You are home recovering from a concussion. You didn’t sleep well the night before. You’re tired, and more than a little bored. And that morning cup of coffee isn’t quite doing the trick. Tempted as you may be to reach for a second cup, you remember your concussion specialist telling you to limit caffeine intake to just one 8-ounce cup of black coffee or its equivalent a day for now.
Why?
The Truth About Caffeine and Concussions
“When my patients are big coffee drinkers, they can take it pretty hard when I tell them that caffeine and concussions don’t play nice together,” says Medical Director and founder of Mid-Atlantic Concussion (MAC) Alliance, Vincent Schaller, MD, DABFM, CIC. And while Dr. Schaller can empathize with their plight, he stands firm on the caffeine restrictions while patients recover from concussions and other Traumatic Brain Injuries (TBIs).
Consuming Caffeine After a Concussion: What’s the Limit?
According to the Mayo Clinic, up to 400 mg. of caffeine a day is considered safe for most healthy adults. But for concussed patients, Dr. Schaller asks that they limit their daily intake to no more than 100 mg., which is roughly what an 8-oz. cup of black coffee contains.
Consumer Reports found that an 8-oz. cup of home-brewed coffee can have anywhere from 96 to 128 mg of caffeine. While caffeine content in coffee, tea and other beverages can vary quite a bit depending upon brand and how they are compared, this 100 mg. or less limit works well for those newly recovering from a concussion or TBI.
4 Reasons Why Caffeine Interferes With Concussion and TBI Recovery
1. The Sudden Caffeine Rush Is Short-Lived and Sets You Back Overall.
“Consuming caffeine when your brain is fatigued can feel like you are stomping on the gas pedal, giving you some quick acceleration and energy, but this empties the gas tank very quickly,” says Dr. Schaller. “Any boost you temporarily get comes at too high a cost, as it can hinder your brain’s ability to heal itself from your TBI.”
This can happen because an injured brain uses a lot of energy to heal and repair itself. If you artificially inject a burst of energy, it will deplete the limited resources it has. This can delay recovery for people with post-concussion syndrome (PCS), or cause symptoms to flare up.
2. Caffeine Messes With More Than Just Your Post-Concussion Energy Levels.
One common TBI symptom that can be negatively impacted by excessive caffeine during concussion recovery is neurofatigue. Sometimes referred to as brain fog or mental fatigue, this condition can result a patient feeling extremely drained and exhausted. Other PCS symptoms that can be negatively impacted by excessive caffeine consumption include:
- Balance issues
- Loss of concentration
- Memory problems
- Aphasia
- Trouble sleeping
- Migraines
- Dysautonomia
Dysautonomia refers to a group of medical conditions caused by problems with the autonomic nervous system (which controls involuntary body like your heart rate, blood pressure, breathing, digestion, and more). People recovering from a concussion or TBI who are experiencing dysautonomia may find that caffeine makes their symptoms worse because it can cause overactivation of the sympathetic nervous system.
3. If you can’t sleep, you can’t fix it.
The injured brain needs solid sleep to aid the healing process. It’s difficult to get that sleep in the period immediately following your injury. The recommended Brain Rest Protocol calls for 7 to 8 hours of sleep every night. Your pre-injury caffeine habit can disrupt that schedule. Limiting your caffeine intake helps a healing brain get the much-needed good night of sleep.
4. Caffeine and concussions can bring on the migraines.
Your pre-injury caffeine consumption may have been high enough to trigger migraines all on its own. Coincidentally, headaches or migraines are among the common symptoms of PCS. Put the two together and you are in for a painful ride. Think about what happens when you hold your thumb on a garden hose: it turns the normally flowing water into a strong spray. Similarly, when caffeine constricts the blood vessels in your brain, normally flowing blood becomes a strong spray through the blood vessels. This is why the caffeine feels like an energy boost. Normally, caffeine constricts blood vessels and it can help ease a migraine that is causing dilated blood vessels and decreasing flow to the brain. When the brain experiences reduced blood flow, it causes ischemic pain—much like the heart does during a heart attack, when a blockage cuts back blood flow, resulting in chest pain. But when a migraine pattern persists post TBI, caffeine-induced blood vessel constriction is often short lived. What’s worse, there is often a rebound effect where the blood vessel resume dilating, and the migraine actually worsens. For these reasons, minimizing caffeine use post TBI is best.
How Much Caffeine Is in Coffee, Anyway?
According to Consumer Reports, ounce for ounce, espresso has more caffeine than regular coffee. However, most folks consume at least eight times more regular coffee than espresso when they drink coffee. If you drink 8 ounces of coffee, you’re likely getting somewhere between 96 to 128 mg of caffeine.
Watch for Sneaky Sources of Caffeine.
Did you know that caffeine is one of the only FDA-approved drugs naturally found in or legally added to a broad array of foods and beverages? The Center For Science in the Public Interest (CSPI) lists many product sources of caffeine, and there are some surprising items on it, such as:
- Starbucks Pike’s Place blend packs a caffeine punch: 410 mg. in a venti (20 oz.) and 310 mg. in a grande (16 oz.)
- A 20 oz. Dunkin’ Coffee has 270 mg.
- Death Wish Coffee Co. Unsweetened Cold Brew contains 300 mg. in just 8 oz.
- Death Wish Coffee Co. Instant Coffee has 300 mg. in just one packet
- A 12 oz. serving of Pepsi Zero Sugar has 69 mg., while the same size Diet Coke contains just 46 mg.
- Just 1.9 oz. in a regular serving of 5-Hour Energy Extra Strength contains 230 mg.
- Monster Energy contains 160 mg. in a 16 oz. serving, while two Red Bull (regular or sugar-free, 8.4 oz each) provide about the same
- A ½ tsp. of MiO Energy drink concentrate contains 60 mg.
- Ben & Jerry’s Coffee Toffee Bar Crunch Ice Cream contains 49 mg. in a 2/3-cup serving
- A 5.3 oz. serving of Dannon Lowfat Coffee Yogurt contains 40 mg. of caffeine
- Jelly Belly Extreme Sport Beans contains 50 mg. per ounce of candy
What Our Specialists Tell Their Patients About Caffeine and Concussions
“For post-concussion patients, right out of the gate I will ask them to limit their caffeine intake to one eight-ounce cup of coffee, or the equivalent, a day or less,” says Dr. Schaller. “I will ask them to continue this until headaches and/or sleep disturbances are under control.”
As headaches decrease and sleep improves, the amount of caffeine intake can be gradually increased, he adds. Discussing how to implement this increase with your healthcare provider is important because they have a full picture of your medical history, medications and unique recovery progress.
Post-concussion or post-TBI patient should talk to their primary care provider or concussion specialist if:
- They continue to have headaches or sleep issues even after limiting themselves to one cup of black coffee, or the equivalent, a day
- Their post-concussion symptoms pick up again after they begin to increase caffeine into their diet again
- They experience a sudden relapse of symptoms, particularly headaches and sleep issues, after returning to their regular caffeine intake levels
Where to Find a Concussion Specialist in the Mid-Atlantic Region
Since 2010, MAC Alliance has treated over 15,000 patients in Delaware, Pennsylvania, Maryland, New Jersey, Virginia, New York, Georgia and beyond. To find a MAC Alliance Concussion Care Center near you, please use our easy-to-use location finder or call (302) 235-8808.
