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Wine and Headaches -- Maybe Not What You Think

by Sara and Monty Preiser

"This list has some great wines," we said in unison as we sat down for dinner with five others at a new restaurant we were reviewing. "Does anyone have a preference?" one of us asked. A moment passed while everyone looked at each other to see who would speak up, and then one young lady gave an answer we have heard from man and woman alike on way too many occasions. "The sulfites in red wine give me a headache," she said, "so I prefer white." Biting our tongue that evening, we enjoyed some excellent Chardonnay, but later on we resolved to give some column time to this continuing myth.

The myth is NOT that some people suffer from headaches when they drink red wine, because that is factual. What is incorrect is that the headaches are caused by the sulfites in red wine. Modern evidence just does not support that conclusion.

One of the leading articles on this issue appeared in the New York Times in July of 2002, and it is rare one finds a later discussion about headaches and red wines without mentioning this concise and well written Times piece. We borrow from it from time to time in this article, but we have also gone to the primary sources cited by the Times, as well as reviewed other research and opinions.

Studies show that when people experience headaches from red wine, they usually feel queasy as well. These symptoms are part of a recognized, if not well understood, medical syndrome called "Red Wine Headache" (or simply "RWH"). While there seems to be no doubt the syndrome exists, definitive causes of it are as varied as the cure for hiccups.

The most popular reason advanced for these red wine headaches is the presence of sulfites in the wine, but this theory has been pretty well debunked in recent times. Over 20 years ago the Food and Drug Administration determined that a little less than 1% of the population is allergic to sulfites, meaning they lack the digestive enzyme which would allow the processing of sulfites commonly found in foods like lunch meat, sausage, and cheese. Therefore, the FDA required that wines containing certain levels of this compound say so by placing the phrase "contains sulfites" on the label. This information has long been translated by some into a warning that people who get headaches from red wine should stay away BECAUSE OF the sulfites. That is incorrect. The language is intended only as a warning to that small minority who are in fact allergic to sulfites.

What evidence suggests that something other than the sulfites in red wine causes headaches? Primarily the fact that many white wines contain more sulfites than red wines, yet do not cause headaches. Sweeter whites need sulfur (sulfites) to keep their residual sugars from fermenting, and for the dry whites, many winemakers add SO2 (sulfur dioxide, which when in solution forms "sulfites") because the whites need more protection from oxygen than the reds, and SO2 acts as an antioxidant. Thus, in most cases white wines have more sulfites than do reds.

Dr. Fred Freitag, of the Diamond Headache Clinic in Chicago, concluded that, "Sulfites can cause an allergic reaction, but they give headaches only to asthmatics. The more common reaction to sulfites is a breathing problem."

So if sulfites are not the culprit, what is?

Some believe the etiology of the headaches to be tannins, the compounds in wine that come from the skin and seeds. The Harvard Health Letter notes several well-controlled experiments showing that tannins in the blood cause the release of the enzyme serotonin, which in high levels can cause headaches in people who already suffer from migraines. The problem is self evident. This theory does not cover the reason that people who do not suffer from migraines still get RWH. Additionally, other common foods, such as soy, tea, and chocolate contain tannins, and reported headaches from these foods are rare.

Some studies point to histamines in wine as being the cause of allergic-type reactions, especially headaches. Histamines, found throughout the body as well as in plants, animals, and microbes, are also found in food products, especially those that are fermented. Some histamines make blood vessels expand or contract, causing pressure in the head, and, ultimately, a headache. Since histamines are far more common in red wines than whites, could this be the cause? Perhaps, but a study of 16 people with an intolerance to wine reported in the February 2001 Journal of Allergy and Clinical Immunology found no difference in reactions to low and high-histamine wines.

It just seems that every time a potential reason for the red wine headache is postulated, someone shoots it down. It can be quite frustrating, especially to those who are afflicted, and even more so to those who are afflicted and love red wine.

Remember Dr. Freitag? It turns out he is a sufferer of red wine headaches, too, and he reports that he can drink some reds and not others. Almost any California red is fine, he says, but only certain reds from France. Keeping in character, though, Dr. Freitag says some of his patients can only drink French reds.

It is possible that Joe Coulombe, the founder of Trader Joe's, may have an explanation. He opines that most Americans today drink very young California red wines, and more of it since the medical benefits have been accepted. Some of the substances which cause hangovers become inert with age, so Coulombe believes that drinking older wines will reduce exposure to both hangovers and wine headaches. So who knows?

Is there any solution agreed upon by even a small majority of experts? Not really. However, a curious person might try a half glass of red and wait fifteen minutes, by when a headache, if it is to come, will make itself felt. If no pain, then that wine should be no problem. Further, we add our own advice here that the quality of the wine can have a great effect on a possible headache. Stay with the good stuff if possible.

Whether the cause of red wine headaches is histamines, sulfites, tannins, none of them, or all of them, the bottom line is that one should go with what feels best. If red wines are a problem, thankfully there are plenty of great white wines to try. And, finally, the Times offered the best advice when it suggested you don't confuse RWH with the headache that comes six hours after a full evening of drinking. That's usually called a hangover.


Wine writers and educators Monty and Sara Preiser divide their time between Palm Beach County, Florida and the Napa Valley in California. They publish the world's most comprehensive guide to Napa Valley wineries and restaurants titled, appropriately, The Preiser Key to Napa Valley.

Note: This information was accurate when it was published. Please be sure to confirm all rates and details directly with the businesses in question before making your plans.

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