Doctor on Call

Wendy, a 39-year-old businesswoman and married mother of 3 in Calistoga, California writes:

“I have a question about red wine and headaches. Why is it that sometimes I can drink as much red wine as I want without any problem, but other times even half a glass will start up a migraine? I’ve had migraine most of my life, but my headaches are currently under pretty good control. Over the years I’ve learned that if I get enough sleep, eat a healthy diet and exercise regularly, my headaches are infrequent and rarely severe… except when I drink red wine. Not always, but just often enough to make me wary. I’m not a big drinker, but I do enjoy having a glass of wine with my husband before dinner. This is an important daily ritual for us, a time for us to relax and catch up. I’d like to continue doing this without the stress of wondering whether, with every sip, I may be inching closer to a horrible headache. One last thing-could this have anything to do with my menstrual cycle? It may be my imagination, but for the last few months it seems like drinking wine only triggers a migraine if I’m having my period.”

The Doctor's Reply

Ah yes, the old migraine/red wine dilemma. And how unjust it should be a problem for Wendy, living as she does in the heart of California’s wine country. Over the years a surprising amount has been written about red wine as a trigger for acute migraine. For example, why red wine in particular? Some investigators have incriminated tannins, naturally occurring polyphenol compounds from the relevant grape. Tannins contribute to a wine’s complexity and dryness. And they are more common in red wines than in whites.

Others have refuted this, claiming that tannins have not clearly been demonstrated to trigger migraine and that, if anything, the sweeter white wines are more likely to cause acute migraine due to their potent combination of alcohol and sugar. Whatever the truth about tannins, Wendy is still left with her red wine headaches. Once again, no single trigger - however potent -is a trigger for every migraineur, and in the individual migraineur an established trigger rarely causes a migraine attack each and every time the affected individual is exposed to the stimulus. Furthermore, when attacks are triggered, they may involve a spectrum of migraine symptoms that extends from no headache whatsoever (aura only) to the deepest pit of physical and emotional misery. To restate this at a more pragmatic level, drinking red wine at times may cause you to suffer migraine symptoms, but if you have a passionate devotion to red wine, you may choose to play your cards and take your chances.