The wide availability of the beverages, from grocery stores, convenience stores and school bookstores makes them readily accessible for purchase by adolescents, even though the products often retail for more than twice the price of "traditional" soft drinks. In 2006, more than 30% of adolescents reported using energy drinks, an increase of more than 3 million teens in 3 years. A culture of blogs, urban legends, and "under-ground" chic has further increased their appeal. Aggressive marketing campaigns featuring celebrities and athletes target adolescents and young adults. B y promising immediate energy and decreased fatigue, energy drink brands have created a $3.5 billion yearly industry. Clin Ped Emerg Med 9:35-42 C 2008 Published by Elsevier Inc. Suggestions for future research are also offered. This article provides a review of caffeine's pharmacokinetics and describes the clinical manifestations and management of caffeine toxicity. Rapid growth in the consumption of these supplements has resulted in increasing reports of caffeine poisoning. The caffeine content of these products is presently unregulated. The availability of caffeine-containing energy beverages, combined with aggressive marketing and urban legend, has promoted their widespread use, particularly among adolescents. Conclusion: Dietary and medicinal caffeine consumption appears to be a modest risk factor for chronic daily headache onset, regardless of headache type. In secondary analyses, associations were confined to younger ( age < 40) women ( OR = 2.0, p = 0.02) and those with chronic episodic ( as opposed to chronic continuous) headaches ( OR = 1.69, p = 0.01), without physician consultation ( OR = 1.67, p = 0.04) and of recent ( < 2 years) onset ( OR = 1.67, p = 0.03). No association was found for current caffeine consumption (i.e., post CDH) ( OR = 1.36, p = 0.12). Results: In comparison with episodic headache controls, CDH cases were more likely overall to have been high caffeine consumers before onset of CDH ( odds ratio = 1.50, p = 0.05). High caffeine exposure was defined as being in the upper quartile of dietary consumption or using a caffeine-containing over-the-counter analgesic as the preferred headache treatment. Current and past dietary caffeine consumption and medication use for headache were based on detailed self-report. Controls ( n = 507) reported 2 to 104 headache days/year, and cases ( n = 206) reported greater than or equal to 180 headache days/year. Methods: Population-based cases and controls were recruited from the Baltimore, MD, Philadelphia, PA, and Atlanta, GA, metropolitan areas. Objective: To investigate the possible association of dietary caffeine consumption and medicinal caffeine use with chronic daily headache (CDH).
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