Uncorking the Mystery: Why Red Wine Gives You a Headache

A bottle of Cabernet Sauvignon paired with dark chocolate might seem like the perfect romantic indulgence, but for some, even one glass of wine can lead to a headache.

It’s anecdotally known among headache specialists that red wine can be a common trigger for headaches, especially among people prone to migraines. However, researchers haven’t been able to pinpoint why imbibing even a tiny amount of red wine can bother some people. A study published recently in Scientific Reports offers some clues.

There is good news for headache sufferers who long for red wine over other types of alcohol. There’s a reason it’s considered the nectar of the gods.

Various types of alcohol, and even different types of wine, can affect everyone differently. 

According to the study, 37% of alcohol drinkers get “occasional” headaches. Among those who experience a headache within three hours of drinking — 28% attribute it to red wine. Compare this to spirits (14%), white wine (10%), sparkling wine (10%) or beer (10%). 

Sulfites, histamines and the tannins in red wine have all been considered possible culprits for headaches. The recent study focused on a plant flavanol called quercetin in red wine. Because quercetin is also found in some fruits and vegetables, researchers believe the problem could be in its combination with alcohol. 

Types of wine headaches

A headache associated with wine is an actual diagnosis in the International Classification of Headache Disorders. There are two types of wine headaches, depending on the start time after drinking. Unlike a hangover, a wine headache occurs shortly after consuming alcoholic beverages. 

Immediate alcohol-induced headache: A headache that develops within three hours after ingesting alcohol and resolves after 72 hours. This kind of wine headache is the most common.

Delayed alcohol-induced headache: A headache that develops within 5-12 hours after ingesting alcohol.

Wine headaches are typically on both sides of the forehead, are pulsating and are aggravated by physical activity. 

Researching red wine headaches

Researchers have long speculated that red wine triggers headaches more often than other types of wine because of the flavonoid phenolic compounds it contains compared to white wine or other types of alcohol. Other alcoholic beverages usually contain these compounds, but red wine tends to have a higher concentration.

One possible reason that red wine causes headaches is because these compounds inhibit an enzyme called phenol sulfur transferase (PST).

When this happens, the body can’t break down the wine’s phenolic flavonoids, resulting in a buildup of free phenols in the circulation. This can cause some people to get headaches after ingestion.

Another possible culprit for red wine headaches is the tannins that naturally exist in red wine. 

Tannins come from grape skins and make a red wine feel dry in your mouth. Because of how it’s made, tannins are higher in red wine. 

Not all red wine is the same. 

In a study comparing French wine with South American wines, the South American wines tended to lower the incidence of headaches 12 hours after consumption compared to French wines. French wines are made from a grape called Tannat, which has a high tannin level. South American wines, like Malbec, may have a lower amount of tannins due to lower maceration (prolonged soaking) times. 

Aged wine has a higher tannin level. Drinking an earlier vintage might help prevent a red wine headache.

Possible prevention for a red wine headache?

If red wine triggers a headache, you still have some options. Perhaps try another type of alcohol with fewer phenols, like white wine, beer, or hard liquor. If red wine remains your favorite, try a variety from a different region or a recent vintage.

Or try taking a dose of over-the-counter painkillers before drinking wine. In one blind-controlled study1, participants were given a tablet containing acetaminophen, ibuprofen, or a placebo before drinking a glass of red wine. None of the participants who received ibuprofen developed a headache within two hours of consuming red wine. Those who received the placebo did develop a headache. Two out of four participants who received acetaminophen developed a headache within 6-12 hours after the red wine. 

This was a small study, and more research is needed. It does suggest that pre-medicating with an analgesic before drinking red wine could potentially lower the risk of developing a red wine headache.

While there’s yet to be a robust study with a large population sample on the cause and treatment of red wine headaches, existing studies offer some ideas for enjoying a glass of Merlot or Malbec on occasion.

Cheers!

By Michelle Bravo, M.D.
Board-certified Neurologist and specialist in Headache Medicine 

Tags: Dr. Michelle Bravo, headache care in Miami, neurology care in Miami, red wine