What is caffeine withdrawal?

Caffeine withdrawal is characterised by a set of physical and psychological symptoms that develop after stopping or reducing habitual caffeine use. The DSM‑5 recognises caffeine withdrawal as a diagnosable condition when symptoms cause clinically significant distress or impairment.

Typical symptoms

• Headache (most common and often throbbing).
• Marked fatigue or drowsiness.
• Low mood, irritability or difficulty concentrating.
• Flu‑like symptoms: nausea, muscle pain, stiffness.
• Hypersomnolence in some individuals.

Onset, peak and duration

• Onset: 12–24 hours after last caffeinated intake (can be up to 36 hours).
• Peak: 24–48 hours after cessation.
• Duration: Typically 2–9 days; headaches may persist up to 2 weeks in some cases.

Risk factors

• High habitual caffeine consumption (≥200–300 mg/day).
• Rapid cessation rather than gradual taper.
• Sensitivity to caffeine and individual metabolic differences.
• Concomitant sleep deprivation or stress.

Diagnosis — key points

1. Establish recent reduction/cessation of regular caffeine intake and temporal link to symptoms.
2. Exclude other causes for headache, fatigue or mood change (e.g., migraine, infection, depression, medication side effects).
3. DSM‑5 criteria: at least three of the characteristic symptoms developing within 24 hours and causing significant distress/impairment.
4. Consider workplace and safety issues (drivers, heavy machinery operators) when diagnosing.

Management strategies

• Education: Reassure about self‑limited nature; explain timeline.
• Gradual taper: Reduce caffeine intake by ~25% every 3–7 days rather than stopping abruptly.
• Symptomatic relief: Simple analgesics (paracetamol/ibuprofen) for headache; maintain hydration and rest.
• Short temporary caffeine: Small dose of caffeine (e.g., 50–100 mg) can abort severe withdrawal headache but may prolong dependence—use judiciously.
• Sleep and lifestyle: Improve sleep hygiene, regular meals, light exercise and stress management.
• Workplace adjustments: Allow flexible duties or rest breaks for affected workers during acute phase.

When to refer or investigate further

• Persistent or atypical headaches, neurological signs, or red‑flag features — consider neuroimaging and specialist referral.
• Severe functional impairment or comorbid psychiatric illness — consider mental health referral.
• Recurrent problematic caffeine use with unsuccessful attempts to reduce — consider addiction or behavioural medicine referral.