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Red Wine Headaches

Red Wine Headaches

By Harvard Health Publications

Here’s a toast to the good tidings that the occasional glass of wine is something of a health drink. May your favorite Merlot, Cabernet Sauvignon, or Pinot Noir keep your heart strong, your HDL cholesterol high, and, possibly, your brain cells active and well connected! Alas, for some, that toast would be a preamble to a throbbing headache, especially if the wine is red. The red wine headache is a real—if poorly understood—phenomenon.

The Sulfite Story

Sulfites are possibly to blame. They are compounds that contain sulfur and a less-than-optimal number of oxygen atoms. Consequently, they “grab” oxygen before it can react with food and spoil it. In wine, sulfites also control bacteria that might otherwise digest the alcohol content, turning a $50 bottle into some very expensive vinegar. Some sulfites are created naturally during fermentation, as the yeast breaks down sugars in the grape juice into alcohol and carbon dioxide. But wine makers often add more as a preservative.

Sulfites were once considered harmless, but in the 1980s, studies started to show that a small number of people (about 1%, according to the FDA) are sensitive to them. The FDA, therefore, prohibits the use of sulfites on fruit and vegetables intended to be eaten raw, so salad bars and your supermarket’s produce section should be sulfite-free. Depending on their concentration levels and other factors, the sulfite compounds must be included in a food’s list of ingredients. Most wines are emblazoned with a “contains sulfites” warning.

But many experts question whether sulfites are the source of red wine headaches for several reasons. First, breathing problems (including asthma attacks), not headaches, are the more typical reaction to sulfites. Second, red wine is typically the trigger, yet many sweet whites contain more sulfites than reds because they have a higher sugar content. Third, plenty of other foods contain sulfites, so these headaches shouldn’t be particular to red wine.

This doesn’t mean that sulfites in red wine can’t be a problem. For example, red wine has been known to trigger asthma attacks, presumably because of the sulfite content.

The Histamine Hypothesis

White wine is made using only the grape’s juice, or must. Red wines use the entire crushed fruit, including the skins, which contain the biologically active compound histamine. As a result, red wine contains 20-200 times more histamine than white wine.

Some people are histamine-intolerant because of a deficiency in diamine oxidase, an enzyme that breaks down histamine in the small intestine. Alcohol also inhibits the enzyme, so some experts believe that red wine headaches are caused by a combination of wine’s alcohol content and a diamine oxidase shortage. But this theory is contradicted by some studies. For example, a French study in the February 2001 Journal of Allergy and Clinical Immunology of 16 people with “wine intolerance” found no difference in reactions to low- and high-histamine wines. The researchers didn’t dismiss the possibility that histamine plays a role, but suggested that some other ingredient in red wine might boost levels of it in the blood.

The Tannins Tale

Tannins, another constituent of grape skins, give red wine its distinctive pleasant but slightly bitter flavor. They may also explain why red wine is so healthful, because they’re flavonoids, antioxidants found in plant-based food. But here’s proof that there’s no such thing as a free lunch: tannins may cause headaches. Several carefully controlled lab experiments have shown that they provoke blood platelets into releasing serotonin, and high serotonin levels can cause headaches.

Finally, for some people, it may simply be the alcohol. Alcohol, in any drink, is a well-known precipitant of migraine, and some of the headaches set off by wine are migraines.

What You Can Try

If you can tolerate some but not a lot of sulfites, you might try a brand that promises “no sulfites added,” though there are still going to be some from fermentation.

If tannins are the culprit, try a wine with a lower tannin level—Beaujolais instead of Cabernet Sauvignon, for example. Mature wines might be better than young, heavily alcoholic ones, especially if you avoid the sediment.

Some advise taking aspirin or ibuprofen beforehand, although there’s little published evidence that this works.

Histamine hypothesis proponents sometimes suggest a nonsedating antihistamine like Claritin.

Connoisseurs might consider keeping a record of their wine choices and any headaches to figure out which to avoid—and just hope that the wines causing a problem aren’t their favorites.

Last Updated: 06/02

Copyright (c) 2006 by the Presidents and Fellows of Harvard College. Used with permission of StayWell. All rights reserved. Harvard Medical School does not approve or endorse any products on the page. Harvard is the sole creator of its editorial content, and that advertisers are not allowed to influence the language or images Harvard uses.