Red Wine Tops the List of Alcohols Most Reported as Migraine Trigger

Alcoholic beverages, especially red wine, are recognized by patients with migraine as a trigger, which has a significant impact on alcohol consumption behaviors, according to a new study.

Risk of migraine is hypothesized to be influenced by a combination of nonmodifiable genetic factors and modifiable internal (eg, hormonal fluctuations and comorbid disease) and external (eg, sleep patterns and food consumption) risk modulation factors. Patients often try to gain a sense of control over their attacks by identifying and modifying external risk factors, or triggers.

“Alcoholic beverages, a trigger factor that may be avoided, are frequently reported in the top 10 trigger factors,” wrote the study researchers. “However, mainly small and retrospective studies have been performed on a limited collection of different beverages.”

The researchers followed adults aged 18 to 80 years with migraine with or without aura between February 2008 and January 2013. Participants filled out an electronic questionnaire asking whether they had consumed alcohol in the previous 3 months. Those who indicated that they had not consumed alcohol were asked for the reasons, and those who indicated that they had consumed alcohol were asked about the number of days and the amounts of alcohol consumption in the past month, whether alcoholic beverages provoked migraine attacks, and if so, which beverages provoked attacks.

Among the 2197 participants included in the analysis, 783 (35.6%) reported alcohol as a migraine trigger. A total of 1547 participants were consuming alcohol, of whom 658 (42.5%) reported alcohol as a trigger. These participants had a lower body mass index, were more frequently patients with migraine without aura, had a higher annual migraine attack frequency and number of migraine days, drank slightly more per occasion, and consumed more vodka and less red wine.

Consistent with previous studies, red wine was singled out most frequently (77.8%) by participants as a cause of migraine attacks. Meanwhile, vodka was indicated least frequently (8.5%). However, just 8.8% of patients indicated that a migraine attack was provoked consistently after red wine consumption and 10.7% after vodka consumption.

“On average, patients report relatively few standard glasses (2.18 + 1.3 glasses for red wine and 2.16 + 1.9 glasses for vodka) to be consumed to provoke an attack,” added the researchers. “This may be a reflection of a common number of glasses consumed over dinner or at a party, suggested by the 2 glasses that the total population drinks on average.”

Time of onset of a migraine attack was rapid in one-third of patients, and almost 90% had an onset of less than 10 hours regardless of alcohol type.

Among the 650 participants not consuming alcohol, 168 (25.8%) had stopped consuming alcohol because it provoked migraine attacks (16.2%) or were told by others that it might provoke attacks (1.4%) or had never consumed alcohol because they were told by others that it might provoke attacks (8.3%).

Reference

Onderwater GLJ, van Oosterhout W, Schoonman GG, Ferrari MD, Terwindt GM. Alcoholic beverages as trigger factor and the effect on alcohol consumption behavior in patients with migraine [published online December 18, 2018]. Eur J Neurol. doi: 10.1111/ene.13861.