Headache and Alcohol

Abstract

The notion that alcohol intake may trigger headache is well known. Historical data as well as clinical experience indicate that this may be the case for headache patients as well persons without known headache disorders. This monograph reviews the medical literature about alcohol as a headache trigger, what headache types are triggered, and why. Literature search primarily using the terms "alcohol and headache," "migraine and alcohol," "cluster headache and alcohol," and "alcohol hangover headache," as well as combined search, was performed, limiting the search to the last decade. Relevant articles were picked. The search "alcohol and headache" yielded 918 hits for the decade 2004-2014. Combined search gave substantially less, and 30 papers were reviewed, of which 25 are included in this review. Epidemiological studies find some correlations between alcohol intake and mainly primary headache disorders, such as migraine and cluster headache. Cultural differences in alcohol consumption are probably reflected in some of the results and conclusions. Both migraine and cluster headaches may be triggered by alcohol; however, which type of alcoholic beverage triggers these headaches is not clear. There is no single mechanism that explains the pathophysiology of alcohol-induced headache, other that hangover headache in some may be triggered by inactive alcohol dehydrogenase 2. Alcohol-induced headache may be diagnosed as a secondary headache, while in patients with migraine or cluster headache alcohol intake may act as a trigger for these primary headaches. Based on the literature, there is no reason to tell headache patients in general to abstain from alcohol. Individual dispositions as well as cultural factors may play a role in alcohol-induced headache.