http://www.washingtonpost.com/wellness/2024/02/02/red-wine-alcohol-headaches/

Is it true that red wine causes headaches?

By Lindsey Bever

February 2, 2024 at 9:00 a.m. EST

The question:

Does drinking red wine trigger headaches more than other types of alcohol?

The science:

Many people complain of headaches after drinking red wine.

Possiblymillions — many millions — of people suffer from these headaches, said Morris Levin, a neurology professor and the director of the Headache Center at the University of California at San Francisco.

Research supports anecdotal evidence that alcohol appears to trigger headaches for some people. In one meta-analysis, red wine was the most frequently reported culprit, followed by spirits, white wine, and beer or sparkling wine.

There seems to be an even stronger association among those with headache disorders such as migraine, said Chia-Chun Chiang, a headache specialist and assistant professor of neurology at Mayo Clinic. In a study of nearly 2,200 migraine sufferers, about 1 in 3 reported that alcohol triggered attacks and most — about 78 percent — said that wine, particularly red wine, led to migraine attacks, though, for most, the attacks were not consistent.

Experts have some hypotheses about what in red wine can lead to headaches, but they say the precise cause is not fully understood.

“How alcohol triggers headaches, and why only some people experience them, remains a mystery,” said Aaron White, the senior scientific adviser to the director of the National Institute on Alcohol Abuse and Alcoholism.

Some people may be especially sensitive to the tannins in the grapes, histamines or sulfites produced through fermentation or the additional sulfites added to preserve wine. It’s possible there are many different pathways that affect people in different ways, experts said.

Share this articleNo subscription required to readShare

More recently, one study suggested that quercetin, an antioxidant found in grapes, may be responsible.

Liver enzymes convert alcohol, or ethanol, to acetaldehyde, a toxic substance, and then to acetate, a harmless molecule that serves the body in various ways. When acetaldehyde is not broken down properly, it can build up in the blood and cause alcohol flush reaction, which can include headaches. Based on that, researchers theorized that acetaldehyde may also trigger red wine headaches.

Quercetin causes the body to produce quercetin glucuronide, which may impair the liver enzyme that breaks down acetaldehyde, causing a buildup, which may lead to these headaches, said Andrew Waterhouse, a wine chemist and senior author of the study.

The study, published in November, was conducted in a laboratory, not on humans. But the researchers are planning a clinical study to test the theory.

What else you should know:

People, including many ofthose of Asian descent, who lack the enzyme that breaks down acetaldehyde and have had flushing reactions, may want to avoid alcohol, including red wine. Also, those who get severe headaches when they drink alcohol may want to avoid it.

But those who get an occasional red wine headache can take some steps to mitigate them, experts say.

• Consider cheaper red wines. Grapes used to make cheaper wines grow on vigorous vines and get less sunlight — and possibly less quercetin, as quercetin tends to form in grapes that are exposed to a lot of sunlight, said Levin and Waterhouse, co-authors of the quercetin study.
• Try lighter red wines such as pinot noirs; observationally, they appear to be somewhat protective, perhaps because they have lower levels of quercetin, Levin said.
• Eat a meal or a hearty snack before drinking since food helps slow alcohol absorption, potentially limiting side effects, including headaches.
• Stay hydrated.
• For those with headache disorders such as migraine, take prescribed medications to get headaches under control. Then, in some cases, red wine may no longer be a trigger, said Chiang, who is a board member of the American Migraine Foundation.

The bottom line:

Red wine headaches are common. Food, hydration, and potentially lighter and cheaper red wines may help mitigate the problem for some people.