Red wine, alcohol and migraine

What people report

• Survey. In a web questionnaire of 2,197 Dutch patients with migraine, 35.6% named alcohol as a trigger. Among them, 77.8% named red wine (Onderwater 2019).
• Clinic sample. 37.8% of 1,207 patients named alcohol at least occasionally (Kelman 2007).
• Review of older studies. About a third of patients in retrospective studies reported alcohol as a trigger at least occasionally, but only 10% as a frequent one. Prospective studies considerably limit its importance (Panconesi 2008).
• Phone diary. In 62 people followed for 3 months, alcohol was linked to migraine rather than other headache (OR 2.5), only among people not taking preventive medicine (Park 2016).
• Conflict. A 2020 systematic review called the findings conflicting, with some studies showing no association or an inverse one (Hindiyeh 2020).

People with migraine reportedly drink less than controls (Panconesi 2008). Over 25% of those who had stopped or never drank gave the belief that alcohol triggers attacks as a reason (Onderwater 2019). This limits what any survey of drinkers can show.

What controlled studies show

A study compared red wine with diluted vodka and found a significant association between red wine and headache (Littlewood 1988, reported in Peatfield 2003). Peatfield describes it as blinded, but a later review calls its blinding uncertain (Panconesi 2008). Peatfield’s own challenge studies concluded that sample sizes and response consistency were too limited for firm conclusions. A review of oral challenge studies judged one study of the amines in red wine as conclusive, and it was negative (Jansen 2003).

The American Migraine Foundation notes that although red wine is the most commonly named, other drinks can be just as likely to be a trigger.

Why wine is a puzzle

No mechanism is established. Tyramine alone cannot explain the effect, because wine contains too little of it, and a histamine blocker did not convincingly prevent the headache (Peatfield 2003). Biogenic amines, sulphites, flavonoid phenols and vasodilation have all been discussed as hypotheses, and which component matters remains uncertain (Panconesi 2008).

Migraine or hangover headache

ICHD-3 separates delayed alcohol-induced headache from migraine. It develops 5 to 12 hours after drinking, resolves within 72 hours, and has at least one of these features: on both sides, pulsating, or worse with activity.

Timing alone may not separate them. In the Dutch survey, about a third had onset within 3 hours and almost 90% within 10 hours. Record symptoms, not just the hour.

How to check it in your diary

1. Log drink type, amount and time, and the hour the attack began.
2. Log the context. The Migraine Trust says the effect depends on amount and on factors such as tiredness and stress.
3. Count occasions with no attack. Evenings with red wine and no attack are the data that surveys miss.
4. Compare drinks. If you only ever record red wine, you cannot tell wine from alcohol.

A review argued that intolerance to certain drinks in a few patients neither makes alcohol a major trigger nor justifies abstinence (Panconesi 2008). For the general method, see how to test a suspected trigger.