By Marcello Cherchi, MD PhD
For patients
Caffeine is the most widely used psychoactive substance on earth. It is most commonly recognized for its ability to increase alertness and enhance performance of some cognitive and physical tasks, but it has effects on multiple organ systems.
Caffeine has small but measurable effects on some parameters of auditory and vestibular tests in healthy subjects, though the mechanism by which caffeine exerts these effects is incompletely understood.
For clinicians
Overview
Caffeine, the most widely used psychoactive substance, functions as a stimulant. After crossing the blood-brain barrier, caffeine’s main effect is that it binds to adenosine receptors and blocks the activity of endogenous adenosine; it also influences the activity of several other neurotransmitter systems (acetylcholine, noradrenaline, dopamine). From the otoneurological perspective, caffeine has measurable affects on some ocular motor parameters (such as reducing saccadic latency, increasing saccadic velocity, increasing the peak velocity and amplitude of optokinetic nystagmus, and improving performance on certain tracking tasks). It is less clear whether caffeine has consistent effects on the auditory system. Some Ménière’s patients report that caffeine can induce a Ménière’s attack. Some migraine patients find that caffeine may abort a migraine.
Introduction
Chemically, caffeine is 1,3,7-trimethylxanthine. This molecule can cross the blood-brain barrier and is sufficiently similar to adenosine that it can bind to adenosine receptors and block the effect of endogenous adenosine. Adenosine inhibits arousal and thus has a soporific effect, so blocking adenosine receptors (by caffeine) has the opposite effect — namely, increasing alertness and reducing fatigue (van Dam, Hu et al. 2020). Caffeine also affects several neurotransmitter systems, including acetylcholine, noradrenaline and dopamine (Diukova, Ware et al. 2012).
Caffeine and the vestibular system
In 2022 Ghahraman and colleagues published a review of the effects of caffeine on the auditory and vestibular systems (Ghahraman, Farahani et al. 2022). While it seems logical to hypothesize that the overall alerting effect of caffeine is responsible for effects on the vestibular system (Wilhelmus, Hay et al. 2017), as of this writing the mechanism by which caffeine influences the vestibular system is incompletely understood (Ghahraman, Farahani et al. 2022).
Briefly, as far as the vestibular system is concerned, caffeine has measurable effects on some parameters of ocular motor function in normal subjects. Caffeine decreases saccadic latency, increases peak saccadic velocity, and influences the peak velocity and amplitude of the fast phases of optokinetic nystagmus (Connell, Thompson et al. 2017). Caffeine has also been reported to improve adaptive tracking performance (Wilhelmus, Hay et al. 2017).
Caffeine does not appear to have significant measurable effects on cervical vestibular evoked myogenic potentials (McNerney, Coad et al. 2014, Sousa and Suzuki 2014, Tavanai, Farahani et al. 2015, Ledesma, Souza et al. 2016, Souza, Costa et al. 2018, Tavanai, Farahani et al. 2020), ocular vestibular evoked myogenic potentials (Ledesma, Souza et al. 2016), caloric testing (Felipe, Simoes et al. 2005, Ledesma, Souza et al. 2016) or posturography (Enriquez, Sklaar et al. 2009, McNerney, Coad et al. 2014) in normal subjects.
Very limited data suggest that caffeine may potentiate the beneficial effects of medications for motion sickness (promethazine, meclizine, scopolamine) (Estrada, LeDuc et al. 2007).
The studies cited above pertain to the effects of caffeine on vestibular tests in normal subjects. Whether caffeine influences otovestibular test results in patients with specific diseases has not been studied. Consequently it is unknown whether caffeine can influence the accuracy of otovestibular tests in diagnosing disease.
Caffeine and the auditory system
Physiologic studies report conflicting results on the effect of caffeine on the cochlea. For instance, some literature reports that that caffeine can shorten outer cochlear hair cells (Slepecky, Ulfendahl et al. 1988, Skellett, Crist et al. 1995), thereby enhancing cochlear responses, while other studies report that caffeine suppresses cochlear responses(Bobbin 2002).
Studies of brainstem auditory evoked responses sometimes report reduction in response latencies (Dixit, Vaney et al. 2006), which is usually attributed to caffeine’s ability to improve neural transmission in central auditory pathways.
Studies of higher-level auditory function are difficult to interpret because it is not easy to disentangle the effect of caffeine on the auditory system itself versus its effect on the cognitive processes needed to drive the measured behavioral responses.
Caffeine and specific otoneurological diseases
The main clinical relevance of caffeine in otoneurology is for Ménière’s disease and migraine associated vertigo.
Anecdotally some patients carrying a diagnosis of Ménière’s disease report that caffeine intake increases the risk of having a Ménière’s attack. Consequently, some literature recommends that management of Ménière’s disease should include abstinence from caffeine (Sharon, Trevino et al. 2015, Sanchez-Sellero, San-Roman-Rodriguez et al. 2018), though this recommendation is by no means universally accepted (Trinidade, Robinson et al. 2014, Hussain, Murdin et al. 2018, De Luca, Cassandro et al. 2020).
For migraine in general, reduction or elimination of caffeine is often recommended, though caffeine is somewhat of a “double edged sword” for migraine (Alstadhaug and Andreou 2019, Nowaczewska, Wicinski et al. 2020), in that caffeine withdrawal can trigger migraine (Alstadhaug, Ofte et al. 2020), yet a spike in caffeine intake can sometimes abort migraine. For migraine associated vertigo, as with other migraine variants, the recommendation of caffeine restriction is extrapolated from the broader literature on migraine (Mikulec, Faraji et al. 2012), but it has not been studied systematically.
References
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