At the office


Andrew N. Wilner

November 19, 2014

As a writer, I’ve often wondered whether my career was hampered by my lifelong intolerance to alcohol. Usually, but not always, the taste of wine on my tongue or the waft of its aroma to my nose initiates a distinct bitemporal throbbing that increases with each sip and reliably obliterates any joy of the moment. Consequently, I have been forced to look askance at any vinous offering—red, white, or rosé. Unlike Hemingway, Fitzgerald, or Parker, my writing muse has been relegated to a daily struggle with sobriety. On the other hand, as a neurologist, I have the gift of first-hand experience with one of my ‘patients’ most common neurologic afflictions, migraine.

A Historical Perspective

A recent review published in the journal Headache and (here on Medscape) investigated the ancient relationship between wine and headache.[1] It seems that Celsus (25 BC-50 AD) and centuries later Paul of Aegina (625-690 AD) were aware of wine as a headache trigger. Of all alcoholic beverages, wine is the most common initiator of headache, particularly red wine. (Note: We are not talking about “hangovers,” which result from quantity rather than quality. Wine-induced headaches may occur, mysteriously, independent of dosage.)

he Underlying Science

Krymchantowski and Jevoux[1] review the possible substances contained within wine that might provoke headache, including histamine, tyramine, phenylethylamine, sulfites, flavonoid phenolic compounds, and 5-hydroxytryptamine. Although sulfites were long believed to be responsible for wine-induced headaches, the authors suggest that this link is “speculative or in fact wrong” because sulfites are present in much higher concentrations in foods that fail to produce headaches. Their review suggests that phenolic flavonoid radicals, with their potential to interfere with central serotonin metabolism, are probably responsible for the unfortunate relationship between wine and headache.

Clinical Studies

Susceptibility to wine-induced migraine is quite variable. In one of the authors’ studies,[2] 11/33 (33%) of migraine patients reported headaches in all four of four challenges with a half bottle of various wines, while the remainder of the group had only three, two, one, or no attacks. In another study,[3] even wine from the same grapes but grown in different countries (French vs South American Cabernet Sauvignon) produced different rates of migraine.

Future Research

People with migraine who wish to drink wine do so at their own peril. However, the aforementioned findings suggests that diligent research may reveal regional varietals that may be better tolerated.


I’ve never credited alcohol as a key ingredient to creative success. Hard work, inspiration, talent, and financial desperation are probably more important. Surely it was not alcohol that inspired the pens of Dylan Thomas, James Joyce, and F. Scott Fitzgerald (although drinking most certainly hastened their demise). On the other hand, alcohol might lubricate one’s pen and dim the glare of that as yet unsullied white page, every writer’s Brobdingnagian fear. For migraineurs, the scintillating scotomas that efface visual fields followed by hammering headaches and constitutional malaise are an unlikely formula for award-winning prose. Just the thought is a sufficient deterrent to put the corkscrew away.

Tea, anyone?


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