Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Methylxanthines, a class of compounds that includes caffeine, theophylline, and theobromine, have a documented role in the management of migraines, with caffeine being the most relevant methylxanthine for this indication. Caffeine is commonly included as an adjuvant in several over-the-counter and prescription migraine medications (e.g., combinations with acetaminophen or aspirin). Its use is supported by moderate scientific evidence, primarily due to its vasoconstrictive properties and ability to enhance the absorption and efficacy of analgesics. Clinical studies have shown that caffeine can improve headache relief compared to analgesics alone, especially in acute settings. Caffeine's mechanism involves antagonism of adenosine receptors, which may contribute to both its therapeutic and adverse effects in migraine management. However, the evidence does not support the use of other methylxanthines (such as theophylline or theobromine) for migraine treatment, and their role is not established in clinical practice. Chronic or excessive use of caffeine can also lead to medication-overuse headaches or withdrawal headaches, which limits its utility. Overall, while caffeine (a methylxanthine) has a validated, albeit adjunctive, role in migraine treatment, the strength of evidence is moderate, and recommendations are specific to caffeine, not the entire methylxanthine class.

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