The severe pain caused by a hangover headache is one of the most common headaches known.
This is no surprise as alcohol is consumed by almost every culture on earth.
One of the largest headache surveys ever, reported that 72% of people will experience a hangover headache.
This effect of alcohol is so well known that it is very rare for someone to ever consult a doctor over this problem.
You do not have to be a heavy drinker to experience a hangover. In fact, very heavy drinkers are less likely to get one. Light drinkers, especially people with migraine, are more at risk.
Are there symptoms other than headache?
There are other physical signs in hangover, other than headache. These include diarrhoea, sweating, loss of appetite and feeling shaky.
Your heart can race due to an excessive adrenaline drive.
Your attention span is affected during hangover.
It is well known that people may have car crashes the morning after a heavy drinking session.
This is often due residual alcohol in your bloodstream (in which case you are breaking the law). However, it can be the effects of reduced attention span from hangover itself.
What causes the headache?
There has, in fact, been considerable study of the toxic effects of alcohol. Alcohol may produce the following problems:
- Altered cytokine metabolismThis can result in nausea, diarrhoea and create the inflammation in the meninges that produces headache
- Alcohol gets metabolised to acetaldehydeAcetaldehyde is the chemical your liver makes when it tried to digest alcohol.
Acetaldehyde will cause the skin to go red, your heart to race, sweating and may make you sick.
A drug used to treat alcoholism (Disulfiram /Antabuse)causes your body to build up levels of acetaldehyde if you drink.
If you drink while on Antabuse you will get these very same symptoms.
- Dehdration by loss of Anti-Diuretic Hormone (ADH) activity Anti-diuretic Hormone is made in your hypothalamus, and secreted by the pituitary gland at the base of the brain.
When ADH is active, your body prevents water from being lost into your urine.
However, alcohol switches off ADH. This means that you start to pass urine, which usually looks (and is) very dilute.
This can make you dehydrated. Dehydration can lead to a severe headache.
- Disturbed sleep Although alcohol is usually associated with deep sleep, it actually disturbs natural sleep. Sleep deprivation can result in reduced attention span or nausea and may cause headaches.
People who do not drink alcohol do not get these symptoms - it is the only sure way of preventing hangover!
Why do some people get headache after very small amounts of alcohol?
People who have a diagnosis of migraine are very prone to get hangovers.
Very small amounts of alcohol can result in a pretty severe headache.
In fact a hangover headache after small amounts of alcohol can be the first indication that you have a migraine tendency.
Some alcoholic drinks, like red wine, contain chemicals called congeners Congeners give red wine its distinctive flavour. However congeners can produce an inflammatory reaction, which could contribute to headache.
What are the symptoms of delayed alcohol induced headache?
The hangover headache starts to appear after you have been drinking, usually once your alcohol levels start to fall.
Every unit of alcohol you drink takes about one hour to clear your blood stream.
So if you have had 3 pints of beer, this will take about 6 hours for your alcohol level to return to near normal.
As your alcohol level falls, you start to get an all-over headache which is throbbing and is typically worse with movement.
You may feel nauseated or vomit, and want to stay in the dark (these symptoms are just like a common migraine attack).
The pain will usually clear within about 12-24 hours.
These headaches can be severe, as in very painful, and may cause the sufferer to lose a day's activities.
Do I need tests to diagnose alcohol induced headaches?
No! The diagnosis is usually obvious and no brain scans are required.
Hangover Headache Relief: What Works?
Preventing a hangover headache may be obvious - do not drink excessive alcohol.
However, hangover headache relief can be a challenge and everyone has their own theory...Irn Bru, non-fizzy Coca-Cola, strong coffee, raw eggs, fatty bacon, pizza, ginseng, cabbage, fresh air, (hair of the dog = more alcohol?), glutamine, milkshakes.... all said to be good for hangovers.
You may have your own favourite, but here's the list that stood the test of proper clinical research.
It is an anti-inflammatory medicine which also works well in migraine. The first study in hangover dates back to 1983!
People who took tolfenamic acid 200mg just prior to starting to drink, and another 200mg just before retiring to bed after their drinking session were compared with people who did not take tolfenamic acid.
People who took tolfenamic acid were more likely to experience relief of hangover headache symptoms.
Tolfenamic acid is not available in the USA, but its close relation (pharmacologically speaking) mefanamic acid (Ponstan - registered trade mark)) is.
However, I cannot make a recommendation regarding use of mefanamic acid for the USA.
Borage is a plant extract containing gamma-lineolic acid.
In a controlled trial, Borage extract seems to produce some hangover relief, probably through the anti-inflammatory action.
Other medicines or extracts tested scientifically include:
- Fructose or glucose
- Cynara scolymus (artichoke)
- Opuntia ficus-indica (prickly pear).
In the review of these preparations in the BMJ of Christmas 2005, none of these seemed to pass the test.
However, fructose, which is contained in honey and fruit juice does seem a reasonable intervention.
Fructose is a simple sugars, and simple sugars can help your body metabolise alcohol efficiently, which could reduce hangover symptoms.
Well, the best way is, of course, not to drink alcohol to excess.
Alcohol related disease is a major social problem, and excessive or prolonged alcohol intake puts you at risk of liver cirrhosis, head injury, and stroke.
Read About Other Causes of Headache
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- Wiese JG et al The Alcohol Hangover. Annals of Internal Medicine 2000;132:897-902 (Free full text)
- Pittler M et al. Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials British Medical Journal 2005;331:1515-8 (Free full text)
- Lucey D. Hangovers. studentBMJ 2002;10:171-214 (Free full text)