Ask the doctor: What causes red wine headaches?

Ask the doctor

red wine headache

Q. I get headaches after drinking red wine. Why? I'm 56 years old and in excellent health.

A. Getting a headache after drinking red wine seems to be common, but no single explanation has been found. Several theories have been proposed, but none has much evidence behind it.

One theory holds that the culprit is histamine, a compound found in grape skins. Red wine contains more histamine than white wine because it's made from the whole grape (including the skin), not just the juice. Some people have a shortage of an enzyme that breaks down histamine in the small intestine. Alcohol also inhibits the enzyme, so the combination may boost histamine levels in the blood, which can dilate blood vessels and cause a headache.

Tannins, another grape-skin constituent, could be at fault. Tannins are plant chemicals that impart flavor to red wines and contain antioxidants. But they also spur the release of the neurotransmitter serotonin, which at high levels can cause headaches in some people. Other plant chemicals (polyphenols) may be involved.

Some experts think that sulfites, a preservative in wine, are to blame. But sulfite sensitivity usually causes breathing problems rather than headaches. Moreover, many white wines and other foods also contain sulfites.

These potential culprits vary from wine to wine, so if you don't want to give up red wine altogether, you might try different brands or grape varieties to see how they affect you. When you try a new red wine, start with less than half a drink. If it's going to give you a headache, it'll do so within 15 minutes.

Any alcoholic beverage can dilate blood vessels in the brain and cause a headache. Avoid drinking wine, beer, or liquor on an empty stomach or when you're dehydrated. Try to drink a glass of water between glasses of wine. And limit your wine intake. One glass per day is most healthful. But if you have two at a sitting, they should be separated by at least an hour.

To learn more about headaches, their causes and ways to prevent them, purchase Headaches: Relieving and preventing migraines and other headaches from Harvard Medical School.