508 Substance-Related and Addictive Disorders
pation. These external enviro nmental circumstances may precipitate a withdrawal syn-
drome in vulnerable individuals. 
Genetic and physiological factors. Genetic factors appear to increase vulnerability to
caffeine withdrawal, but no specific genes have been identified. 
Course modifiers. Caffeine withdrawal symptoms usua lly remit within 30–60 minutes
of reexposure to caffeine. Doses of caffeine  significantly less than one’s usual daily dose
may be sufficient to prevent or attenuate caffeine withdrawal sy mptoms (e.g., consump-
tion of 25 mg by an individual who typically consumes 300 mg).
Culture-Related Diagnostic Issues
Habitual caffeine consumers who fast for religio us reasons may be at increased r isk for caf-
feine withdrawal. 
Functional Consequences of 
Caffeine Withdrawal Disorder
Caffeine withdrawal symptoms can vary from mild to extreme, at times causing functional
impairment in normal daily activities. Rates of functional impairment range from 10% to
55% (median 13%), with rates as high as 73% found among individuals who also show
other problematic features of caffeine use. Ex amples of functional impairment include be-
ing unable to work, exercise, or care for child ren; staying in bed all day; missing religious
services; ending a vacation early; and cancelling a social gathering. Caffeine withdrawal
headaches may be described by individuals as  “the worst headaches” ever experienced.
Decrements in cognitive and motor pe rformance have also been observed. 
Differential Diagnosis
Other medical disorders an d medical side effects. Several disorders should be consid-
ered in the differential diagnosis of caffeine withdrawal. Caffeine withdrawal can mimic
migraine and other headache di sorders, viral illnesses, sinu s conditions, tension, other