Red Wine Headache vs.
Many people complain of getting
headaches after drinking red wines. Although some of these people
had one bad experience from drinking lousy wine or simply
overindulging and now blame all red wines, there seems to be
enough anecdotal evidence to suggest that others experience a
real physiological reaction after drinking many red wines. As
serious a problem as this is, it is impossible to get government
funding to study how those who are sensitive to red wine could
more safely enjoy it. In the next few months we will examine this
issue from the perspective of several writers and researchers.
The Puzzling Red Wine Headache - By Marian Burros
For some people, a glass of red wine is an invitation to a
roaring headache. After a few episodes of headache and
queasiness, those who suffer them may banish wine from their
tables for life. The symptoms are part of a syndrome known as Red
Wine Headache, or RWH.
The red wine headache is a real if poorly understood
phenomenon, says an article in the June issue of the
Harvard Health Letter. That is a masterpiece of understatement.
There are many theories about what causes the syndrome, but few
facts. Dr. Fred Freitag, associate director of the Diamond
Headache Clinic in Chicago, said no one really knows what leads a
patient to develop this type of headache.
It may be caused by compounds found in grape skins. They
are either naturally occurring or produced through
fermentation, Dr. Freitag said. He would postulate no
further. Its not as if there are hundreds of
thousands of dollars for funding studies to determine the
cause, Dr. Freitag said. There is actually a stigma to studying
the subject. Ive entertained the idea of looking for
grants to study this and I've been told, Dont go
there, its bad P.R., Dr. Freitag said. Bad
publicity comes to those who would study drinking? Carry Nation
is with us yet.
Sulfites used to take the blame for RWH. About 20 years ago the
Food and Drug Administration determined that about 1 percent of
the population is allergic to sulfites and required that wines
containing certain levels of the compound be labeled
contains sulfites. Many people have assumed,
incorrectly, that the labeling is designed to warn people who get
a red wine headache. [In fact, sulfite sensitivity is a true
allergy. Sufferers experience an allergic reaction, but not a
headache. RWH is something else.]
Scientists have pointed out, however, that many sweet white wines
contain more sulfites than red wines yet do not cause
headaches in those who suffer from RWH Additionally, dried fruits
usually contain sulfites but you never hear of dried fruit
headaches. Sulfites can cause an allergic reaction [breathing
problems], Dr. Freitag said, but they give headaches only to
Other experts think tannins are at the root of the headaches.
Tannins are the flavonoids in wine that set ones mouth to
puckering. The Harvard Health Letter notes several
well-controlled experiments showing that tannins cause the
release of serotonin, a neurotransmitter. High levels of
serotonin can cause headaches and that may happen in people who
also suffer from migraine headaches. But that does not explain
why people who do not get migraines get RWH. Dr. Marion Nestle,
chairwoman of the Department of Nutrition and Food Studies at
NYU, added that no one complains about tea, soy, or chocolate
headaches though all contain tannins.
A third school of thought blames histamines. Histamines are 20 -
200% higher in red wine than in white, and those who are allergic
to them are deficient in a certain enzyme. Some experts believe
that the combination of alcohol and that deficiency can cause the
headaches. But a study of 16 people with an intolerance to wine,
reported in the Journal of Allergy and Clinical Immunology (Feb
2001) found no difference in reactions to low- and high-histamine
are naturally occurring compounds found in animals and plants. “In wine, the
amounts of histamine and tyramine are generally pretty small, and by themselves
wouldn’t cause any problems, but you have this alcohol which inhibits the
body’s defense system,” says Mark Daeschel of the Department of Food Science
and Technology at Oregon State University. “Ethanol acts as an MAO
inhibitor.” He said people who take MAO inhibitors (a class of
antidepressants) are warned not to ingest foods that have histamines, and that
should include red wine.
A fourth suggestion is that prostaglandins substances that
contribute to pain and swelling may cause RWH. [More on
this next month!] Yet for most people who suffer from RWH, the
hypotheses are irrelevant. They want to know what to do about the
problem. Some Web sites suggest prevention: for histamine
sensitivity, pop a non-sedating antihistamine like Claritin or
take an aspirin to stop production of prostaglandins.
Dr. Freitag frowns on this. To lick the problem, he advises a
potentially long, painful, and costly experiment. A sufferer of
the headaches himself, Dr. Freitag finds that he can drink some
reds and not others. Try different brands, different
grapes, different countries of origin. Thats the only way
you are going to find out. Drink a half a glass of red
wine; if it is going to give you a headache, it will do so within
15 minutes. If there is no reaction, stick with that wine for the
evening, keeping your alcohol consumption to no more than two
glasses. Keep a journal.
And dont confuse RWH with the headache that comes six hours
after a full evening of drinking. Thats called a hangover!
A Possible Solution
[We now look at an informal study suggesting that aspirin may be
helpful if taken before drinking wine. Because RWH is frequently
and incorrectly blamed on sulfites, we will start a brief
discussion on sulfites.]
In 1981 Herbert Kaufman, M.D., reported that the prophylactic
ingestion of aspirin prevented the red wine headache syndrome,
RWH, (Lancet 1981; 1: 1263). He also noted that once RWH begins,
aspirin has little or no effect in altering the headache. Five
years later, in a non-controlled study, Kaufman reported that
aspirin inhibited the immediate and late phases of RWH, and the
proposed mechanism was through interruption of prostaglandin
synthetase (Immunology and Allergy Practice; 7: 279-84). In a new
controlled study, Kaufman and Dwight Starr, M.D., Mt. Zion
Hospital and Medical Center, examined, through blind evaluation,
various inhibitors of prostaglandin synthetase (IPS) drugs,
aspirin, Acetaminophen, and Ibuprophen, to test if the RWH could
be prevented by the prophylactic use of these specific
During the first stage, twelve subjects (nine females and three
males) with a history of RWH were challenged with red wine, and
all experienced RWH. The subjects returned one week later, stage
two, and were given inhibitors of prostaglandin synthetase or
placebo one hour prior to wine ingestion. The two who received
the placebo were not protected. Kaufman and Starr reported that
ten of the subjects who were premedicated failed to develop the
RWH; two given Acetaminophen developed a "second phase'' RWH
6-10 hours after wine ingestion.
Kaufman and Starr conclude that RWH may be due to a metabolic
defect and corrected by prostaglandin synthetase inhibitors.
Mechanisms of correction remain unclear. Source: H. Kaufman and
D. Starr, Prevention of the Red Wine Headache (RWH); A Blind
Controlled Study. In New Advances in Headache Research, 2nd
edition, ed. F. Clifford Rose. Smith-Gordon, 1991.
In conclusion, this study
was very limited but suggested that taking aspirin and possibly Ibuprofin before
drinking red wine may reduce or eliminate Red Wine Headache.
New Information on Headaches,
Flushing, and Bloating
If you suffer from headaches
and/or flushed skin when drinking wine, try drinking a cup of black tea
before you drink the wine. If you will be drinking over the course of an
evening, have another cup or two of black tea during the evening. Quercetin, a
bioflavonoid found in black tea, significantly inhibits the headache/flush
response (which is an inflammatory effect from histamines), according to Tareq
Khan, M.D., a pain expert with St. Luke's Episcopal Hospital in Houston, Texas.
If the problem you suffer from is bloating dye to
alcohol's dehydrating and water retention effects, try munching on
magnesium-rich snacks like dark chocolate and unsalted nuts,
according to Carolyn Dean, M.D., N.D.
Wine Contains Sulfites?
(Answers to some frequently asked questions about sulfites in
wine - by William Bincoletto)
What are sulfites?
Sulfite is a word used to describe forms of sulphurous acid,
including sulphur dioxide. Sulfites have been used since ancient
times for many purposes, including the cleansing of wine
receptacles by both Romans and Egyptians. As food additives, they
have been used since the 17th century and approved for use in the
United States as long ago as the early 1800s. They are currently
used for their preservative ability, which includes controlling
microbial growth, blanching certain foods, and preventing
spoilage of certain perishable foods, beverages and
pharmaceuticals. It is their antioxidant and anti-microbial
properties that have gained them an important role in wine
making. The sulfites either inhibit or kill bacteria or wild
yeast, thus encouraging rapid and clean fermentation of wine
grapes. Sulfites are also a natural and minor by-product of yeast
fermentation and thus are produced during the wine fermentation
Who is allergic to sulfites?
The FDA in the US estimates that one in 100 people is sulfite
sensitive to some degree, but for the 10% of the population who
are asthmatic, up to 5% are at risk of having an adverse reaction
to the substance. More importantly, the most significant sulfite
sensitivity reactions occur in susceptible asthmatics. From a
public health standpoint, the subgroup of greatest concern is the
sulfite-sensitive asthmatic population. Of those, the ones in
whom the most severe reactions have been reported are
steroid-dependent and are taking such drugs as prednisone or
methylprednisolone. Most of these individuals have been cautioned
by their doctor to avoid sulfite-containing foods or beverages.
The number of asthmatic patients that are included in this
sulfite sensitive group is estimated to be 500,000 in the United
States. In addition, there are a significant number of people with a genedic
blood deficiency called G6PD deficiency. These people will have reactions to
sulfites that range from minor to life-threatening. They should avoid foods,
beverages, and even medications with high levels of sulfites as well as some
foods in the legume family. The USFDA requires labeling of foods containing 10 ppm or
more of sulfites.
What are the symptoms of a sulfite reaction?
The symptoms of a sulfite sensitivity reaction vary from mild to
life-threatening. The most common symptoms are mild and involve a
skin rash accompanied by redness, hives, itching, flushing,
tingling and swelling. Respiratory symptoms include difficulty
breathing, wheezing, and stridor. Gastrointestinal reactions
involve nausea and stomach cramps. Much less common but more
serious signs and symptoms of sulfite sensitivity are low blood
pressure, shock, extreme difficulty breathing, and loss of
consciousness. As noted above, these symptoms of a severe
reactions are most apt to occur in the steroid-dependent
I get headaches, stuffy nose, and rosy cheeks from red
wine. Is this an allergic reaction?
Technically, this is not an allergic reaction. What is being
described is usually referred to as the red wine headache
syndrome. This is not related to the sulfite content of the
wine but probably due to other substances contained within the
wine such as histamines, tyramine, and phenolic flavonoids. Aside
from the discomfort of the headache, these symptoms do not appear
to be a risk for progression to a more serious reaction. Studies
have suggested that these headaches can be avoided or minimized
by taking either aspirin, ibuprofen, or acetaminophen prior to
I can drink only white wines. Do red wines have more
Actually, red wines may have less sulfites. In 1993 the European
Union passed regulations permitting higher levels of total
sulphur dioxide in dry white wine than in dry red wine and an
even higher level in sweet white wines and rose wines. The higher
level in the sweet wines are necessary to prevent the further
fermentation of the higher levels of residual sugar. If you have
a problem with red wines as compared to white wines, it may be
related to the red wine headache syndrome [which was
described last month]. Or, you may just be unfortunate enough to
have an idiosyncratic allergy to one or more naturally occurring
chemicals in some red wines. Experiment with small quantities of
various wines until you find some that dont bother you.
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