Why does alcohol cause headaches?
Alcoholic drinks have been reported as migraine or alcohol headache-trigger in about one-third of the migraine patients in retrospective studies. Some studies found that alcohol use disorder trigger also other primary headaches.
Alcohol consumption has been associated with pregnancy defects, liver disease, pancreatitis, high blood pressure, coronary artery disease, stroke, cancer, addiction issues, and physical injury (trauma to self/others with acute alcohol intoxication). The health benefits of alcohol may be up for debate. 
Alcohol’s exact role in triggering a migraine isn’t fully known. Many things are probably at play. For instance, alcohol byproducts called congeners have been linked to headaches. Dark-colored alcohols like red wine, brandy, and whiskey may contain more of them. Alcohol not only contains a chemical called histamine, but it also spurs your immune system to make more. This boosts inflammation throughout your body.
A chemical called ethanol is alcohol’s main ingredient. Once it gets into your system, it is converted into a chemical that triggers migraine. Ethanol is also a natural diuretic. That means it makes you pee more than normal. All of these things can set you up for a migraine. 
Types of Alcohol-Related Headaches
Alcohol can trigger headaches, including migraines, cluster headaches, and tension-type headaches. In fact, around 30 percent of people who experience recurrent migraines report alcohol as a trigger.
Beverages such as liquor, wine, and beer, contain a chemical called ethanol. There are a number of ways that ethanol may be triggering migraine episodes. First, ethanol is a direct vasodilator; in some individuals, vasodilation or the dilatation of blood vessels may cause migraine attacks. Second, ethanol is a natural diuretic; this leads to the excretion of salt, vitamins, and minerals from the body through the kidneys. Excess consumption of ethanol may produce dehydration and chemical imbalances in the body. 
Alcoholic beverages also contain other chemicals called congeners. Congeners are byproducts of alcohol being fermented or distilled, and they impart the specific tastes and flavors that make each beverage unique. These congeners also have a variety of effects that can trigger migraine, alter other chemicals in the body, and induce the hangover effect if consumed in excess. Alcoholic beverages that are darker in color contain a higher level of congeners. Fructose, the naturally occurring sugar from fruits, helps return portions of the body’s chemical balance back to normal following ethanol consumption.
Many with migraine, and most with cluster headaches, are sensitive to alcohol, even in small amounts.
How Alcohol Triggers Headaches
In the International Headache Society (IHS) classification, alcohol headache is included as secondary headaches, in the section “Headache attributed to a substance or its withdrawal.”  However, problems for the classification of headaches triggered by alcohol using IHS criteria were recently discussed. One is the differentiation between hangover alcohol headache and migraine attack triggered by alcohol in diagnosed migraine patients.
Alcohol has long been associated with the development of headaches, with about one-third of patients with migraine noting alcohol as a trigger.
Based on this association, population studies show that patients with migraine tend to drink alcohol less often than people without migraine.
Wine in particular is an alcoholic beverage that has been linked to headaches dating back to antiquity when Celsius (25 B.C.–50 A.D.) described head pain after drinking wine.
Despite this commonly held belief, there is very little scientific evidence to support the belief that wine is a more common trigger of headaches than other forms of alcohol.
The studies that have been conducted suggest that red wine, but not white and sparkling wines, trigger headaches independent of how much a person drinks in less than 30% of people. Lower quality wines may cause an alcohol headache due to the presence of molecules known as phenolic flavonoid radicals, which may interfere with serotonin, a signaling molecule in the brain involved in migraines. In one study, the odds of a person citing red wine as a trigger of an alcohol headache were over three times greater than the odds of indicating beer as an alcohol headache trigger. In some studies, it was observed that spirits and sparkling wines were associated with migraines significantly more frequently than other alcoholic beverages.
Alcohol as a Migraine Trigger
Many foods are considered capable of triggering migraine attacks, but the relationship is frequently equivocal. Perhaps, only alcohol has what is to be considered a sure dietary trigger, but its importance is still debated. Many retrospective studies show that alcoholic drinks act as migraine triggers, at least occasionally, in about one-third of migraine patients, and as frequent/consistent triggers in about 10% of patients. 
Alcohol Withdrawal Headache
Alcohol withdrawal isn’t pretty; it can trigger a host of unpleasant physical and psychological symptoms that can last a few days or as long as a few weeks. Some are mild and flu-like, with little cause for concern. Other symptoms can be severe, life-threatening, and require inpatient treatment. Fortunately, alcohol withdrawal headaches aren’t usually part of the latter category. They are a fairly commonplace symptom and on their own are not a cause for alarm.
The cause of alcohol headache is the same as a withdrawal itself. Alcohol withdrawal happens when the body has developed a physical dependence on the substance. The brain has learned to compensate for the dulling effect of alcohol by constantly releasing extra chemicals in order to keep up functions as normal. This overstimulation becomes the new normal – even when alcohol is no longer present. The discomfort that occurs is the adjustment period of chemical production returning to normal.
Alcohol withdrawal is not a clear-cut process. It can vary widely from person to person based on the severity of their drinking habits, and get very messy in the interim before the body re-adjusts to functioning without alcohol. Therefore, alcohol withdrawal-induced headaches can be difficult to predict. The average withdrawal process can take a few days or, in rare cases, over a month to pass.
Headaches are one of the first symptoms of alcohol withdrawal to occur. They typically do so within the first 24-hours and can range in intensity from mild to severe (migraine-like). Headaches are often one of the first indicators the withdrawal is occurring. Withdrawal isn’t the only condition associated with alcohol headache after heavy drinking, however. Hangovers are also known to leave heads pounding and bleary after a night of heavy drinking. Sometimes, hangover symptoms can be so severe that it is mistaken for withdrawal.
Types of Alcohol Withdrawal Symptoms
Alcohol withdrawal symptoms can occur within hours after your last drink. However, the time distinction is not as important as the severity of the symptoms and does not follow a linear time-based schedule. Minor, moderate, or severe symptoms of withdrawal can occur at the very onset of the withdrawal process. 
The first stages of withdrawal begin around the 6-hour mark. Symptoms typically peak around the 48-hour mark and subside in intensity. Persisting symptoms that occur or worsen are usually attributed to delirium tremens, the most severe type of withdrawal.
Minor Symptoms (Common)
The most common withdrawal symptoms are ones that affect the autonomic nervous system. These are functions that regulate the body’s automatic body functions like breathing, heart rate, digestion, reflexes, sneezing, etc., and typically cease after 48 hours.
- Alcohol headache
- Dilated pupils
- Higher blood pressure
- Higher body temperature
Moderate Symptoms (Less Common)
Moderate symptoms include psychological side effects. These can begin 12-24 hours after withdrawal begins, and lasts significantly longer, for up to 6 days.
- Hallucinations (visual, auditory, or touch)
Severe Symptoms (Uncommon)
- Fast breathing
- Extreme sweating
- Delirium tremens
How to Stop Alcohol Headaches
It is clear that quantity can play a role in triggering an alcohol headache, and quality probably plays a role, but we do not know for sure how any type of wine or alcohol will affect people with migraine or who are prone to headaches. Like food triggers, the likelihood of a particular type of alcohol triggering an alcohol headache is probably different from person to person. If you suffer from migraines, talk with your doctor about how alcohol may affect you.
What’s the Treatment?
Withdrawal headaches are triggered by the absence of alcohol in the system, while hangover headaches are caused by too much alcohol being consumed at once. So while the pain may feel the same, the underlying cause of a withdrawal alcohol headache is much more serious.
If you have begun to experience alcohol withdrawal symptoms, it is recommended to have a medical intervention for the alcohol detox process. Contact us today to learn more.
For those suffering from addiction, We Level Up FL is here. As a licensed and accredited rehabilitation center, we are dedicated to helping you meet your goals, one day at a time.
In an effort to help you find and maintain sobriety, we favor a personalized approach to care. From the moment you begin with us, our counselors will help you find a path that fits with your background, your substance(s) of choice, your lifestyle, your interests, and your unique needs.
To best customize our services to your needs, our programming includes:
If you are considering alcohol addiction treatment to stop your alcohol headache or for someone you love, We Level Up FL can help. Please contact us today for a confidential consultation with a member of our intake team.
 Alcohol and headaches – https://www.health.harvard.edu/blog/alcohol-and-headaches-2018102615222
 Alcohol as a Migraine Trigger – https://www.webmd.com/migraines-headaches/migraine-triggers-alcoho
 Alcohol and Headaches – https://headaches.org/2021/12/30/alcohol-and-headaches/
 Alcohol-induced headaches: Evidence for a central mechanism? – National Center for Biotechnology Information, U.S. National Library of Medicine
 Level Up Lakeworth – https://leveluplakeworth.com/is-alcohol-withdrawal-headache-normal/