Understanding Alcohol Induced Headaches

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Alcohol-induced headaches are quite common.

In fact, alcohol is the identified trigger in about 33% of people with migraine and a constant trigger in 10% of them. (1) This problem affects all alcohol drinkers, including those whose drinking is already considered harmful.

Several studies have shown that drinking alcohol is a common factor that can induce a primary headache, which is a headache that is not caused by another medical condition. To learn more about this condition, how it relates to alcohol use or misuse, its adverse effects, and how it can be treated read this article.

Types of headaches that may be triggered by alcohol

Headaches caused by alcohol are migraines, tension headaches or cluster headaches. They are all painful, oftentimes debilitating, and hampers the performance of daily activities. Each type has its own characteristics.

  1. Migraines are typically throbbing pain that gets worse and is felt only on one side of the head. It is accompanied by nausea and vomiting, and sensitivity to light and noise. Some migraine sufferers get an “aura”, characterised by ringing in the ears, flashing lights or blind spots.
  2. Tension headaches are the most common type. There is a dull, aching pain on the head, and a tightening feeling on the sides, forehead and back of the head, like pressure being applied.
  3. Cluster headaches are so called because of their cyclical patterns. Bouts may appear from 1 to 8 times a day, with attacks lasting from 15 minutes to 3 hours. Cluster headaches persist for weeks or months, after which they go into a remission period that could last months or years.

Cluster headaches are rare and not life threatening, but the pain they bring on is very intense. They are usually felt around one eye on one side of the head.

Onset of alcohol-induced headaches

The onset of alcohol-induced headaches may be immediate or delayed.

An immediate alcohol-induced headache is also called a cocktail headache and is characterized by the following: (2)

  • Headache develops within 30 minutes to 3 hours of drinking
  • Headache resolves spontaneously 72 hours after cessation of alcohol drinking
  • Headache is of pulsating quality, is felt on both sides of the head, and worsens with physical activity

A delayed alcohol-induced headache (DAIH) is the more common occurrence. It is known by its more popular name - hangover headache.  This headache presents as:

  • Headache developed within 5-12 hours or usually, the morning after drinking
  • Headache goes away without treatment within 72 hours after start
  • Headache symptoms are similar to immediate alcohol-induced headache: pulsating sensation; bilateral; and, worsening with physical activity

How does alcohol cause a headache?

Alcohol as a headache trigger has been accepted, and various population studies back this theory. What is not scientifically proven is the theory that some types of alcohol cause more headaches than others, with red wine being singled out as a culprit.

What a lot of people probably don’t know is how drinking alcohol can lead to that throbbing pain in the head.

Here’s how headaches happen when a person drinks alcohol:

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

Diuretics increase the urine output of the body and the loss of water causes dehydration. This happens when a person drinks too much alcohol, whether it’s beer, wine, or liquor. The frequent urination that leads to dehydration causes the brain cells to contract temporarily, bringing on a headache. (3)

Another effect of ethanol is vasodilation, a swelling of the blood vessels. When blood vessels expand, they stimulate specific brain nerves that result in a headache.

Alcoholic drinks contain congeners, biologically active compounds that contribute to a drink’s taste, smell, appearance, and the high probability of an alcohol-induced headache. These congeners are more abundant in red wine, whisky and brandy, and in lesser amounts in gin and vodka.

Although there is no scientific basis that headaches are more frequent when red wine is imbibed, surveys of drinkers say that it does give them a headache more than other alcoholic drinks.

Some agents in alcohol are responsible for increasing the body’s plasma serotonin and plasma histamine levels that, in susceptible people, can trigger alcohol-induced headaches.

How much alcohol does it take to cause a headache?

A lot of factors come into play when trying to determine how much or how little alcohol one drinks that can cause a headache.

One person can drink several bottles of beer or glasses of wine and not have a headache while another may take only a small amount and get a pounding pain in the head. Or, one can go on a binge one day and wake up without a hangover. Yet, that same person may have only a small glass at another time and then suffer from one. 

Quality of wine - the quality of wine, in particular, can make a difference in its headache-producing capability. Low quality wines have added sugar for sweetness and synthetic tannin for bitterness and an astringent taste. Sugar can deplete the B vitamins in the body and tannins meddle with the serotonins, all of which contribute to a headache.

Type of drink - some drinks cause headaches more than others, although there is no scientific basis for it yet. It is believed that congeners, the substances produced during fermentation, is the culprit.

Congeners add to the flavour and colour of an alcoholic drink. But they also compete with ethanol in the breaking down process. As a result, the alcohol does not break down faster and stays longer in the body. Another possible cause is the release of the stress hormones epinephrine and norepinephrine because of the presence of congeners.

These hormones trigger an inflammatory reaction that produces a headache.

Dark coloured alcohol drinks like red wine, rum and brandy contain more congeners than the clear drinks like vodka and gin, and that is the probable reason why people say red wines give them a headache.

Why do some get a headache quickly and others not?

Certain conditions influence whether drinking will result in an alcohol-induced headache or not, and the amount of drink imbibed is only a small part of it.

Body weight - a person who weighs 200 lbs will have less chance of getting a headache than another person weighing 150 lbs if both drink the same amount of the same drink. The bigger body mass will have more space for alcohol to spread out which effectively lessens its concentration.

Gender - women are generally more prone to hangover headaches than men due to the following differences:

  • The female body is 52% water while the male is 61% water. Hence, the woman’s ability to dilute alcohol is less than the man’s, making women more susceptible to having headaches after drinking.
  • Dehydrogenase, the enzyme that breaks down alcohol is in smaller amounts in the female body than in the male. With more of this enzyme, men can drink in bigger quantities than women without getting drunk. (4)
  • Women who are not yet menopausal undergo hormonal changes every month due to their menstrual cycle. At certain days of the month, they are more easily affected by alcohol’s effects like a headache. Men do not have these hormonal changes.

Certain ethnic groups - the genetic composition of the Japanese is such that they are slower than other races in breaking down acetaldehyde, a primary by-product of alcohol. This trait is responsible for the reddening of their skin and getting a hangover after drinking a small amount of alcohol.

Some people are genetically prone to migraines and have the tendency to develop headaches when drinking while regular alcohol drinkers do not have this issue.(5) But headaches aside, alcohol abuse leads to serious health conditions for both men and women.

Understanding Alcohol-induced Headaches

Which types of alcohol are most and least likely to cause a headache?

All alcoholic drinks contain ethanol but why does red wine cause more headaches than vodka or gin? The answer lies in the quantity of congeners a drink has. Congeners are complex molecules that are the by-product of the fermenting process.

Congeners add colour to alcoholic drinks. Thus, it’s the dark coloured drinks like red wine, rum and whiskey that have higher congener content than the clear drinks such as vodka, white wine and gin. Ergo, the chances of getting a headache from dark beverages are greater than from light-coloured drinks.(6)

How to avoid an alcohol-induced headache

An alcohol-induced headache, which is a component of a hangover, has many negative consequences. It is the reason for absenteeism and poor performance in the workplace. It puts the person in danger when driving or handling hazardous equipment. It leads to bad decision making, poor focus, and strained relationships.

The most obvious way to avoid it is to stop drinking. If quitting is difficult, an alcohol rehab is an option that has worked for many and changed their lives.

Other ways to avoid getting a headache from drinking:

Drink slowly. The body processes one drink (1.5 oz.) per hour, so drinking slower reduces the build-up of alcohol in the system and may prevent a headache.

Eat before, during and after drinking. Food in the stomach slows down alcohol absorption in the body and maintains blood sugar levels. A low blood sugar level can cause headache, nausea and saps the energy.

Drink a glass or bottle of water with every drink. Doing this reduces the intake of alcohol while hydrating the body. Alcohol is a diuretic, making urination more frequent and resulting in a dehydrated body. Dehydration brings about a splitting headache.

Choose lighter coloured drinks over the dark ones. White wine, beer, vodka, or gin have less congeners in them. Congeners are the side products of fermentation and are higher in red wines, whiskey, and rum. They are believed to produce alcohol-induced headaches.

When a headache comes from alcohol withdrawal

Headaches also occur during an alcohol detox, which is the initial phase of an alcohol recovery programme. The pain is one of the many withdrawal symptoms that start within 6 to 24 hours after the last drink. These symptoms can develop or change unexpectedly and without medical assistance, they can be very unpleasant or even life-threatening.

In an alcohol detox timeline, the first 7 days are the most severe, although severity can extend beyond the first week, depending on the length of time the alcohol misuse has been going on.

Because of the dangers that withdrawal from alcohol presents, a professional inpatient rehab programme is highly recommended. Medical doctors, therapists, counsellors, and nurses will be on hand to help the patient get through the withdrawal symptoms and move on to the succeeding interventions to achieve a successful recovery.

An alcohol misuse disorder treatment course in an outpatient or inpatient rehab will use medications prescribed by physicians to reduce the withdrawal symptoms and make the patient more comfortable. The medications will help keep the system in balance and minimize the likelihood of a relapse.

How to treat an alcohol-induced headache

While drinking is associated with celebrations and merrymaking, the morning-after headache is nothing to be merry about. But, since alcohol is not an illicit substance and adults are not prohibited from buying and drinking alcoholic beverages, it’s easy to have one too many glasses or bottles or shots.

Left alone, an alcohol-induced headache will generally resolve by itself in 24 hours although there have been reports of some lasting as long as 72 hours. But treating it will free the person from misery faster and resume normal activities.

Here are suggested treatments for headaches from drinking alcohol:

  • Increase fluid intake. Fitness drinks like Gatorade will restore the body’s fluid and electrolyte balance. Since headaches are caused by dehydration, replacing the lost fluids will help in a faster cure.
  • Get enough sleep and rest. When a headache follows a night of drinking, take a pain reliever with a glass of water, and have an uninterrupted sleep. The combination of staying up till late at night and drinking alcohol plays havoc on the body’s circadian rhythm.
  • Sleep and wake patterns are disrupted, causing a headache. Catching up on lost sleep restores the body and gets rid of the headache.
  • Eat nutritious foods. A healthy meal of proteins, carbs and fats nourishes the body and aids in speedy recovery of a hangover headache.
  • Eat fruits or drink fruit juices. Fruits contain fructose, a natural sugar that helps to break down alcohol in the body.

Take painkillers that belong to the NSAIDs (non-steroidal anti-inflammatory drugs). These include drugs that are ibuprofen, mefenamic acid, naproxen, diclofenac sodium, and coxib.

Avoid acetaminophen and paracetamol (Tylenol, Excedrin) since they add to the strain on the liver that alcohol does.

Conclusion

Understanding how drinking alcohol can bring about a headache is a step towards preventing or treating them. More importantly, drinkers should be aware of the negative effects of alcohol on one’s physical and mental health, its consequences on the family and personal life, occupation, social relations, and legal issues.

If you’re looking for professional treatment facilities in the UK that specialize in alcohol rehab, Gloucester is home to centres that have proven track records of success in treating substance addictions.


About the author

Peter Szczepanski

Pete 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. To read more about Pete visit his LinkedIn profile.