How important is alcohol as a trigger of migraine?
A food may be likely considered a trigger of a migraine attack if: a) a strict time relationship exists between the consumption and the start of headache, b) that this link is not occasional. From retrospective patient reports, it is very difficult to make sure a link exists. In fact, especially in the drug-new symptoms example, a possible link to other frequent triggers (stress, post-stress, fear, anxiety, menstruation, weather changes, etc) must be considered. When chocolate was studied to assess a chocolate trigger-headache link no connection was found with migraine and tension-type headache. Many consider alcohol to be a sure migraine trigger, but its importance is still debated.
What is the interval from alcohol consumption to the start of headache?
Alcohol can trigger a migraine attack within a few hours (30 min to 3 hours). This is the typical headache induced by alcohol. Another type is the delayed alcohol-induced headache (DAIH). This hangover headache appears in the next morning after alcohol intake. At this time the blood alcohol level is falling and reaches zero. The symptom of headache is present in 2/3 of subjects with alcohol hangover. The DAIH can be experienced by anyone, but people with migraine are more susceptible. Furthermore, migraine patients can develop headache with the ingestion of modest amounts of alcohol. All alcoholic drinks can provoke either immediate or delayed headache.
Should migraine patients avoid alcohol consumption?
Alcohol in low dose, especially of red wine, reduces the risk of cardiovascular disease. Migraine, specifically with aura or high frequency, increases the risk of some cardiovascular diseases. The unselective suggestion of alcohol abstinence for all migraine patients is not correct. In fact, patients with high migraine frequency with increased risk of ischemic stroke may benefit from a low dose of alcohol. Certainly alcoholic drinks may trigger migraine and tension headache in some subjects. This is probably much less likely than that suggested by patient’s recall. Moreover, it is frequently necessary to consume alcohol along with other factors (anxiety, stress events, emotions etc) to trigger a headache attack. Before alcohol is considered responsible for a migraine attack, the patient should review certain factors. These include careful recording of the intake of the amount of alcohol, the specific drink types, the frequency of induced-headache to the amount and type and the 48 hours prior to headache and any "situation" or "stress" prior to the alcohol intake. If you find consistent agreement among these factors and the headache, alcohol is possibly causing headaches.
This article is a legacy contribution from the American Headache Society Committee for Headache Education (ACHE) and the Fred Sheftell, MD Education Center.