Understanding Alcohol Induced Headaches

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KEY Takeaways

Alcohol induced headaches include migraines, tension headaches, and cluster headaches.

Alcohol is the identified migraine trigger in about one-third of migraine sufferers [1]. Onset of alcohol induced headaches can be immediate or delayed. The amount of alcohol it takes to induce headache varies between individuals.

Reducing or eliminating alcohol intake reduces the risk and occurrence of these types of headaches.

Types Of Alcohol Triggered Headaches

According to the Headache Classification Committee, the types of headaches typically caused by drinking alcohol are migraines, tension-type headaches, or cluster headaches [2].

These headaches are all painful and debilitating, and can hamper the performance of daily activities such as driving, attending work, and engaging in social and relationship commitments. 

According to the Curr Pain Headache Rep [3], the types of headaches include:

Migraine Headaches

A migraine attack involves a throbbing pain that gets worse and is usually only felt on one side of the head. It comes with nausea, vomiting, and sensitivity to light and noise [4].

Some migraine patients get an aura, which is characterised by ringing in the ears, flashing lights, or blind spots [5].

Tension Headaches

Tension headaches are the most common type. These include a dull, aching pain in the head, and a tightening feeling on the sides, forehead, and back [6].

Cluster Headaches

Cluster headaches are so-called because of their cyclical patterns.

Bouts may appear from one to eight times a day, with attacks lasting from 15 minutes to a few hours [7].

Clusters are rare and not life-threatening, but the pain they bring on is very intense.

Patients usually feel pain centred around one eye or on one side of the head [8].

Familial Hemiplegic Migraine

Familial Hemiplegic Migraines are a form of headaches that are accompanied by unilateral motor weakness [9].

Binge drinking or drinking in excess can precipitate headache triggers [10].

Onset Of Alcohol-Induced Headaches

The onset of headaches after consumption of an alcoholic beverage may be immediate or delayed.

An immediate alcohol-induced headache is characterised by the following [11]:

  • Headache develops within 30 minutes to three hours of alcohol consumption;
  • Resolves spontaneously around 72 hours after cessation of alcohol intake or at the end of the alcohol hangover;
  • Has a pulsating quality, is felt on both sides of the head, and worsens with physical activity.

A delayed alcohol-induced headache is a more common occurrence, and is characterised by the following [12]:

  • Develops within five to twelve hours of alcohol consumption;
  • Goes away without treatment within 72 hours;
  • Includes symptoms similar to immediate alcohol-induced headache, including pulsating sensation, bilateral pain, and worsening with physical activity.

How Delayed Alcohol-Induced Headaches Occur

Consuming alcohol is a known headache trigger [13].

The main ingredient of alcoholic drinks is ethanol, a chemical compound that acts as a diuretic.

Diuretics increase the body's urine output, and water loss causes dehydration [14].

Frequent urination leads to dehydration and causes brain cells to contract temporarily, bringing on a headache [15].

Another effect of ethanol is vasodilation, swelling of blood vessels. 

When blood vessels expand, they stimulate specific brain nerves which results in headache [16].

Alcoholic drinks contain congeners, which are biologically active compounds that contribute to taste, smell, and appearance of a drink.

Congeners additionally increase probability of an alcohol-induced headache [17].

These congeners are more abundant in red wine, whisky, and brandy, with lesser amounts found in gin and vodka [18].

Red wine in particular has been shown to increase the body's plasma serotonin and plasma histamine levels, which can trigger migraine symptoms, and alcohol-induced headaches in individuals that are more susceptible [19].

How Much Alcohol Does It Take To Cause A Headache?

Everyone reacts differently to consuming alcohol, with different factors contributing to how much or how little one must drink in order to get a headache.

One person may have several bottles of beer, or glasses of white wine, and not have a headache, while another may have only a small amount of red wine and experience headache symptoms.

One study showed that 300ml of red wine provoked headaches in red wine-sensitive individuals, while a drink of vodka with an equivalent alcohol content did not have the same result [20].

Quality Of Wine

Quality of wine can determine whether someone does or does not experience an alcohol-induced headache [21].

Low-quality wines have added sugar for sweetness, synthetic tannins for bitterness, and an astringent taste.

Sugar depletes the Vitamin B already in the body, and tannins meddle with serotonin, both of which contribute to a hangover headache [22].

Type Of Drink

Congeners are more prominent in dark coloured alcoholic drinks such as red wine, rum, whisky and brandy, and less in clear drinks such a vodka and gin.

As such, dark coloured drinks may lead to increased likelihood of hangover headaches for some [23].

How To Avoid An Alcohol-Induced Headache

Alcohol-induced headaches can lead to absenteeism and affect work performance; they put the drinker at higher risk of injury; and lead to poor decision-making and decreased focus [24].

A reduction or elimination in alcohol intake would naturally reduce the risk and occurrence of alcohol-induced headaches.

  • Consume Alcohol Slowly - It can take a few hours for the body to process one drink of alcohol (44ml), and drinking more slowly reduces blood alcohol levels in the system which may prevent headaches [25].
  • Eat Before, During, And After Drinking - Food in the stomach slows down alcohol absorption in the body and maintains blood sugar levels [26]. Low blood sugar levels can lead to headaches, nausea, and low energy [27].
  • Drink Water With Every Drink - Alcohol is a diuretic, making urination more frequent and resulting in a dehydrated body. Dehydration can bring about an immediate headache [28].
  • Choose Lighter Coloured Drinks Over Dark Ones - Light coloured drinks have fewer congeners than drinks that are dark in colour.

Increased consumption of a beverage with a higher concentration of congeners increases the likelihood of getting an alcohol-induced headache [29].

How To Treat An Alcohol-Induced Headache

An alcohol-induced headache will generally resolve itself within 24 hours, although some can last as long as 72 hours [30].

Mitigate the pain and discomfort of an alcohol-induced headache by [31]:

  • Increasing fluid intake
  • Getting enough sleep and rest
  • Eating nutritious foods
  • Eating fruits or drinking fruit juices

Average consumption of more than two to three alcoholic drinks daily can lead to various health issues, and contribute to the occurrence of alcohol-induced headaches [32].

Abbeycare suggest consultation with appropriate medical professionals or health care providers for support with alcohol-induced headaches.

Last Updated: January 18, 2023

About the author

Peter Szczepanski

Peter has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. Peter also co-authored the new 6th edition of Drugs In Use by Linda Dodds, writing Chapter 15 on Alcohol Related Liver Disease. Find Peter on Respiratory Academy, Aston University graduates, University of Birmingham, Q, Pharmaceutical Journal, the Dudley Pharmaceutical Committee, Dudley Council, Twitter, and LinkedIn.