Alcohol Use as a Comorbidity and Precipitant of Primary Headache: Review and Meta-analysis


Purpose of Review

In contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache.

Recent Findings

The majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17–29%) of individuals with primary headache endorsed alcohol as a trigger. No differences were found between individuals with migraine (with or without aura) or TTH. Odds of endorsing red wine as a trigger were over 3 times greater than odds of endorsing beer.


An absence of increased risk for AUDs among those with primary headache may be attributable to alcohol’s role in precipitating headache attacks for some susceptible individuals. Roughly one fifth of headache sufferers believe alcohol precipitates at least some of their attacks. Considerable study heterogeneity limits fine-grained comparisons across studies and suggests needs for more standardized methods for studying alcohol-headache relationships and rigorous experimental designs.

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Correspondence to Rachel E. Davis-Martin.

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Conflict of Interest

Ashley N. Polk and Rachel E. Davis-Martin declare that they have no conflict of interest.

Todd A. Smitherman has received personal fees from Alder Biopharmaceuticals outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Psychological and Behavioral Aspects of Headache and Pain

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Davis-Martin, R.E., Polk, A.N. & Smitherman, T.A. Alcohol Use as a Comorbidity and Precipitant of Primary Headache: Review and Meta-analysis. Curr Pain Headache Rep 21, 42 (2017).

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  • Alcohol
  • Trigger
  • Migraine
  • Red wine
  • Headache
  • Comorbidity