Abstract
The aim of this study was to critically evaluate and compare the different methods to assess overall hangover severity. Currently, there are three multi-item hangover scales that are commonly used for this purpose. All of them comprise a number of hangover symptoms for which an average score is calculated. These scales were compared to a single, 1-item scale assessing overall hangover severity. The results showed that the hangover symptom scales significantly underestimate (subjective) hangover severity, as assessed with a 1-item overall hangover severity scale. A possible reason for this could be that overall hangover severity varies, depending on the frequency of occurrence of individual symptoms included in the respective scale. In contrast, it can be assumed that, when completing a 1-item overall hangover scale, the rating includes all possible hangover symptoms and their impact on cognitive and physical functioning and mood, thus better reflecting the actually experienced hangover severity. On the other hand, solely relying on hangover symptom scales may yield false positives in subjects who report not having a hangover. When the average symptom score is greater than zero, this may lead to non-hungover subjects being categorized as having a hangover, as many of the somatic and psychological hangover symptoms may also be experienced without consuming alcohol (e.g., having a headache). Taken together, the current analyses suggest that a 1-item overall hangover score is superior to hangover symptom scales in accurately assessing overall hangover severity. We therefore recommend using a 1-item overall hangover rating as primary endpoint in future hangover studies that aim to assess overall hangover severity.
Highlights
The alcohol hangover is defined as the combination of negative mental and physical symptoms which may be experienced the day after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero [1,2]
Hangover symptoms can vary in their presence and severity between different drinking events in the same individual, and not all symptoms have equal impact in terms of impairment or being bothersome, regardless of their severity
It is evident that composite, multi-item hangover symptom scales will likely underestimate severe hangovers and, at the same time, overestimate light hangovers, partly masking the true hangover effect
Summary
The alcohol hangover is defined as the combination of negative mental and physical symptoms which may be experienced the day after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero [1,2]. Overall hangover severity may be assessed with a single item rated on a scale ranging from absent (0) to extreme (10) This 1-item score is hypothesized to encompass all symptoms experienced by the drinker, including their relative impact on daily activities and mood. There are three important reasons why aggregate symptom scores may deviate from the true hangover effect These are related to (1) the relative presence and severity of hangover symptoms, (2) the impact of the experienced symptoms on cognitive functioning, physical activities, and mood, and (3) the fact that several assessed symptoms are experienced without having a hangover, or even without consuming alcohol at all.
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