Hangover headache can also be referred to as veisalgia cephalalgia. Veisalgia refers to hangover and cephalalgia to headache. Hangover headaches are a type of delayed headaches and due to its cause, is commonly known as delayed alcohol induced headache. When you are a victim of alcohol intoxication, throbbing headaches the morning after are what you commonly associate hangovers with. Not that hangover headaches occur in the morning; mornings are approximately within the range of 4-20 hours after moderate to heavy drinking within which headaches ensue. Alcohol triggers a headache within 30 minutes to 3 hours.
Ever had a migraine? Well, alcohol hangover headaches are similar in manifestation as does migraines. Migraineurs will mention a more severe headache than will non-migraineurs. Similarly, people who have consumed less alcohol may complain of less kabobs than those who have had a good number of bottles. Another variance in the grade of headaches is the type of alcohol drink consumed. Was it red or white wine, vodka, gin or whisky?
The cause of hangover headaches is obvious from its name but not so when you go deeper into the individual chemicals. Clinical studies that have been conducted have been retrospective. While retrospective studies involve questionnaire filling and compilation of past events, they are not able to explain the mechanism.
However, here are a number of possible biochemical explanations that have done well in explaining the mechanistic approach to the pathology of headaches.
Hangover headache causes
Alcohol as a cause of headache is very shallow and cliché. Looking at the individual components of alcoholic drinks, you will understand the actual cause.
This compound which is responsible for the toxic effects of ethanol, seemed to lack any substantial effect in the brain (Hunt 1996) due to the following reasons:
i. The liver works tirelessly to metabolize acetaldehyde into acetate reducing its serum concentrations to levels that are not identifiable. It had been found that after consumption of alcohol, its concentration is nearly one micromole.
ii. In cases where the serum concentration of acetaldehyde is relatively higher due to reasons such as low function of the enzyme acetaldehyde dehydrogenase or drug induced, this compound is still not able to pass the blood brain barrier. This is explained by the presence of the enzyme that degrades it into acetate at this location according to Boris Tabakoff, University of Colorado.
iii. Upon inhibition of this scavenging enzyme, and therefore a rise in the concentration of acetaldehyde, intoxication still occurred.
However, more research has indicated that the brain is able to oxidize ethanol itself and produce acetaldehyde. This is effectively done under the action of catalase, alcohol dehydrogenase and microsomal enzymes. Most reviews have in deed suggested the implication of acetaldehyde in hangover headaches (Swift R, Davidson D (1998)) . Acetaldehyde upsurge in the blood vessels of the brain result in competitive inhibition of the production of endogenous aldehydes as the body thinks it has enough of aldehydes. Therefore, aldehydes produced from some neurotransmitters such as serotonin, results in an increase of serotonin,and norepinephrine. Serotonin may be responsible for the headache by causing vasoconstriction of blood vessels. Any change in blood pressure from these neurotransmitters in the cranium causes headaches according to Deitrich and Erwin.
The caveat of all this information is that acetaldehyde is normally rapidly broken down into acetate and its level is not detectable in the blood. This shows that headache hangovers are caused by acetaldehyde by a very small significant proportion.
Since acetaldehyde is broken down by the ADH (Acetaldehyde dehydrogenase), it is most expectedly that the level of acetate should be higher in the serum. The level of acetate is remarkably elevated but in a slow fashion due to the slow action of acetaldehyde dehydrogenase for 6 hours and above. Therefore, the levels of acetate are in millimolar concentration units as opposed to micromolar in the case of acetaldehyde (Wiese JG) . To cap it all up, acetate results in headaches with this kind of concentration and such would be seen in hemodialysates with acetate as their buffer. Kidney dialyses using this dialysate have had patients complaining of headaches as a symptom of hyperacetatemia.
Congeners are by-products of fermentation processes involved in the preparation of alcoholic drinks such as wines. They are important for their characteristic color and odor. Reports have suggested that congeners such as sulfites and phenols cause headaches. Some other congeners such as those in red wines and brandy can raise the level of histamine and serotonin. Serotonin is a neurotransmitter that is involved in the pathology of headaches and even migraines. The darker the drink such as in whiskey, brandy and red wine, the higher the amounts of congeners such as acetaldehyde and acetone. Lighter colored drinks such as white wine and gin have less of these. Other congeners such as fusel oil and furfural have not yet been well backed up by research.
Tyramine and histamine are also present in alcoholic beverages. They have been considered probable causes of headaches and migraines. Though there are foods that contain more of these two than alcohol, alcohol has been shown to trigger the production of histamine from mast cells. Tyramine in alcohol is as small as 1-2 mg/L, very small comparable to richer tyramine sources such as meat and cheese. However, tyramine has to be in quantities of between 100-200mg/L to cause tyramine ‘cheese effects’.
Alcohol causes diuresis which is excessive urination which leads to dehydration if not replaced. Dehydration deprives the cranium of water and reduces blood pressure in the cranial blood vessels. This causes an imbalance in the pressure between the intra and extra-cranial blood vessels. In this process, serotonin may be produced to counter the vasodilation and cause a severe headache; a migraine.
Darker coloured drinks such as whiskey, brandy, red wine, have more of these by-products than lighter drinks such as vodka, gin, or white wine. However, certain studies on white wine and spirits suggested more frequent involvement than with darker drinks.
Hangover headache symptoms
There are two types of alcohol induced headaches according to the International Headache Society: immediate and delayed.
In this material, delayed headaches are the hangover headaches and may manifest as follows:
i. Pain on both sides of the head or unilateral
ii. Headache more localized on the forehead.
iii. Head pain that is throbbing and pulsating
iv. Pain that becomes worse on exertion
v. Headache that alleviates 2-3 days after
How to get rid of a Hangover Headache, Cure & Remedies
There are many ways to get rid of hangovers in general and headaches in the process. If you ask different people on how to go about it, you will always receive different answers. However, water has given some extent of neutrality in people of different origins. What is a cure to hangover headaches in the U.S may not be a cure in China. Based on the causes of hangover headaches:
i. Take chug-a-lugs of water after every drink of alcohol you take. It may be cumbersome moving to and fro the loo but it will help prevent dehydration. It will therefore prevent headaches that may result from hypotension. Water will also promote excessive urination that balances that of alcohol being flushed out and in the meantime, toxins will also be eliminated. Rehydrating before going to sleep reduces the pain of headaches hours later.
iii. Drinks that restore the body’s electrolyte balance such as coconut water, Pedialyte and soup
iv. Green leafy vegetables such as spinach and lettuce.
v. Anti-inflammatory foods that counter inflammation due to histamine that would trigger headaches. These include tea-berry and winter-green that have the ability to inhibit enzymes that promote synthesis of potent vasodilators and platelet aggregation.
vi. Fruit juice may also be helpful in rehydration apart from replenishing lost potassium.
vii. Increased serum levels of acetate causes headache via acetate-induced adenosine accumulation. Since coffee inhibits adenosine action, coffee may help alleviate headaches. However, care need to be taken with coffee as it is a diuretic and may further cause dehydration.
viii. Anti-inflammatory drugs may help but caution needs to be taken too in the selection of a drug that will not react with alcohol. Studies have shown that aspirin reduces the ability of the stomach to break down alcohol by 30% as researched by Bronx Veterans Affairs Medical Center and published in The Journal of the American Medical Association. Taking a small dose of aspirin or ibuprofen is safe with alcohol. Paracetamol/Tylenol with alcohol leads to an interaction in which a toxic compound to the kidney is produced as a metabolite. There is a 123% increased risk of kidney disease (WebMd)
Tips & Ideas to Prevent or relief Hangover headache/Migraine
Abstaining from drinking is the best way to prevent headaches and any other symptoms of a hangover. If not possible, have few drinks of less than 5 ounces. However, it is easy to blow the rooftop and overdrink so follow these tips:
1. Take a lot of water before, during and after drinking right before you put yourself to sleep.
2. Make sure that you have had some food that will form a layer on the stomach wall and reduce absorption of alcohol into the system. According to Boris Tabakoff, a researcher at the University of Colorado, food slows down absorption of alcohol.
3. Have lighter drinks as your alcoholic beverages while avoiding the darker ones.
4. Remember class matters too. Have drinks that are considered expensive to most as these are usually well distilled off the congeners
5. Consider practicing some sleep hygiene tips to put yourself to sleep. Such may include basics such as switching off the lights or wearing a face mask. With this, you will not interfere with your REM sleep which is very important.
6. Forget about the hair of the dog theory.
BY HAKEEM KIBOI.