaline levels, sleep disorders and so on.

Like migraine and cluster headaches, rebound headaches are vascular in nature and characterized by steady pounding or throbbing on both sides of the head caused by constricting and dilating blood vessels. This type of vascular headache is in theory the easiest to prevent, but since it is directly triggered by poor lifestyle choices, it may be the most difficult to eliminate. In essence, rebound headaches are a recuperative measure by the body that is telling you something is wrong and forcing rest and a change in behavior by way of head pain. They occur commonly as a result of toxic build-up of medication, alcohol or caffeine in the system, as well as from prolonged periods of physically draining activity, such as cramming for finals or that wild 72 hour weekend party.

The best way to avoid rebound headaches, then, is to refrain from daily over-stimulation. Late nights and early mornings; coffee all day; drinking all night; excessive partying; hours and hours of studying. The rebound pain (and sometimes stupor) only come after the heightened activity is removed and the body has to adjust back to normal. It is better to slowly wean off coffee or stimulant drinks and foods and recreational drugs, than try to cut them out cold turkey.

And when the rebound headaches come, usually a small dose of the item (a few sips of coffee, for example), two glasses of water, a hot shower and rest will return the body to a livable state until the next day when it has rebalanced itself.