Red wine headache
||This headache disorder article lacks information pertaining to its ICHD-2 diagnostic criteria and/or classification.|
Red wine headache ("RWH") 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.
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 lunchmeat 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. It is unclear if consuming alcohol in combination with sulfites may have a different effect.
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 bacterially 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.
Other experts[who?] think tannins are the cause 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). Grape varieties like Sangiovese, Gamay (Beaujolais), Tempranillo, and the Italian grapes Dolcetto and Barbera, are less tannic. Also, grapes grown in certain wine regions are less tannic, like French reds from Burgundy, and Spanish wine regions like Spanish Riojas.
French reds from Bordeaux, and Italian reds like Barolo and Barbaresco (both made from Nebbiolo grapes), are particularly tannic. Vintage port is also very tannic when young, as are wines made from the Syrah (Shiraz) and Cabernet Sauvignon grapes.
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.
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.
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 (Advil), paracetamol (Tylenol) 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 (acetaminophen) was effective in blocking the early stage. However, combining paracetamol/acetaminophen and/or NSAIDs (like ibuprofen) with alcohol are not good for the liver, and can be potentially harmful. Some individuals will experience extreme nausea, vomiting, and abdominal pain when combining alcohol with acetaminophen and/or NSAIDs. The combination should never be used.
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 F.G.Freitag of Diamond Headache Clinic in Chicago.
It has also been postulated[who?] that RWH could be caused by a strain of yeast or bacterium found in red wine. This strain is a laboratory created malolactic strain that is used in almost all red wines. Malolactic fermentation, or known as the secondary fermenation, is creating biogenic amines (bioamines) that are getting people sick. UC Davis creates this lab culture, and now they are going back to the lab to genetically modify this strain of malolactic to prevent bioamines. The strain ML001 is a prime example of a malolactic culture that is genetically modified.
- 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.