Tuesday, February 23, 2010

Why Chai?—caffeine as medicine

Believe it or not, I got through medical school without a caffeine dependency.  While a lot of my friends have an IV drip straight from the espresso machine, I try and keep my intake to a minimum.  Most people feel better after a rich morning coffee.  I’m already wired. You’ve seen me dancing post-call doing backflips down the hall (I wish I could do backflips).  Coffee makes me want to jump out of my skin. 

Even though I am caffeine averse, this psychostimulant has a variety of therapeutic purposes.  For all the joking and wishing, there actually is an intravenous form of caffeine in the hospital.  Overworking residents is not one of the indicated uses. 

One of my most vivid memories from medical school was when I learned how to do electroconvulsive therapy on my psychiatry rotation.  Caffeine is sometimes given during ECT because it lowers the seizure threshold and increases seizure time.  When a psychiatrist hands you two electrical probes and tells you to press the button, you have to comply!  ECT has been developed into a humane, extremely effective treatment of refractory depression and has helped many people that medicine doesn’t touch.  Thankfully, it’s nothing like the old movies like One Flew Over the Coo Coo’s Nest where the batty psychoanalyst straps the patient down and vigorously shocks him into prolonged convulsions.   

Caffeine also plays an interesting role in headaches and pain.  When in combination with either acetaminophen (Tylenol) or aspirin, the amount of analgesic needed to relieve headaches is reduced by about 40% 1.  Caffeine also works as an adjuvant to acetaminophen and aspirin and provides greater relief when in combination than alone; this is why people love Excedrin. 

The relationship between headaches and caffeine is complex, considering the most common symptom of caffeine withdrawal is headache 2.  A recent study of over 50,000 Norwegians found that zinged up Scandinavians were more likely to have infrequent headaches than those that did not drink coffee, although causality cannot be establish and there are many confounding factors 3

If you have a headache, a caffeinated treat might just do the trick.  Homemade chai is easy, rich and delicious.  Mine has a huge punch from loose leaf Darjeeling tea so it is definitely powerful stuff.  It lacks the cloyingly sweet and overpowering cinnamon kick that the boxed stuff has, and it makes your apartment, barn, trailer, home, abode or dwelling smell unbelievable.  If you still don’t feel better, throw some Advil in for some crimson chai. 

PS, this stuff is REALLY strong because I just drank it.  My hands are shaking from the caffeine overload.  What's on TV at 2am? 

Chai (makes about 6 cups)

15 black peppercorns
8 green cardamom pods
15 cloves
2 medium cinnamon sticks (plus more for serving)
2 inches ginger root peeled
1 bay leaf
4 cups water
2 cups milk
4 tablespoons loose-leaf Darjeeling tea (about 8-10 teabags or 0.8 oz)
3 tbsp honey
1 tbsp sugar

Add peppercorns, cardamom, cloves, cinnamon, ginger and bay leaf to mortar and pestle and give a couple of good pounds.  If you don’t have one, you can put everything in a plastic bag and smash with a frying pan or something else heavy.  Put spices in water on high and bring to boil, after boils, reduce heat to low, simmer, covered for about 20 minutes.

Add milk and tea, simmer for another 5 minutes.  Strain with mesh strainer or cheesecloth add honey and sugar.   Serve with cinnamon stick and enjoy.

Shapiro, RE. 2008. Caffeine and headaches. Current Pain and Headache Reports 12, no. 4:311-5.

Juliano, LM. and RR Griffiths. 2004. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacologia 176, no. 1:1-29.

Hagen, K., et al. 2009. High dietary caffeine consumption is associated with a modest increase in headache prevalence: results from the Head-HUNT Study. The Journal of Headache and Pain 10, no. 3:153-9.


  1. Love homemade chai, nothing beats it.

  2. Looks really nice-could use a cup of it right now.