The problem of identifying “triggers” for migraine is that triggers are not always triggers. Patients’ perception of triggers often change when they keep headache diaries. Studies are conflicting regarding alcohol and headache. Generally, the consumption of alcohol is less among people who report headaches. A possible explanation is that migraineurs avoid alcohol to reduce the risk of triggering migraine. An interesting study involved high school students who were given questionnaires. Those who experienced headache were asked to identify what they believed triggered headache. Only a few believed that alcohol triggered their headache, while statistical analysis showed that alcohol was a trigger in more than half. These students were probably not yet taught to expect a headache when consuming alcohol. This is called a “societal bias.” In some studies, alcohol is considered a migraine trigger in about a third of people; iIn others, only about 5%.

Cluster headache patients, as opposed to migraine patients, more consistently report alcohol as a trigger during a cluster period but not between these periods.

Similarly, studies about wine as a trigger are inconsistent. Some claim white wine is the stronger trigger, whereas others red wine. Beer seems to be an important trigger for cluster headache in the US but not in other countries.

Alcohol in itself does not seem to be the main migraine trigger. Some people who have migraine after drinking red wine can drink the same amount of alcohol in spirits without a headache. Other compounds in wine, such as histamine, sulfites, and tannins, can be factors, but most studies show that they are not able alone to trigger headache.

Hangover headache has also been studied. Alcohol flushing is caused by a compound termed alcohol dehydrogenase 2. People with alcohol flushing are more prone to get alcohol hangover headache. Hangover symptoms occur in people with and without migraine, but migraineurs seem to have more migraine-like hangovers.

Jack Florin, MD

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