July 17, 2002
By MARIAN BURROS
FOR some people, a glass of red wine is an invitation to a
roaring headache. After a few such episodes, which usually
include a feeling of queasiness, those who suffer them may
banish wine from their tables for life.
The symptoms are part of a syndrome known as Red Wine
Headache, or R.W.H.
"The red wine headache is a real if poorly understood
phenomenon," says an article in the June issue of the
Harvard Health Letter. That is a masterpiece of
There are many theories about what causes the syndrome, but
few facts. Dr. Fred Freitag, associate director of the
Diamond Headache Clinic in Chicago, said no one really
knows what leads a patient to develop this type of
It may be caused by "compounds found in the skins of grapes
and they are either naturally occurring or produced through
fermentation," Dr. Freitag said. He would postulate no
further. "It's not as if there are hundreds of thousands of
dollars for funding" studies to determine the cause, Dr.
Freitag said. There is actually a stigma to studying the
"I've entertained the idea of looking for grants to study
this and I've been told, `Don't go there, it's bad P.R.,' "
Dr. Freitag said. Bad publicity comes to those who would
study drinking? Carry Nation is with us yet.
Sulfites used to take the blame for R.W.H. About 20 years
ago the Food and Drug Administration determined that about
1 percent of the population is allergic to sulfites and
required that wines containing certain levels of the
compound be labeled "contains sulfites." Many people have
assumed, incorrectly, that the labeling is designed to warn
people who get a red wine headache.
Scientists have pointed out, however, that because of their
higher sugar content, many sweet white wines contain more
sulfites than red wines - yet do not cause headaches in
those who suffer from R.W.H. Additionally, dried fruits
usually contain sulfites but you never hear of dried fruit
Sulfites can cause an allergic reaction, Dr. Freitag said,
but they give headaches only to asthmatics. The more common
reaction to sulfites is a breathing problem.
Other experts say that the tannins in red wine are at the
root of the headaches. Tannins are the flavonoids in wine
that set one's mouth to puckering. The Harvard Health
Letter notes several well-controlled experiments showing
that tannins in the blood cause the release of serotonin, a
neurotransmitter. High levels of serotonin can cause
headaches and that may happen in people who also suffer
from migraine headaches.
But that does not explain why people who do not get
migraines get the syndrome.
Dr. Marion Nestle, chairwoman of the department of
nutrition and food studies at New York University, added
that no one complains about tea, soy or chocolate headaches
- though all contain tannins.
A third school of thought blames histamines. Histamines are
20 percent to 200 percent more likely to be in red wine
than in white, and those who are allergic to them are
deficient in a certain enzyme. Some experts believe that
the combination of alcohol and that deficiency can cause
the headaches. But a study of 16 people with an intolerance
to wine, reported in the Journal of Allergy and Clinical
Immunology in February of 2001, found no difference in
reactions to low- and high-histamine wines.
For every study proving the hypothesis there is one to
disprove it. Take your pick.
(One recent study suggested that prostaglandins -
substances that contribute to pain and swelling - may cause
Yet for most people who suffer from R.W.H., the hypotheses
are irrelevant. They want to know what to do about the
problem. Some Web sites suggest prevention: for histamine
sensitivity, pop a nonsedating antihistamine like Claritin
(or take an aspirin to stop production of prostaglandins).
Dr. Freitag frowns on this. To lick the problem, he
advises what might be a long, painful and costly
Dr. Freitag, a sufferer of the headaches, said he has found
he can drink some reds and not others. Almost any
California red is fine but only certain reds from France -
nothing in the Burgundy family, though, which includes all
cabernet sauvignon grapes from Italy and Spain. But some of
his patients can only drink French reds.
"If you really like red wine," Dr. Freitag said, "you
should try different brands, different grapes, different
countries of origin. That's the only way you are going to
Here's how to challenge yourself, if you must. Drink a half
a glass of red wine; if it is going to give you a headache,
it will do so within 15 minutes. If there is no reaction,
stick with that wine for the evening, keeping your alcohol
consumption to no more than two glasses. Keep a journal.
And don't confuse R.W.H. with the headache that comes six
hours after a full evening of drinking. That's called a
Complement of The New York Times