Current Pain and Headache Reports

, Volume 15, Issue 3, pp 177–184 | Cite as

Alcohol and Migraine: What Should We Tell Patients?

  • Alessandro PanconesiEmail author
  • Maria Letizia Bartolozzi
  • Leonello Guidi


Alcoholic drinks are a migraine trigger in about one third of patients with migraine in retrospective studies on trigger factors. Many population studies show that patients with migraine consume alcohol in a smaller percentage than the general population. Moreover, research has shown a decreased prevalence of headache with increasing number of alcohol units consumed. The classification criteria of alcohol-related headaches remain problematic. We discuss the role and mechanism of action of alcohol or other components of alcoholic drinks in relation to alcohol-induced headache. In accordance with data from a recent prospective study, we believe that reports overestimate the role of alcohol, as well as other foods, in the triggering of migraine. If a relationship between the intake of alcohol and the migraine attack is not clear, a small dose of alcohol is not contraindicated either for enjoyment or its protective effect on cardiovascular disease.


Hangover Migraine Headache Alcohol Headache classification criteria Trigger factors Wine Serotonin Serotonin release Alcohol consumption Congeners Vasodilatation Lifestyle 



No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia 2007;27:394–402. This is the largest study on trigger factors of migraine. PubMedCrossRefGoogle Scholar
  2. 2.
    Clifford Rose F. Food and headache. Headache Q. 1997;8:319–29.Google Scholar
  3. 3.
    •• Panconesi A. Alcohol and migraine: trigger factor, consumption, mechanisms. A review. J Headache Pain 2008;9:19–27. This is a comprehensive review on the relationship between alcohol and migraine. PubMedCrossRefGoogle Scholar
  4. 4.
    Hauge AW, Kirchmann M, Olesen J. Trigger factors in migraine with aura. Cephalalgia. 2010;30:346–53.PubMedCrossRefGoogle Scholar
  5. 5.
    Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009;25:446–52.PubMedCrossRefGoogle Scholar
  6. 6.
    •• Schurks M, Diener H-C. Cluster headache and lifestyle habits. Curr Pain Head Rep. 2008;12:115–21. This is a good review of alcohol consumption and smoking habits among patients with cluster headache.CrossRefGoogle Scholar
  7. 7.
    • Wober C, Brannath W, Schmidt K, et al. Prospective analysis of factors related to migraine attacks: the PAMINA study. Cephalalgia 2007:27:304–14. This is a large prospective study of migraine triggers. PubMedCrossRefGoogle Scholar
  8. 8.
    Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders. Cephalalgia. 2004;24 suppl 1:1–160.Google Scholar
  9. 9.
    Olesen J, Steiner T, Bousser M-G, et al. Proposals for new standardized general diagnostic criteria for the secondary headaches. Cephalalgia. 2009;12:1131–6.Google Scholar
  10. 10.
    Littlewood JT, Gibb C, Glover V, et al. Red wine as a cause of migraine. Lancet. 1988;1:558–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Evans RW, Sun C, Lay C. Alcohol hangover headache. Headache. 2007;47:277–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Rasmussen BK, Olesen J. Symptomatic and non symptomatic headaches in a general population. Neurology. 1992;42:1225–31.PubMedGoogle Scholar
  13. 13.
    Howland J, Rohsenow DJ, Allensworth-Davies D, et al. The incidence and severity of hangover the morning after moderate alcohol intoxication. Addiction. 2008;103:758–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Slutske WS, Piasecki TM, Hunt-Carter EE. Development and initial validation of the hangover symptoms scale: prevalence and correlates of hangover symptoms in college students. Alcohol Clin Exp Res. 2003;27:1442–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Kuster GW, da Silva AL Piraja, Aquino CH, et al. Frequency and features of delayed alcohol-induced headache among university students. Headache. 2006;46:688–91.PubMedGoogle Scholar
  16. 16.
    Scher AI, Terwindt GM, Picavet HSJ, et al. Cardiovascular risk factors and migraine. The GEM population-based study. Neurology. 2005;64:614–20.PubMedGoogle Scholar
  17. 17.
    Aamodt AH, Stovner LJ, Hagen K, et al. Headache prevalence related to smoking and alcohol use. The Head-HUNT Study. Eur J Neurol. 2006;13:1233–8.PubMedCrossRefGoogle Scholar
  18. 18.
    • Kurth T, Schurks M, Logroscino G, Buring JE. Migraine frequency and risk of cardiovascular disease in women. Neurology 2009;73:581–8. This is a cohort study among participants in the Women’s Health Study. PubMedCrossRefGoogle Scholar
  19. 19.
    Molarius A, Tegelberg A, Ohrvik J. Socio-economic factors, lifestyle, and headache disorders—A population-based study in Sweden. Headache. 2008;48:1426–37.PubMedCrossRefGoogle Scholar
  20. 20.
    Yokoyama M, Yokoyama T, Funazu K, et al. Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population. J Headache Pain. 2009;10:177–85.PubMedCrossRefGoogle Scholar
  21. 21.
    Fernandez-de-las-Penas C, Hernandez-Barrera V, Carrasco-Garrido P, et al. Population-based study of migraine in Spanish adults: relation to socio-demographic factors, lifestyle and co-morbidity with other conditions. J Headache Pain. 2010;11:97–104.PubMedCrossRefGoogle Scholar
  22. 22.
    Milde-Busch A, Blaschek A, Borggrafe I, et al. Associations of diet and lifestyle with headache in high-school students: results from a cross-sectional study. Headache. 2010;50:1104–14.PubMedCrossRefGoogle Scholar
  23. 23.
    Garcia-Martin E, Martinez C, Serrador M, et al. Alcohol dehydrogenase 2 genotype and risk for migraine. Headache. 2010;50:85–91.PubMedCrossRefGoogle Scholar
  24. 24.
    Ramchandani VA, O’Connor S, Neumark Y, et al. The alcohol clamp: applications, challenges, and new directions—an RSA 2004 symposium summary. Alcohol Clin Exp Res. 2006;30:155–64.PubMedCrossRefGoogle Scholar
  25. 25.
    Wiese JG, Shlipak MG, Browner WS. The alcohol hangover. Ann Intern Med. 2000;132:897–902.PubMedGoogle Scholar
  26. 26.
    Verster JC. The alcohol hangover—a puzzling phenomenon. Alcohol Alcohol. 2008;43:124–6.PubMedGoogle Scholar
  27. 27.
    •• Rohsenow DJ, Howland J. The role of beverage congeners in hangover and other residual effects of alcohol intoxication: a review. Curr Drug Abuse Rev. 2010;3:76–9. This is a review of the few studies that assessed the effects of drinks with high or low content of congeners on hangover. PubMedCrossRefGoogle Scholar
  28. 28.
    Damrau F, Liddy E. Hangovers and whisky congeners: comparison of whisky with vodka. J Nat Med Assoc. 1960;52:262–5.Google Scholar
  29. 29.
    Maxwell CR, Spangenberg RJ, Hoek JB, et al. Acetate causes alcohol hangover headache in rats. PLoS ONE. 2010;5:e15963. doi: 10.1371/journal.pone.0015963.PubMedCrossRefGoogle Scholar
  30. 30.
    Perrino Jr AC, Ralevski E, Acampora G, et al. Ethanol and pain sensitivity: effects in healthy subjects using an acute pain paradigm. Alcohol Clin Exp Res. 2008;32:952–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Jochum T, Boettger MK, Burkhardt C, et al. Increased pain sensitivity in alcohol withdrawal syndrome. Eur J Pain. 2010;14:713–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Ramchandani VA, Flury L, Morzorati SL, et al. Recent drinking history: association with family history of alcoholism and the acute response to alcohol during a 60 mg% clamp. J Stud Alcohol. 2002;63:734–44.PubMedGoogle Scholar
  33. 33.
    Deng XS, Deitrich RA. Ethanol metabolism and effects: nitric oxide and its interaction. Curr Clin Pharmacol. 2007;2:145–53.PubMedCrossRefGoogle Scholar
  34. 34.
    Gazzieri D, Trevisani M, Tarantini F, et al. Ethanol dilates coronary arteries and increases coronary flow via transient receptor potential vanilloid 1 and calcitonin gene-related peptide. Cardiovasc Res. 2006;70:589–99.PubMedCrossRefGoogle Scholar
  35. 35.
    • Nicoletti P, Trevisani M, Manconi M, et al. Ethanol causes neurogenic vasodilation by TRPV1 activation and CGRP release in the trigeminovascular system of the guinea pig. Cephalalgia 2008;28:9–17. This article asserted that a vasodilatation of meningeal vessels by CGRP release may be relevant to the mechanism by which alcohol triggers migraine. PubMedCrossRefGoogle Scholar
  36. 36.
    Dell’ Agli M, Buscialà A, Bosisio E. Vascular effects of wine polyphenols. Cardiovasc Res. 2004;63:593–602.CrossRefGoogle Scholar
  37. 37.
    Rathel TR, Samtleben R, Vollmar AM, Dirsch VM. Activation of endothelial nitric oxide synthase by red wine polyphenols: impact of grape cultivars, growing area and the vinification process. J Hypertens. 2007;25:541–9.PubMedCrossRefGoogle Scholar
  38. 38.
    • Spaak J, Merlocco AC, Soleas GJ, et al. Dose-related effects of red wine and alcohol on hemodynamics, sympathetic nerve activity, and arterial diameter. Am J Physiol Heart Circ Physiol. 2008;294:H605–12. In this article, some of the cardiovascular effects of ethanol and wine were characterized and compared in the same individual.PubMedCrossRefGoogle Scholar
  39. 39.
    Bau PF, Bau CH, Naujorks AA, Rosito GA. Early and late effects of alcohol ingestion on blood pressure and endothelial function. Alcohol. 2005;37:53–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Stendel R, Irnich B, al Hassan AA, et al. The influence of ethanol on blood flow velocity in major cerebral vessels. A prospective and controlled study. Alcohol. 2006;38:139–46.PubMedCrossRefGoogle Scholar
  41. 41.
    Ashina M, Tfelt-Hansen P, Dalgaard P, Olesen J. Lack of correlation between vasodilatation and pharmacologically induced immediate headache in healthy subjects. Cephalalgia. 2010. doi: 10.1177/0333102410394672.Google Scholar
  42. 42.
    • Panconesi A, Bartolozzi ML, Guidi L. Migraine pain: reflections against vasodilatation. J Headache Pain 2009;10:317–25. This article discusses the evidence against vasodilatation as migraine pain generator and some findings in support of central origin of the pain. PubMedCrossRefGoogle Scholar
  43. 43.
    • Panconesi A. Serotonin and migraine: a reconsideration of the central theory. J Headache Pain 2008;9:267–76. This review critically evaluates studies concerning variation of peripheral and central serotonin parameters in patients with migraine. PubMedCrossRefGoogle Scholar
  44. 44.
    Rothman RB, Baumann MH. Serotonin releasing agents. Neurochemical, therapeutic and adverse effects. Pharmacol Biochem Behav. 2002;71:825–36.PubMedCrossRefGoogle Scholar
  45. 45.
    Baylen CA, Rosemberg H. A review of the acute subjective effects of MDMA/ecstasy. Addiction. 2006;101:933–47.PubMedCrossRefGoogle Scholar
  46. 46.
    Wilkins C, Sweetsur P, Girling M. Patterns of benzylpiperazine/trifluoromethylphenylpiperazine party pill use and adverse effects in a population sample in New Zealand. Drug Alcohol Rev. 2008;27:633–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Thompson I, Williams G, Caldwell B, et al. Randomized double-blind, placebo-controlled trial of the effects of the ‘party pills’ BZP/TFMPP alone and in combination with alcohol. J Psychopharmacol. 2010;24:1299–308.PubMedCrossRefGoogle Scholar
  48. 48.
    • Kloner RA, Rezkalla SH. To drink or not to drink? That is the question. Circulation 2007;116:1306–17. This excellent review discusses the relationship between alcohol and cardiovascular diseases. PubMedCrossRefGoogle Scholar
  49. 49.
    • Schurks M, Rist PM, Bigal ME, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009:339. doi:  10.1136/bmj.b3914. This is a comprehensive and good review on the association between migraine and cardiovascular disease.
  50. 50.
    •• Martin PR. Behavioral management of migraine headache triggers: learning to cope with triggers. Curr Pain Head Rep. 2010;14:221–7. This article suggests learning to cope with triggers instead of avoidance. A revision of studies on migraine triggers also was conducted. CrossRefGoogle Scholar
  51. 51.
    Cook CCH, Tarbet H, Ball D. Classically intoxicated: correlations between quantity of alcohol consumed and alcohol related problems in a classical Greek text. BMJ. 2007;335:1302–4.PubMedCrossRefGoogle Scholar
  52. 52.
    Leone M, Vila C, McGown C. Influence of trigger factors on the efficacy of almotriptan as early intervention for the treatment of acute migraine in a primary care setting: the START study. Expert Rev Neurother. 2010;10:1399–408.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Alessandro Panconesi
    • 1
    Email author
  • Maria Letizia Bartolozzi
    • 1
  • Leonello Guidi
    • 1
  1. 1.Headache Center, Department of NeurologySan Giuseppe HospitalEmpoliItaly

Personalised recommendations