Headaches are one of the most dreaded hangover symptoms. And many people are surprised to find out that it doesn’t take much alcohol to trigger them. Headaches and migraines can be extremely uncomfortable, and even debilitating at times. Learning more about exactly what causes alcohol-induced headaches can provide motivation for building healthier habits and feeling better. Let’s look at why alcohol makes your head hurt, what you can do to remedy it, and how to avoid headaches down the road.
Why Does Alcohol Cause Headaches and Migraines?
Alcohol primarily causes headaches because of three of its key compounds: congeners, histamines, and ethanol. Let’s dive deeper into each of these.
Congeners
Congeners are minor compounds that occur in alcoholic beverages as a natural result of distilling and fermenting. They are also added for taste, smell, and appearance. Congeners are primarily found in darker liquors like brandy, whiskey, and wine. There are exceptions to this rule, however, such as tequila—a light-colored liquor that nevertheless carries high levels of congeners.
Aside from contributing to the flavor of the alcohol, congeners increase the severity and frequency of hangover symptoms, including headaches. Congeners tend to aggravate brain tissue and blood vessels, which contributes to headaches. Clear liquors, like white rum, vodka, and gin, have significantly fewer congeners and may cause fewer headache symptoms. Although, as we’ll discuss below, there are other factors that can lead to headaches no matter what form of alcohol you consume.
Histamine
Histamine is an organic compound best known for being part of our immune response. When the body thinks a substance is harmful, it releases histamines, which triggers many of the symptoms associated with allergies. While our bodies naturally produce histamines, alcohol actually contains histamines as well. This is because histamine is a byproduct of fermentation.
Histamine has been known to cause headaches for almost 100 years.² When it enters the bloodstream it dilates blood vessels, which leads to headaches. While all alcohol contains high levels of histamines, red wines have a significantly higher amount than other beverages, and therefore may lead to more severe headaches.
Ethanol
Ethanol is the primary toxin responsible for why alcohol makes you drunk. Like histamine, ethanol is a vasodilator, which directly dilates blood vessels and can often trigger migraines and other headaches.
Ethanol is also a diuretic, meaning it increases urination, which then leads to electrolyte loss and dehydration. Dehydration causes brain cells to contract temporarily, also resulting in headaches. Ethanol is found in every alcoholic drink, and is a key reason why any form or amount of alcohol may contribute to headaches.
It’s also worth noting that alcohol-induced anxiety, or ‘hangxiety’, can worsen and even cause headaches in some cases. Because alcohol is a depressant, it suppresses our nervous system. Once the initial effects of alcohol wear off, our nervous system becomes overexcited, leading to anxiety. Because anxiety can trigger or worsen headaches, these two hangover symptoms are often related.
Types of Headaches From Drinking
Drinking alcohol can result in several different types of headaches with unique characteristics. Let’s take a closer look at the three most common types.
Headache While Drinking
Also known as a “cocktail headache,” this is an immediate headache that can be brought on by even a tiny amount of alcohol consumption. According to the International Headache Society, this type of headache occurs within just 3 hours after drinking alcohol, and typically resolves within 72 hours. These headaches are characterized by any of the following symptoms:
- Pain on both sides of the head
- A pulsating or throbbing sensation
- Worsened or aggravated symptoms after physical activity
Delayed Alcohol-Induced Headache
This is the type of headache most often associated with hangovers. These headaches start to occur when your blood alcohol levels begin to drop, typically 5-10 hours after drinking. They can last up to 72 hours. Delayed alcohol-induced headaches are generally considered to be moderate and not as severe as a migraine, although they may still feel quite uncomfortable.
Typical symptoms include:
- Throbbing or pulsating pain on both sides of the head
- Pain mostly in the forehead
- Worsened or aggravated symptoms after physical activity
- Relief within three days
Migraine Headache
Alcohol can also trigger migraine headaches. These headaches are unique from the other two on this list. For one, they tend to be more severe. They also can present unusual symptoms, such as:
- Throbbing pain
- Pain on just one side of the head
- Nausea and vomiting
- Sensitivity to light and noise
- Visual disturbances associated with an “aura”
Individuals who are already prone to have migraine headaches should be especially aware of alcohol-induced migraines. Roughly 3 in 10 migraine sufferers report that alcohol is a trigger at least some of the time.
Support Group: How to address anxiety while managing your drinking
How Much Alcohol Can Cause a Headache?
You might think that one alcoholic beverage doesn’t contain enough alcohol to cause a headache, but this isn’t always the case. Everyone’s body reacts differently to alcohol, and an individual might respond differently to the same drink over the course of their lifetime. Some of the other factors that play a role in alcohol-induced headaches include:
- What type of alcohol you drink
- The quality of ingredients and fermentation processes used to make the drink
- Your overall health status, especially your sensitivities, allergies, or prescription medications
- Your nutritional status
- Your history with headaches in general
What Factors Affect the Risk of an Alcohol-Induced Headache?
As discussed above, the amount of congeners, histamine, and ethanol in a given drink all play a part in the development and severity of headaches. Your overall health condition and tendency to experience headaches also play a role. Lastly, the volume and speed at which you drink can impact the duration and severity of your headache.³
Of course, everyone is different. Learning more about your specific health history and drinking habits can help you better understand your risk of alcohol-induced headaches. At Monument, you can speak with a specialized physician, like myself, to get personalized information and care.
How to Prevent a Headache After Drinking Alcohol
There are hundreds of supplements, vitamins, and internet “hacks” to prevent a headache after drinking alcohol. In truth, the best way to prevent a headache associated with alcohol is to either not drink at all or to decrease the amount of alcohol you consume. (See: how to practice mindful drinking) Changing your drinking habits can be difficult, but with time and support it can bring life-changing benefits. For immediate prevention steps, here are a few guidelines on what you should and shouldn’t do to minimize headaches after drinking:
Hydrate
Since alcohol has a dehydrating effect, drinking 16 ounces of water between each alcoholic beverage can help offset alcohol-related dehydration. Drinks that include electrolytes, such as sports drinks, can help replace the electrolytes you lose from the diuretic effects of alcohol.
Replenish Vitamin B
Additionally, alcohol consumption decreases the level of B vitamins in the body, which can make headaches worse. Supplementing with Vitamin B12 or B6 before or after drinking may improve symptoms.
Be Cautious With Pain Medication
While some people try to prevent headaches by taking over-the-counter pain medications before drinking, this can be dangerous. When you take a drug such as Tylenol while drinking, there is a potential for severe side effects, including liver damage.
Additionally, NSAIDs like Aleve and Ibuprofen often cause stomach irritation, and because alcohol already inflames the lining of the stomach, special care must be taken when mixing the two. If not, it can lead to gastritis, stomach ulcers, and GI bleeding.
Try N-acetyl-cysteine
One alternative to taking pain medications is to take a natural amino acid called N-acetyl-cysteine (NAC). When the body breaks down alcohol, it increases levels of acetaldehyde, a chemical compound associated with hangover symptoms. N-acetyl-cysteine fights the toxic effects of acetaldehyde, potentially lessening the likelihood of hangover headaches. While n-acetyl-cysteine is generally well tolerated, it can have side effects such as nausea and vomiting. It’s recommended you discuss any use of supplements with your physician before you start taking them.
How to Treat Alcohol-Induced Headaches and Migraines
Many of the same tips for preventing a headache after drinking also work for treating one. Hydration and electrolyte replacement is one of the best things you can do to help recover from an alcohol-induced headache. Make sure to avoid hydrating drinks that are heavy in sugar, as either low blood sugar or high blood sugar can make a hangover headache worse. As mentioned above, B vitamins such as B6 and B12 can also be helpful after drinking, and pain medication should be used sparingly and with caution. Eating a nutritious meal can also help minimize symptoms.
There is a myth that drinking more alcohol can help with hangover symptoms, commonly known as the “hair of the dog.” While symptoms may temporarily lessen, they will likely return with even more intensity than before. Self-medicating with alcohol only creates an unhealthy cycle that can be hard to break, and leads to even more health issues in the long-term.
As a physician, my best advice for decreasing or avoiding alcohol-related headaches is to take steps to change your relationship with alcohol. Monument is an online alcohol treatment platform that can help provide support every step of the way. You can get peer support, and explore treatment options like therapy and medication to stop drinking. Relief from alcohol is within reach.
Sources:
- Annals Int Med. “The alcohol hangover, https://pubmed.ncbi.nlm.nih.gov/10836917/.” Accessed Oct 20, 2022.
- J Headache and Pain. “Histamine and migraine revisited : mechanisms and possible drug targets, https://pubmed.ncbi.nlm.nih.gov/30909864/.” Accessed Oct 20, 2022.
- Neurology. “Clinical characterization of delayed alcohol-induced headache, a study of 1,108 participants, https://pubmed.ncbi.nlm.nih.gov/33970880/.” Accessed Oct 20, 2022.
- Johns Hopkins. “Hangover Headache, hopkinsmedicine.org/health/conditions-and-diseases/headache/hangover-headache.” Accessed Oct 20, 2022.
- National Headache Foundation. “Alcohol and Headaches, headaches.org/alcohol-and-headaches.” Accessed Oct 20, 2022.
About the Author
Dr. Elizabeth Klenk graduated from the University of Toledo with a BA in Biology and from the University of Cincinnati with a Master of Science in Biological Sciences followed by her MD. She was a hockey player and played goalie for several high level mens' teams. Dr. Klenk also reads avidly and enjoys spending time with her children, playing music, hiking, and participating in cattle herding competitions across the country with her Border Collies. She lives on a working cattle ranch in Ohio with her family and is an active part of the farm in her spare time.