We may finally know what causes red wine headaches

Reddit’s popular wine community is full of stories about the dreaded “red wine headache.”

“I love red wine and I don’t want to have to give it up forever, but after a few glasses, the next day I can barely function as I have a pounding headache that doesn’t go away!” one member lamented.

“I can still drink white wine, rosés, and ports without issue. But no matter what red I have, a nasty headache ensues,” another described.

“People generally role [sic] their eyes at me when I tell them this and say I just drank too much…” a third wrote.

Is there something to these complaints? Does drinking red wine actually trigger headaches separate from hangover headaches?

It’s not a hangover

Those afflicted are not crazy: Scientific research has shown that red wine does indeed cause headaches more than other forms of alcohol, even white wine. These headaches can arise just a half hour after drinking only a couple glasses. The curious condition was initially given credence in a study published in The Lancet back in 1988. Scientists had subjects drink either red wine or vodka (disguised to look the same) — in equivalent amounts and with the same alcohol concentration – and found that the red wine triggered migraines far more often.

Thirty-five years later, “red wine headache” still hasn’t been satisfactorily explained. Researchers have scrutinized various compounds that are uniquely prevalent in red wine, like sulfites and histamines, to see if they might be behind the malady. Alas, controlled studies and indirect evidence have vindicated them.

Blame quercetin

Now, two chemists at the University of California-Davis and a neurologist specializing in headache from the University of California-San Francisco have proposed a new culprit, and they present some strong early evidence to support their accusation.

That culprit is quercetin. Found in all sorts of fruits and vegetables, as well as red wine, the flavonoid compound is widely considered to be beneficial, with anti-inflammatory properties. But, as authors Apramita Devi, Morris Levin, and Andrew Waterhouse demonstrate in their paper, which was published in the journal Scientific Reports, quercetin consumed in the presence of alcohol can cause a problem.

To break down alcohol, the body metabolizes it first to acetaldehyde, then to acetate, and finally to water and carbon dioxide. In the bloodstream, quercetin is transformed to quercetin glucuronide. The trio showed that this derivative inhibits a key enzyme called ALDH2, which converts acetaldehyde to acetate. This causes acetaldehyde to build up in the body, which can produce adverse effects such as nausea, facial blushing, and headache.

Red wine headache explained?

The researchers further estimated that one drink of red wine could slow acetaldehyde metabolism by 37%. People whose bodies aren’t as efficient at metabolizing alcohol, who are uniquely susceptible to acetaldehyde’s effects, or who are already prone to migraines or headaches would be more likely to suffer from red wine headache.

“We think we are finally on the right track toward explaining this millennia-old mystery,” Levin said in a statement. “The next step is to test it scientifically on people who develop these headaches.”

Levin and his co-authors already have a clinical trial on humans planned. The forthcoming experiment will have subjects drink red wines with varying levels of quercetin to see if imbibing higher amounts of the compound increases the rate of headache.