Red wine headache
Encyclopedia
Red wine headache is a headache
often accompanied by nausea
and flushing
that occurs in many people after drinking even a single glass of red wine. This syndrome
can sometimes develop within 15 minutes of consumption of the wine.
The condition does not occur after consumption of white wine or other alcoholic beverages. Some individuals report that they get a migraine
headache hours later from drinking some red wines. No one knows for certain why this syndrome occurs. It probably has more than one cause.
and processed food like lunchmeat have far more sulfites than red wine. Less than 1% of the population is sensitive to sulfites.
There are sulfite sensitive individuals who have asthma problems from red wine and dried fruit (such as apricots and golden raisins) that have added (not just natural) sulfites. Some of these sulfite sensitive individuals generally do not have asthma problems from red wine that only has sulfites naturally inherent to the grapes.
s except in rare cases. Red wine has 20–200% more histamines than 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 could cause headaches. However, a study of 16 people with an intolerance to red wine, reported in the Journal of Allergy and Clinical Immunology
(Feb 2001), found no difference in reactions to low and high histamine wines. Taking loratadine
(Claritin) an hour before drinking should reduce the reaction to histamines and the resulting symptoms. This would tell an individual whether histamines were the cause of their problem.
Another solution that has been advanced is to drink a cup of black tea
before you drink the wine. If one 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
. Again, if histamine is not the cause of a given individual's reaction to wine, the antihistamine effects of black tea will be of no more help than the antihistamine effects of loratadine, just as in the example of the previous paragraph.
Wines can also take on tannins from the oak or other woods used in wine barrels for storage. Different woods in different countries affect the type of tannins in the wine.
Tannins help prevent oxidation, an important role in a wine's aging potential. As age-worthy red wines mature, tannin molecules gradually accumulate and precipitate out of the wine in the sediment.
Certain wine styles have much less tannin content than others, due to reduced maceration time (grape juice contact with the grape pulp, including sources of tannin such as stems, seeds).
French reds from Bordeaux
, and Italian reds like Barolo and Barbaresco, are particularly tannic. Vintage port is also very tannic when young, as are wines made from the syrah (shiraz) and cabernet sauvignon
grapes.
French reds from Burgundy
, and Italian wines like Dolcetto and Barbera, are less tannic. Wines made from Pinot Noir
and Sangiovese grapes, as well as Spanish Riojas
are less tannic. Beaujolais
and Tempranillo
are also lower tannin wines.
A quick way to identify these lower tannic wine bottles on a store shelf is to look for the sloped shoulder "Burgundy bottle". This is specially true for European wines, but several new world wineries have also adopted traditional bottle shapes to help consumers distinguish their wines.
There is a difference between the varieties and brands of red wine and the amount one can consume before the headache occurs, but the reports have not been consistent from person to person. Considering how the amount of tannins changes with aging, this would not be surprising.
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 New York University
, added that no one complains about tea, soy, or chocolate headaches though all contain tannins.
The tannins that are extracted from grapes found in red wine are primarily condensed tannins which are polymers of procyanidin monomers. Hydrolysable tannins are extracted from the oak wood the wine is aged in. Hydrolysable tannins are more easily oxidised than condensed tannins.
(Advil), acetaminophen (Tylenol) and aspirin are prostaglandin inhibitors. Some people get good results taking a dose of an inhibitor an hour before consuming red wine. Aspirin and ibuprofen were shown to be effective at blocking both early and late stages of the RWH, and acetaminophen was effective in blocking the early stage. It should be noted that acetaminophen and alcohol are not good for the liver, and can be potentially harmful.
Dr. Lynn Gretkowski, co-founder of WineDoctors.com states that tyramine could be the cause of RWH. Last year, she told The Wine Spectator (May 31, 2009), “Tyramine is thought to be a vassal active substance that causes the dilation and contraction of blood vessels - the squeezing and relaxation component of headaches.” She goes on to say that younger wines and wines that have not been extensively racked or filtered will tend to have higher rates of tyramine. Not all wine has the same level of tyramine present so not all red wine causes RWH symptoms.
While tyramine has not yet been definitely proven as the source of the Red Wine Headache, it seems to be a more probable cause than sulfites or histamine.
or bacteria
found in red wine.
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
often accompanied by nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
and flushing
Flushing (physiology)
For a person to flush is to become markedly red in the face and often other areas of the skin, from various physiological conditions. Flushing is generally distinguished, despite a close physiological relation between them, from blushing, which is milder, generally restricted to the face, cheeks or...
that occurs in many people after drinking even a single glass of red wine. This syndrome
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
can sometimes develop within 15 minutes of consumption of the wine.
The condition does not occur after consumption of white wine or other alcoholic beverages. Some individuals report that they get a migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
headache hours later from drinking some red wines. No one knows for certain why this syndrome occurs. It probably has more than one cause.
Sulfites
Since wines contain a warning label about sulfites many people have assumed that sulfites are the cause of RWH. This is not the case. Almost all wine contains sulfites. Many sweet white wines have more sulfites than red wines. Dried fruitDried fruit
Dried fruit is fruit where the majority of the original water content has been removed either naturally, through sun drying, or through the use of specialized dryers or dehydrators. Dried fruit has a long tradition of use dating back to the fourth millennium BC in Mesopotamia, and is prized...
and processed food like lunchmeat have far more sulfites than red wine. Less than 1% of the population is sensitive to sulfites.
There are sulfite sensitive individuals who have asthma problems from red wine and dried fruit (such as apricots and golden raisins) that have added (not just natural) sulfites. Some of these sulfite sensitive individuals generally do not have asthma problems from red wine that only has sulfites naturally inherent to the grapes.
Histamines
RWH is probably not caused by histamineHistamine
Histamine is an organic nitrogen compound involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Histamine triggers the inflammatory response. As part of an immune response to foreign pathogens, histamine is produced by...
s except in rare cases. Red wine has 20–200% more histamines than white, and those who are allergic
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
to them are deficient in a certain enzyme
Enzyme
Enzymes are proteins that catalyze chemical reactions. In enzymatic reactions, the molecules at the beginning of the process, called substrates, are converted into different molecules, called products. Almost all chemical reactions in a biological cell need enzymes in order to occur at rates...
. Some experts believe that the combination of alcohol and that deficiency could cause headaches. However, a study of 16 people with an intolerance to red wine, reported in the Journal of Allergy and Clinical Immunology
Journal of Allergy and Clinical Immunology
The Journal of Allergy and Clinical Immunology is a medical journal in the field of allergy and immunology. It is the official journal of the American Academy of Allergy, Asthma, and Immunology. The journal was established in 1929 as the Journal of Allergy and obtained its current name in 1971...
(Feb 2001), found no difference in reactions to low and high histamine wines. Taking loratadine
Loratadine
Loratadine is a second-generation H1 histamine antagonist drug used to treat allergies. Structurally, it is closely related to tricyclic antidepressants such as imipramine, and distantly related to the atypical antipsychotic quetiapine. It is marketed by Schering-Plough under several trade names...
(Claritin) an hour before drinking should reduce the reaction to histamines and the resulting symptoms. This would tell an individual whether histamines were the cause of their problem.
Another solution that has been advanced is to drink a cup of black tea
Tea
Tea is an aromatic beverage prepared by adding cured leaves of the Camellia sinensis plant to hot water. The term also refers to the plant itself. After water, tea is the most widely consumed beverage in the world...
before you drink the wine. If one will be drinking over the course of an evening, have another cup or two of black tea during the evening. Quercetin
Quercetin
Quercetin , a flavonol, is a plant-derived flavonoid found in fruits, vegetables, leaves and grains. It also may be used as an ingredient in supplements, beverages or foods.-Occurrence:...
, 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
St. Luke's Episcopal Hospital
St. Luke's Episcopal Hospital serves as the lead hospital for St. Luke's Episcopal Health System, and is based at the Texas Medical Center in Houston. St. Luke's Episcopal Health System also includes St. Luke's Episcopal Health Charities, St. Luke's The Woodlands Hospital, St. Luke's Sugar Land...
in Houston, Texas
Houston, Texas
Houston is the fourth-largest city in the United States, and the largest city in the state of Texas. According to the 2010 U.S. Census, the city had a population of 2.1 million people within an area of . Houston is the seat of Harris County and the economic center of , which is the ...
. Again, if histamine is not the cause of a given individual's reaction to wine, the antihistamine effects of black tea will be of no more help than the antihistamine effects of loratadine, just as in the example of the previous paragraph.
Tannins
Other experts think tannins are at the root of RWH. Tannins are the flavonoids in wine that give its degree of mouth-drying bitterness. The taste is the same as when you bite into a grape skin. Tannin is a chemical substance that comes from grape skins, stems, and seeds. The skins also impart color to wine, which is why red wines typically have a lot more tannin than whites. Red wines are fermented while in contact with the skins and seeds. Modern winemakers take care to minimize undesirable tannins from seeds by crushing grapes gently when extracting their juice.Wines can also take on tannins from the oak or other woods used in wine barrels for storage. Different woods in different countries affect the type of tannins in the wine.
Tannins help prevent oxidation, an important role in a wine's aging potential. As age-worthy red wines mature, tannin molecules gradually accumulate and precipitate out of the wine in the sediment.
Certain wine styles have much less tannin content than others, due to reduced maceration time (grape juice contact with the grape pulp, including sources of tannin such as stems, seeds).
French reds from Bordeaux
Bordeaux wine
A Bordeaux wine is any wine produced in the Bordeaux region of France. Average vintages produce over 700 million bottles of Bordeaux wine, ranging from large quantities of everyday table wine, to some of the most expensive and prestigious wines in the world...
, and Italian reds like Barolo and Barbaresco, are particularly tannic. Vintage port is also very tannic when young, as are wines made from the syrah (shiraz) and cabernet sauvignon
Cabernet Sauvignon
Cabernet Sauvignon is one of the world's most widely recognized red wine grape varieties. It is grown in nearly every major wine producing country among a diverse spectrum of climates from Canada's Okanagan Valley to Lebanon's Beqaa Valley...
grapes.
French reds from Burgundy
Burgundy wine
Burgundy wine is wine made in the Burgundy region in eastern France, in the valleys and slopes west of the Saône River, a tributary of the Rhône. The most famous wines produced here - those commonly referred to as "Burgundies" - are red wines made from Pinot Noir grapes or white wines made from...
, and Italian wines like Dolcetto and Barbera, are less tannic. Wines made from Pinot Noir
Pinot Noir
Pinot noir is a black wine grape variety of the species Vitis vinifera. The name may also refer to wines created predominantly from Pinot noir grapes...
and Sangiovese grapes, as well as Spanish Riojas
Rioja (wine)
Rioja is a wine, with Denominación de Origen Calificada named after La Rioja, in Spain. Rioja is made from grapes grown not only in the Autonomous Community of La Rioja, but also in parts of Navarre and the Basque province of Álava. Rioja is further subdivided into three zones: Rioja Alta, Rioja...
are less tannic. Beaujolais
Beaujolais
Beaujolais is a French Appellation d'Origine Contrôlée wine generally made of the Gamay grape which has a thin skin and is low in tannins. Like most AOC wines they are not labeled varietally. Whites from the region, which make up only 1% of its production, are made mostly with Chardonnay grapes...
and Tempranillo
Tempranillo
Tempranillo is a variety of black grape widely grown to make full-bodied red wines in its native Spain. It is the main grape used in Rioja, and is often referred to as Spain's "noble grape". Its name is the diminutive of the Spanish temprano , a reference to the fact that it ripens several weeks...
are also lower tannin wines.
A quick way to identify these lower tannic wine bottles on a store shelf is to look for the sloped shoulder "Burgundy bottle". This is specially true for European wines, but several new world wineries have also adopted traditional bottle shapes to help consumers distinguish their wines.
There is a difference between the varieties and brands of red wine and the amount one can consume before the headache occurs, but the reports have not been consistent from person to person. Considering how the amount of tannins changes with aging, this would not be surprising.
The Harvard Health Letter notes several well-controlled experiments showing that tannins cause the release of serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
, a neurotransmitter
Neurotransmitter
Neurotransmitters are endogenous chemicals that transmit signals from a neuron to a target cell across a synapse. Neurotransmitters are packaged into synaptic vesicles clustered beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to...
. High levels of serotonin can cause headaches and that may happen in people who also suffer from migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
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 New York University
New York University
New York University is a private, nonsectarian research university based in New York City. NYU's main campus is situated in the Greenwich Village section of Manhattan...
, added that no one complains about tea, soy, or chocolate headaches though all contain tannins.
The tannins that are extracted from grapes found in red wine are primarily condensed tannins which are polymers of procyanidin monomers. Hydrolysable tannins are extracted from the oak wood the wine is aged in. Hydrolysable tannins are more easily oxidised than condensed tannins.
Prostaglandins
RWH could be caused by the release of prostaglandins which some people are not able to metabolize. Prostaglandins are substances that can contribute to pain and swelling. IbuprofenIbuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
(Advil), acetaminophen (Tylenol) and aspirin are prostaglandin inhibitors. Some people get good results taking a dose of an inhibitor an hour before consuming red wine. Aspirin and ibuprofen were shown to be effective at blocking both early and late stages of the RWH, and acetaminophen was effective in blocking the early stage. It should be noted that acetaminophen and alcohol are not good for the liver, and can be potentially harmful.
Tyramine
Tyramine may well be a major player in RWH syndrome. Tyramine is an amine that is produced naturally from the breakdown of protein as food ages. More specifically it is formed by the decarboxylation of the amino acid tyrosine. It is found in aged, fermented, and spoiled foods. Everyday foods we consume including aged cheeses, overripe and dried fruit, sauerkraut, soy, and many processed foods contain high levels of tyramine. Tyramine is suspected of inducing migraine headaches in about 40% of migraine sufferers, according to Dr. F.G.Freitag of Diamond Headache Clinic in Chicago.Dr. Lynn Gretkowski, co-founder of WineDoctors.com states that tyramine could be the cause of RWH. Last year, she told The Wine Spectator (May 31, 2009), “Tyramine is thought to be a vassal active substance that causes the dilation and contraction of blood vessels - the squeezing and relaxation component of headaches.” She goes on to say that younger wines and wines that have not been extensively racked or filtered will tend to have higher rates of tyramine. Not all wine has the same level of tyramine present so not all red wine causes RWH symptoms.
While tyramine has not yet been definitely proven as the source of the Red Wine Headache, it seems to be a more probable cause than sulfites or histamine.
Other possibilities
It has also been postulated that RWH could be caused by a strain of yeastYeast
Yeasts are eukaryotic micro-organisms classified in the kingdom Fungi, with 1,500 species currently described estimated to be only 1% of all fungal species. Most reproduce asexually by mitosis, and many do so by an asymmetric division process called budding...
or bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
found in red wine.