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Expedition medicine - caffeine withdrawal

Caffeine Withdrawal

Coffee, tea, soda or whatever your favorite ingestion method is…caffeine rocks! Maybe it is because I am a resident, but I drink tea on a daily basis. Caffeine helps combat fatigue, increase alertness and the beverages that contain it often taste yummy. Caffeine is also habit forming and the DSM IV even lists caffeine as a substance that can cause clinical withdrawal symptoms.
The fact that caffeine can cause clinical withdrawal symptoms and is so widely used has a great impact on those that provide health care to people who may be in a setting where they cannot get their “daily coffee fix”, such as a multi-day wilderness trip or remote travel. Those who are regular coffee drinkers may be familiar with some of the symptoms of caffeine withdrawal:
Headache (gradual onset, often throbbing and severe)
Fatigue
Irritability
These problems usually show up on the second or third day of being “cut-off from their source”.
When people are packing and getting ready for a rafting trip, multi-day hike or any kind of travel that takes them way off the beaten track, hopefully they are putting some planning into their packing and gear. Coffee can be easily forgotten when life-vests, bug spray and potable water are often higher priority items and concerns. This is very wise, but when that severe, throbbing headache creeps up on the second day of your 7 day trip…that caffeine becomes very important.
I speak with a lot of doctors and health care providers that work on expeditions in remote areas and this topic has come up from two physicians I respect, very much. Dr. Howard Donner mentioned, several times at a recent lecture, on problems he faced in treating caffeine withdrawal on multi-day trips. I also had an opportunity to speak with Dr. Sean Hudson about his personal “luxury item” he brings with him on long expeditions and he said, “I always take some good coffee and an MSR filter. I can happily go without food for a day but struggle without my caffeine“. The reason for a lack of caffeine can range from forgetting it, losing it or accidentally having a non-coffee drinker buy the food supplies and buying de-caf (gasp!) or any other method that separates people from their drug of choice.
Fortunately the headaches, typically, respond well to ibuprofen or tylenol and a clever expedition doctor will recognize the symptoms, combine these with the history of no-caffeine for a few days and diagnose a caffeine withdrawal case. Caffeine replacement is also another viable option and there are several forms that can be easily carried by the medical provider. Caffeine tablets are one option, as are premade packets of coffee, with both being very portable and fitting easily in a medical kit.
I feel that is important to state that not all headaches are caused from caffeine withdrawal and a headache could be a sign of a far more serious problem. However, caffeine withdrawal should be included in the differential diagnosis, especially on the first few days of a trip.
For further reading:
http://www.caffeinedependence.org/caffeine_dependence.html#withdrawal
http://www.medscape.com/viewarticle/490510

 

 

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