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Is Red Wine Really the Cause of That Day-After Headache?

Headache, Italian Wine, Red Wine, Rosso, Vino, Wine -

Is Red Wine Really the Cause of That Day-After Headache?

I KNOW PLENTY of people who experience headaches that they believe are triggered by drinking red wine—including, every so often, me. Red Wine Headache is a common complaint, to the point that it has both an abbreviation (RWH) and its own Wikipedia page, though with a disclaimer taking note of an absence of medical evidence regarding the condition and its causes. As Dr. Alexander Mauskop, director and founder of the New York Headache Center (yes it's a real thing) in Manhattan, stated, "We don't know anything for sure."

Wine-related headaches are one of the most common complaints in the center, particularly among migrane sufferers, said Dr. Mauskop. He has heard a few theories regarding RWH. One calls on the type of oak used in the fermentation and aging of wine to be the trigger of the headaches, though Dr. Mauskop couldn’t recall if French oak or American oak was said to be worse. He's also heard speculations about the sulfites in red wine as contributing factors, however he doesn't see many headache patients who are really sulfite-allergic. That condition is very uncommon, furthermore, red wines have a lower centralization of sulfites in general than white wines do.

Dehydration can cause headaches, and liquor acts as a diuretic—which implies, obviously, that dehydration can come about because of drinking either red or white wines, just as other alcoholic beverages. A red wine migraine may likewise flag a deficiency of magnesium. "Alcohol is a well known depleter of magnesium," said Dr. Mauskop. He suggests headache sufferers to take 400 milligrams of magnesium every day. Dr. Mauskop himself gets headaches from red wine every so often.

When he feels a headache coming, he'll in some cases take Imitrex (generic name: Sumatriptan), a drug that influences serotonin receptors, in this manner relieving pain.

Strangely, however, there's lots of talk about red wine headaches, just like the Wikipedia page cautioned, I found almost no medical evidence on the topic. After consulting with experts, the only study I discovered was distributed three decades ago in the Lancet, the influential British medical journal.

In the 1988 study, "Red Wine as a Cause of Migraine," six researchers served 19 members of a patient group at the Princess Margaret Migraine Clinic in London either vodka or red wine to evaluate whether their headaches were red wine-specific or caused entirely by alcohol. The beverages were served in dark vessels and different endeavors were made to camouflage their flavor just as their color.

A portion of the members were headache sufferers who recognized themselves as red wine-sensitive, others were headache patients who were not, supposedly, red wine-sensitive, and another eight members were a control group of non-migrane sufferers.

The doctor has heard theories about sulfites in redwine,but he sees very few headache patients who are truly sulfite‑allergic.

The red wine was described in the study as “Spanish” and the vodka was blended with lemon juice to dilute it to a similar alcohol level. Study participants were given 300 milliliters, equal to about 10 ounces or two typical glasses of wine. The results were inconclusive:

A few members who claimed to be red wine-sensitive developed headaches from red wine, some did not. Some who claimed to have no such sensitivity developed cerebral pains after drinking vodka. The researchers recommended different possible explanations. Is it accurate to say that it was only a question of drinking too much? The study acknowledged that tyramine, another naturally occurring compound in food and wine, has been found to trigger migraines. But in this case, the tyramine level in the wine administered to participants was noted as quite low: just 2 milligrams per liter, which means each patient consumed less than 1 milligram. The conclusion: More research was needed.

I was interested about the capability of tyramine to trigger headaches however I had little luck finding any additional data on the topic. Chris Gerling, an extension associate at Cornell University's Viticulture and Enology program in Ithaca, N.Y., noted that tyramine levels in grapes are highly variable. "It's extremely difficult to put forth a sweeping statement about colors or grape varietes. Regions of the world report diverse findings," he said. Mr. Gerling noted that since red wines tend to experience malolactic fermentation more often than white wines do and often spend time in barrels where bacteria can thrive, reds have the potential to develop higher levels of tyramine. Red wines likewise have higher amounts of histamines, a byproduct of fermentation, than white wines.

Some have cited histamines as a possible cause for headaches, though Mr. Gerling cautioned, in what was becoming a familiar refrain, “Nothing can be stated with certainty.” Phenols, compounds that give red wines some of their color, flavor and body, have also been put forward as possible headache-causing culprits—as yet another unproven theory.

So I found myself pretty much right back where I began, with lots of theories and no real answer. It wasn’t possible to identify potentially problematic wines by the high tyramine or phenol levels of the grapes or the amount of time they spent in particular barrels or even their respective histamine levels. I could stock up on magnesium and take a tablet a day, and I could drink water along with wine. I could also f ollow the lead of some friends who identify as red wine-sensitive and take an antihistamine tablet when I indulge.

These strategies might or might not work, Dr. Mauskop said. If I already had enough magnesium in my system, taking more wouldn’t prevent a headache.

I could take a blood test to determine my magnesium level and, depending on the results, visit his office for a magnesium shot. Some of his patients do so monthly and find it helpful. But Dr. Mauskop didn’t think the antihistamine would be of much help.

“Histamine release by red wine is not the main reason for headaches, otherwise antihistamines would help most people—and they don’t,” he explained. I’m not going to stop drinking red wine, even if it gives me a headache from time to time.

And there is a chance that sometime in the future I might be better able to predict which wines will be more likely to make my head hurt. Dr. Morris Levin, chief of the headache medicine division and the director of the University of California San Francisco Headache Center, is working on a research project that he thinks might identify potentially problematic reds. “Wouldn’t it be great to be able to tell people which wines would be safe to drink?” he asked, rhetorically.

Dr. Levin is about to begin the process of recruiting patients, and he hopes to include 50 participants or more in the research study. Shamelessly, I petitioned him to include me. “I’m putting you on the list,” he said. While I wait to hear more, it’s given me something to feel hopeful about in the new year.

1 comment

  • Suzanne

    I not only get headaches from red wine but also my skin flushes bright red. No red wine = no headache or flushing.

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