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Wine and...Headaches
By Rebecca Murphy
Feb 14, 2017
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Some people believe that the sulfites in wine give them a headache.  It’s true that there are those who get headaches after drinking even a small amount of red wine.  However, research has eliminated sulfites as the cause.  Actually, researchers are still trying to determine precisely which component of wine might cause a headache.

The whole issue of wine-induced headache is complicated.  So is the issue of whether sulfites cause problems.  First, many wine drinkers believe that American wine producers started adding sulfites to wines in the1980s.  American wine producers, with a few exceptions, have always put sulfites in their wines.  So do wine producers from other parts of the world.

Sulfites, or sulfur dioxide, have been used since the Romans and Egyptians started making wines.  Since the 1800s in the United States, sulfur dioxide has been widely used as a food additive to prevent browning and spoilage.  Winemakers use sulfur dioxide to keep barrels and other equipment clean and to prevent oxidation in the wine.  It is also used to kill bacteria and yeasts.  Even if the winemaker does not add sulfites during the wine making process, fermentation itself produces sulfur dioxide.

The misconception that wine makers suddenly started adding sulfites to wine grew out of a federal government mandate in the late 1980s that stipulated that wines containing more than 10 parts per million (PPM) of sulfur dioxide should carry a label stating "contains sulfites."  Suddenly, we consumers became aware of sulfites.

However, we are exposed to sulfites in food products, in some pharmaceuticals and as pollutants in the atmosphere.  Dried, canned or frozen fruits, fried potatoes, seafood and beer usually contain sulfites.  Interestingly, other food products that contain sulfites, such as dried fruits are not required to be labeled despite the fact that they may contain as much as 10 to 100 times as much sulfites as wine.

So why does it matter how much sulfur dioxide is in a bottle of wine?  For most people, it is not a problem, but for a very small group with asthma, sulfites can cause a severe allergic reaction.  These people may have symptoms like a skin rash, allergic shock, also known as anaphylaxis, wheezing, chest tightness, cough, flushing, weakness, slowed heart rate, runny nose, tearing, shortness of breath, and loss of consciousness.  In fact, a dose of four to six grams, about 100 times the amount of sulfur we are normally exposed to in a day, can cause nausea, vomiting, and gastric irritation.  Sulfites, like everything else in our environment, can be harmful when the dose is high enough.

Headaches come in many forms, but it is primarily those that stem from the expansion of blood vessels, or vascular headaches like migraine and cluster, that are associated with food sensitivities.  Researchers have focused their suspicions on a couple of different culprits: amines and phenolic compounds.  Amines are small compounds common to plants, animals and microorganisms.  One amine you are probably familiar with is histamine.  Phenolic compounds provide much of the flavor components of wine and include tannin, which is an important agent for the structure and aging ability of red wine. Tannin is also a major component of tea.  When you taste a red wine or a tea and you feel like you have a coating on your teeth, you are feeling the tannins.  Both amines and phenolic compounds occur naturally in wine.

Based upon the research on amines and phenolic compounds, it appears that wine associated headache is not an allergic reaction, but a chemical one.  For amines, the process may involve the lack of or a deficiency of certain kinds of enzymes needed to metabolize various types of amines. In red wine these would be histamine and tyramine.  There is at least one research study that found levels of tyramine to be the about the same in red and white wines.  Researchers agree that the levels of these amines are not high enough in wine to be a problem for most people.  For phenolic compounds, it is possibly a process involving blood platelets and serotonin, which is known to play a role in causing regular migraine headaches.  In either case there has not been enough research to confirm or eliminate the role of either amines or phenolic compounds in headaches.

The late Herb Kaufman, an allergist in San Francisco, conducted research on the "red wine headache."  He said it occurs within minutes of drinking as little as two ounces of red wine and the sufferer will experience maximum pain in two hours.  The headache may recur eight hours after drinking red wine.  While Kaufman was not able to determine what causes the red wine headache, he was able to eliminate sulfites and yeasts as the culprits.

Kaufman suggested several steps that a person can do to help prevent red wine headache.  Avoid drinking wine on an empty stomach, a recommendation based on many factors.  Besides making food taste better, drinking wine with food keeps blood alcohol levels lower than drinking wine without food.  Allow plenty of time between drinking wine and going to sleep.  Try some mild physical exercise, like a walk, before or soon after drinking wine.  Avoid liqueurs, cordials or chocolate and red wine at the same meal.  Drink a small amount of red wine on a frequent basis to develop a partial resistance. 

Researchers found that those people who drink small to moderate amounts of wine or other alcoholic beverages on a regular basis rather than drinking large amounts in one drinking occasion, say Saturday night have a lower risk of heart disease and a lower risk of dying from all causes.  Most importantly for suffers of red wine headache, Dr. Kaufman suggested taking aspirin (650 mg or two standard tablets) or ibuprofen (400 mg or two standard tablets) about 30 minutes before drinking red wine.  This can help prevent the headache.

There have been reports of people developing other reactions to the alcohol in wine, beer, and/or spirits.  Research has found that many Asians are deficient in an enzyme called aldehyde dehydrogenase (the second enzyme needed to break down alcohol).  After a drink, many will experience a reddening of the skin in the face, neck and/or chest.  Japanese researchers reported that some Asians who have asthma may experience an asthma attack after drinking alcoholic beverages. 

Winemakers may sometimes use "fining" agents to clarify their wines.  These may be made from milk, fish or egg products.  People who are sensitive to milk, fish or eggs might have a reaction to a wine that has been treated with one of these fining agents.  People who have allergies to yeasts or molds may also have a reaction to wine.  Yeasts are used in the fermentation process and molds are sometimes added to the unfermented juice and crushed grapes, to increase the amount of juice extraction.  The amount of yeasts, mold and fining agents that may remain in the wine are very small amounts, but people who are sensitive to these may experience a reaction from wine. 

Allergic-type reactions to alcohol in general and wine in particular are extremely rare.  Those who experience them should probably avoid alcohol.  Needless to say, those who are unable to drink in moderation, or for whom drinking is a legal issue, should also avoid alcoholic beverages.  For most people, drinking wine is only a problem if consumed in excess.  That is the real headache.