What is the relationship between migraine and wine?

Migraine is a brain disorder characterized by recurrent headaches. These episodes are characterized by intense headache, usually unilateral, throbbing, and accompanied by intolerance to light and noise, nausea and vomiting. Episodes last from a few hours to three days.

It has been known since ancient times that there are factors that can precipitate a migraine attack in people diagnosed with migraine. Alcohol is one of the ten most frequent precipitating factors of migraine attacks. Stress, hormonal changes in women, fasting, weather, sleep disorders, certain smells, cervical pain and certain light stimuli are also among the most frequent.

More than one third of migraine patients report that alcohol can cause headaches. But consistently this occurs in less than 10% of cases. In 80% of migraine sufferers the type of alcoholic beverage that causes headache pain most frequently is wine, especially red wine. White wine and champagne can also trigger attacks. However, red wine is a proven traditional headache trigger even in non-migraine sufferers.

The International Classification of Headache Disorders (ICHD-3) (IHS) differentiates between two types of alcohol-induced headache. One is “immediate alcohol-induced headache”. The other is “delayed alcohol-induced headache” (hangover headache).

The immediate alcohol-induced headache is typical of migraine. This alcohol-induced headache in people with migraine occurs early. In many cases within three hours of drinking alcohol, and even within the first 30 minutes. The person may begin to perceive a headache before having finished lunch or dinner.

The other type of alcohol-induced headache is the delayed headache. This is the headache headache (hangover headache) you get when you wake up the morning after you have consumed a considerable amount of alcohol, which we call a hangover. People with migraine are more susceptible to this type of headache than those without migraine.

The differences between the rapid onset of migraine attacks and delayed headache (hangover) and their different characteristics suggest a different mechanism in headache provocation.

Migraine sufferers consume less alcohol than non-migraine sufferers.

This data suggests that people stop consuming alcohol, especially red wine, by identifying it as a factor responsible for episodes of headache.

At present we still do not know what causes alcohol-induced migraine attacks. Although in some cases it is likely that alcohol itself is responsible, there is evidence that specific substances in different alcoholic beverages are the precipitating factors for headache pain. Studies have shown that higher alcoholic beverages (e.g. whiskey, rum, vodka) cause migraine attacks less frequently than red wine.

There are different theories but there is still no clear explanation as to why red wine is a potential precipitating factor for headaches.

In relation to winemaking, it is necessary to consider different variables that include the type of grape variety or grape used in winemaking, possible blends, or the aging process, conservation and shelf life.

On the other hand, different substances have been identified in wine that are potentially responsible for headaches in particularly sensitive individuals: histamine, sulfites, flavonoid phenolic compounds and 5-hydroxytryptamine (5-HT).

If a person finds that alcohol causes migraine attacks, probably the best option is not to drink alcohol. This is a personal decision. The same is true if any of the other migraine precipitating factors listed above are identified. If in doubt as to whether alcohol is a cause of headaches, it is helpful to use a detailed migraine diary recording date, duration, intensity, medications and effects, and food and beverages from the previous day and the same day. Review of the data collected may clarify the possible relationship of alcohol intake, or other factors, to some of the headaches.

Moderation in alcohol intake is likely to reduce the risk of headache. However, there are people in whom the ingestion of a single glass of red wine (125-150 ml) is enough to give them a headache.

If after drinking alcoholic beverages a headache appears, which we identify as a migraine attack, it is indicated to use the same drugs that are usually used for migraine (non-steroidal anti-inflammatory drugs, triptans, ditanes) under medical supervision.

Oriol Franch

25/03/2023