Soon after settling in Wisconsin, I was introduced to real coffee drinking. A Norwegian patient asked me if he could drink coffee. He thought I was joking when I told him “Sure, just hold it to less than 17 cups per day”. His face fell because he drank almost twice that much. Then there was a barber who complained of headaches every Thursday for ten years. After a rather extensive get acquainted conversation, the cause of this unusual complaint was revealed. He had not been a coffee drinker prior to marriage and finishing barber school. Thursday was his day off and there was no business partner or wife to offer coffee. He followed my advice to carry 2 thermoses of coffee everywhere he went on his day off. His Thursday headaches ceased.
Headache as the withdrawal symptom of caffeine addiction is not sufficiently known. For instance, the mother of a teenage daughter brought the young lady in because of sudden onset of severe headache. The crucial information: the mother had recently told the daughter that she would have to buy her own soft drinks but this child’s allowance was insufficient to support her habit. Neither of them was aware of the connection. The headache of caffeine withdrawal is not relieved by morphine in doses adequate to relieve the pain of war wounds. This is illustrated by a lady with pancreatitis causing severe abdominal pain relieved by large doses of morphine. The second day of intravenous feeding and nothing by mouth, she got a severe headache not relieved by the large doses of morphine. She was not a coffee drinker, but a few more questions revealed that she drank a gallon of iced tea per day. Some caffeine injected into her IV tubing relieved her headache before the injection was complete.
When people state that only Anacin and Excedrin relieve their headaches, this usually means caffeine withdrawal headaches. Some of them take their caffeine containing pills in anticipation of trouble. This results in the caffeine in the headache pills becoming part of their drug requirement. Ironically, the aspirin or other ingredients also present may proceed to cause stomach pain, a potential “foot in the door” for Christian Science.
So caffeine has a stereotyped withdrawal syndrome (the headache), a characteristic of addiction. The withdrawal syndrome of narcotics is goose bumps, sweating and diarrhea. Quitting “cold turkey” refers to the goose bumps similar to the appearance of leftover turkey skin. Much of slang originated in drug and criminal circles. Another characteristic of addiction is that former addicts, even years after stopping the drug use, become re-addicted on fewer, smaller doses than naive users (users without prior drug experience). I became aware of this after returning from 2 years in Asia where I drank tea, even though I do not like it, in order to get boiled water and avoid dysentery. I could easily wean off but I would get withdrawal headaches in late afternoon after 3 to 4 days of a cup of coffee for lunch, a much smaller dose than would produce this result in someone who had not been severely addicted. I had been such a person prior to the 2 years in Asia. Remember, I did not even like tea. My addiction was purely physical, not psychological.
Caffeine demonstrates that drug addiction does not necessarily cause health problems or social problems. These depend on the toxicity of the drug and the consequences of attempts at prohibition.
Chairman, Monroe City Council Board of Health, May 1, 2001
Addendum, July, 2002: Not long after I started thinking about poisons, herbs and drugs derived from natural sources in terms of chemical warfare between plants and animals, it occurred to me that caffeine is so low in toxicity it is hard to explain why plants bother to make it. This month I ran into an item in Nature, the British science journal, reporting that a very small concentration of caffeine kills slugs and snails. .