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Neurological Conditions: Red wine and HeadachesIntroductionRed wine and headaches? Yes headache can indeed occur in certain individuals even with a small amount of drinking red wine and it is called as RWH (red wine headache). Although any kind of alcoholic beverages may precipitate headache in some susceptible people, but this one looks like a distinct entity. Those people who get the RWH do not generally experience severe headache with white wine or other alcoholic drinks (beer, whisky, gin etc), rather they get severe headache essentially during or after consuming red wines. What causes it?
It is still a mystery as to what exactly precipitates this headache. Several hypotheses have been put forward. The following substances have been blamed for this headache; • Sulfites Sulfites are present in other wines too so that cannot be victimized so easily. Although histamine present in wine, especially the higher concentration of red wine makes it look like it is the culprit but a study has shown that the histamine concentration does not make much difference, means people experienced headache even when the histamine concentration was low. Serotonin is a neurochemical (neurotransmitter) and it has been blamed for migraine headaches but patients with RWH do not necessarily suffer from migraine so makes everything confusing. Tannins are blamed too but exactly how they precipitate the headache is not clear. Prostaglandins may as well the mediators of this headache as some of them can be prevented by taking a prostaglandin inhibitor like ibuprofen. However there is no confirmation on this suggestion yet. How does the patient present?
The headache episodes typically occur after the consumption of red wine. It may occur in about 15 to 30 minutes or sometimes later. Some patients experience a migraine type headache after the wine drink. Patients may experience flushing (dilatation of blood vessels and excessive blood flow to face and other areas of the body), nausea, vomiting etc. Diagnosis
If the history is typical then no need of any special investigations like a CT or MRI of brain. But in less clear cut cases it is better to get one of these tests just to make sure that nothing was missed. Treatment
Once the headache started NSAIDs (non steroidal anti-inflammatory drugs like ibuprofen, naproxen) can be tried. Sometimes taking these pills prior to the drinking session might prevent the headache episode. Antihistaminic drugs may help if histamine is causing the headache. All these drugs do carry side effects like gastrointestinal bleed, severe sedation etc so not routinely recommended. SynopsisProbably the wisest method to prevent this type of headache is to avoid consuming red wines unless somebody has some strong reason to stick to it. A neurologist is commonly involved in the management of headache induced by red wines.
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