or 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 poorly
understood phenomenon,"
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 headache.
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 subject.
"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 in America 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
headaches.
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 R.W.H.)
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 experiment.
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 find
out."
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 hangover.
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