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Have Yourself a Cup of Joe. Or Maybe Not.

December. It’s here. I’m not panicking yet, but there’s just too much to do, right? Christmas, Chanukah, New Year’s – and Jae’s and my book(!) will all be here in a second. Which brings me to caffeine. Caffeine is good, it’s bad – it’s complicated. Let’s discuss.

First, here are the numbers, comparing milligrams of caffeine in various substances:

  • 80-135                        2 tablets of aspirin or acetaminophen + caffeine

  • 80-125                         1 cup coffee

  • 80                                 Red Bull

  • 40-60                           tea

  • 35                                 cola

  • 20                                dark chocolate (1 oz)

  • 15                                green tea

  • 15                                cocoa

  • 2-4                              decaf coffee

 Now, the evidence. You already know that caffeine tends to make people more alert. Caffeine, in even low to moderate amounts (30-350 mg), improves alertness, concentration, learning, and decision-making (1). It’s helpful to people whose circadian rhythm has been disrupted, such as with jet lag and shift work (2).

 For the most part, caffeine has no serious long-term health effects. In fact, coffee consumption is associated with decreased overall mortality (3). But now, it gets more complex:

Sleep: Friend or Foe?

Since caffeine increases alertness and mitigates the effects of sleep deprivation (4), the other side of that coin is that caffeine makes it take longer for you to fall asleep, stay asleep, and have deep sleep (5). In most people, this effect may last for six hours after caffeine ingestion.

 Headaches: Cause or Cure?

Headaches and caffeine have a complicated relationship. Kind of a love-hate thing. On the one hand, caffeine can alleviate both routine (tension) and migraine headaches. Analgesics that contain caffeine are more effective against headaches than analgesics alone (6). Howeverhabitual consumption of caffeine is associated with both chronic migraines and analgesic rebound headaches (the phenomenon where you get a headache from taking analgesics too often) (7). What is more, when people consume more than 750 mg of caffeine a day, the pain-relieving effectiveness of the caffeine may diminish.

And then, of course, there’s the “Pre-Op” or Yom Kippur Headache” – that headache (tension or migraine) so many of us get as a result of abrupt caffeine withdrawal (8). That phenomenon is its own circle of hell, isn’t it?

Dr. J’s Recommendations: 

  • Don’t drink coffee or consume other forms of caffeine within six hours of going to bed.

  • Don’t overdo pain medications containing caffeine. In fact, if you have chronic tension or migraine headaches, try to gradually wean yourself off of caffeine altogether. After you do that successfully, when you do get a headache, having some caffeine will deliver a much bigger pain-killing jolt.

  • To prevent the Yom Kippur headache in the future (and yes, it’s a serious day, a somber day, a long day – but a headache isn’t going to help you atone for your sins any more effectively), over the course of several days before the fast, gradually decrease the amount of caffeine you consume. That way, you may not get a withdrawal headache at all (9). 

That’s it for me. Now I’m going to start writing my Pre-Holiday To-Do List. It’s enough to give me a headache.



1.Smith A et al.Effects of repeated doses of caffeine on mood and performance of alert and fatigued volunteers. J Psychopharmacol. 2005;19(6):620. 

2.Ker K et al. Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database Syst Rev. 2010.

3.Crippa A et al. Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis. Am J Epidemiol. 2014 Oct;180(8):763.

4.Lieberman HR et al. Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Sea-Air-Land. Psychopharm 2002; 164(3):250.

5.Clark I, Landolt HP. Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials.Sleep Med Rev 2017; 31:70.

6.Goldstein J et al. Acetaminophen, aspirin, and caffeine in combination versus ibuprofen for acute migraine: results from a multicenter, double-blind, randomized, parallel-group, single-dose, placebo-controlled study. Headache. 2006;46(3):444. 

7.Bigal ME et al. Chronic daily headache: identification of factors associated with induction and transformation.Headache. 2002;42(7):575. 

8.Fennelly M et al. Is caffeine withdrawal the mechanism of postoperative headache? Anesth Analg 1991; 72(4):449.

9.Lee MJ et al (2016) Caffeine discontinuation improves acute migraine trea
tment: a prospective clinic-based study. J Headache Pain 17(1):71.