Red wine headache
Red wine headache ("RWH") is a headache often accompanied by nausea and flushing that occurs after consuming red wine in susceptible individuals. White wine headaches have been less-commonly reported. Dr. Frederick G. Freitag, a headache specialist and associate professor at the Medical College of Wisconsin, believes red wine headaches are likely linked to tyramine and tannins in wine. Dan L. Keiller, president of the Medical Wine Interest and Education Society, reports that histamine in wine may be a cause as well.
Many wines contain a warning label about sulfites, and some people believe that sulfites are the cause of RWH and other allergic and pseudoallergic reactions. However, this may not be the case. Dried fruit and processed foods like lunch meat have more sulfites than red wine. Reactions to sulfites are not considered a "true allergy" and reactions more commonly occur in persons with asthma and may manifest themselves in difficulty breathing or skin reactions, rather than headache.
Some wines may be exempt from including a sulfite warning. Wines that have under 10mg/l of sulfites do not need to be labeled that they contain sulfites. This includes added and natural sulfites, like sulfites that come from the soil, or those produced by yeasts during alcoholic fermentation. Wines labeled "100% Organic", "Organic", "Made With Organic Grapes", "Made With Organic and Non-Organic Grapes" or without organic certification may contain sulfites, and must disclose this on the label. This also means that the so called "Natural" wine can also contain sulfites. Different rules might apply in different continents.
Histamine is present in a variety of fermented products such as wine, aged cheeses, and sauerkraut. Red wine has 20–200% more histamine than white wine, and those who are allergic to it may be deficient in the enzyme diamine oxidase. Experts believe that in some individuals, alcohol consumption may lead to elevated plasma histamine levels even in the absence of histamines in the beverage consumed. A study of 16 people with an intolerance to red wine found no difference in reactions to low and high histamine wines. Other biogenic amines may also have an effect. Taking an antihistamine an hour before drinking may reduce the reaction to histamine and the resulting symptoms.
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. Ibuprofen, paracetamol and aspirin are prostaglandin inhibitors. Aspirin and ibuprofen were shown to be effective at blocking both early and late stages of the RWH, and paracetamol was effective in blocking the early stage. However, paracetamol and NSAIDs like ibuprofen must not be taken with alcohol as the combination can cause liver damage.
Tyramine, produced by aging (decarboxylation of tyrosine) of foods containing protein, including aged cheeses, overripe and dried fruit, sauerkraut, soy, and many processed foods, may be a major player in RWH syndrome.
- What's really causing that red wine headache Debbie Carlson, Chicago Tribune, May 25, 2016
- Why Do I Get Headaches From Wine? Dorothy J. Gaiter and John Brecher, Wall Street Journal, October 2000.
- K. MacNeil The Wine Bible pg 34 Workman Publishing 2001 ISBN 1-56305-434-5
- "Sulphites - One of the ten priority food allergens". Health Canada. Retrieved 2 May 2014.
- "Guidelines for Labeling Wine with Organic References". US Department of Agriculture, Agriculture Marketing Service. Retrieved 2 May 2014.
- Maintz, Laura; Novak, N (May 2007). "Histamine and histamine intolerance". American Society for Clinical Nutrition. 85 (5): 1185–1196.
- Kanny, Gisele; et al. (February 2001). "No correlation between wine intolerance and histamine content of wine". Journal of Allergy and Clinical Immunology. 107 (2): 375–378. doi:10.1067/mai.2001.112122.
- 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.