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Hangover Headache Help

Robert Benchley, American humorist.

Dec. 29, 2006 -- The night before, one more glass of champagne seemed like a great idea. Next morning, your throbbing head suggests otherwise.

The last time this happened, you swore off overdrinking for good. That plan would have worked. But being someone who loses count from time to time, it was not the plan for you.

Many, many others are in the same boat. A 1992 Danish survey found nearly three-fourths of adults there occasionally suffer hangover headache, making it the most common form of headache reported.

Short of abstinence, is there any way to prevent a headache from too much alcohol? Is there a cure?

There is, indeed, quite a lot you can do, says neurologist Christine Lay, MD, of The Headache Institute, Roosevelt Hospital, in New York City.

Lay and colleague Christina Sun, MD, authored a forthcoming article on this condition in Headache, the journal of the American Headache Society.

Why We Get Hangover Headaches

Hangovers almost always come with a hideous headache. But you don't have to drink too much to get a hangover headache.

Lay says infrequent, light drinkers are more likely than heavy drinkers to suffer such headaches.

"You don't necessarily have to overdo it. Even dipping in just a little bit can cause a headache," she says.

This is because alcohol has both direct and indirect effects that contribute to headache.

The first thing alcohol does is cause dehydration. Alcohol switches off an anti-dehydration mechanism in the body, causing you to urinate more often than you should.

Alcohol also stresses your liver, making it less able to produce glucose. Glucose -- sugar -- is the fuel that drives every cell in you body. Brain cells are particularly susceptible to a shortage of this fuel.

Alcohol also affects the chemicals that cells in your body use to communicate with each other. One of these chemicals is prostaglandin, which regulates the way you feel pain, among other things.

Finally, alcohol has an inflammatory effect, making your blood vessels swell. This is why some people don't have to wait until morning for their headache.

The main indirect effects of alcohol come from a chemical called acetaldehyde, made as your body processes the booze.

This chemical works like a drug, making you sweat and flush, your heart race, and your stomach turn nauseous. If enough acetaldehyde accumulates in your body, you vomit.

Another indirect effect of alcohol is disturbed sleep. This is why it's so hard to "sleep off" a hangover.

"When you drink too much, you feel like going to sleep -- but there is a paradoxical awakening during the night," Lay says. "Alcohol interferes with rapid-eye movement sleep; and people wake frequently. This waking contributes to headache."
Preventing Hangover Headache

Like Benchley wrote, nothing short of death will keep you from getting sick if you drink huge quantities of alcohol. But if you plan to drink moderately, there are some things you can do to fend off a headache.

First, Lay says, eat a greasy meal before drinking.

Greasy foods coat the stomach and slow absorption of alcohol. And most greasy foods are full of carbohydrates, which turn into sugar in your body. That gives you an extra supply of the sugars alcohol causes to drop.

When choosing an alcoholic beverage, consider clear ones.

Dark beverages, such as red wine and whiskey, contain more of the flavorful substances called congeners. These natural byproducts of alcohol fermentation may contribute to the inflammation that worsens alcohol headaches.

When drinking, don't guzzle. Sip alcoholic beverages slowly. Give your body time to process the alcohol.

Between drinks, have at least one big glass of a nonalcoholic beverage.

Water is excellent. Fruit juices, such as tomato juice and cranberry juice, help your body replace thglucose it has losing due to alcohol. Soft drinks may also help in this way -- and the caffeine in some of these drinks may help counteract the swelling of small blood vessels caused by alcohol.

If you do consume caffeine, be sure to increase your water intake. Caffeine causes your body to lose water -- and nothing is more important than avoiding dehydration when drinking.

Lay off the cigarettes. Lay notes that smoking keeps your brain from getting the oxygen it needs.

And if you didn't already know that drugs aren't good for you, hear this: Don't drink and take drugs.

If you are taking prescription medications, talk to your doctor BEFORE you take a drink. Find out two things: Does alcohol block or enhance the effects of your medication? Does your medication enhance the effects of alcohol?

If you don't have stomach or bleeding problems -- and if your doctor says it's OK -- you might consider taking aspirin or one of the NSAID family of pain relievers, which includes naproxen and ibuprofen. These drugs inhibit prostaglandin -- that pain regulator -- and help counteract the prostaglandin-enhancing effects of alcohol.

Lay says some NSAIDs are particularly effective at inhibiting prostaglandin. One is a prescription NSAID called Ponstel. Another close relative of Ponstel -- not available in the U.S. -- is sold as Clotam in the U.K. A small 1983 clinical trial showed that people who take Clotam before drinking and before going to bed have milder hangover headaches.

"These drugs go after the bad guy in the hangover," Lay says.

However, Ponstel is not approved for use as a hangover remedy. Do not use it for this purpose unless your doctor specifically says you can do so.

DO NOT take either brand-name Tylenol or the generic brand, acetaminophen. In combination with alcohol, this drug stresses the liver.
Curing Hangover Headache

If your hair hurts as you read this, it's too late to prevent your headache.

Fortunately, it's not too late to do something to make yourself feel better.

"The most important thing is dehydration," Lay says. "Drink some water."

Even if you could manage it, a greasy meal isn't a good idea at this point. But you need something in your stomach.

Lay advises something bland, with protein and carbs -- a poached egg on toast should do the trick.

And take in some sugar. Acidic juices aren't going to go down well -- but a little tomato juice or apple juice would be great.

If your stomach can handle it -- and if you don't suffer from ulcers or bleeding disorders -- take aspirin, naproxen, ibuprofen, or another NSAID. Again, do NOT take acetaminophen (Tylenol).

If you suffer migraine headaches, it may be hard to tell whether you have an alcohol headache or a migraine. But if you have a prescription for one of the triptan family of migraine drugs, taking one might help, Lay says.

What about all those over-the-counter hangover cures? Lay says some of them can work.

"Most of these cures contain an anti-inflammatory drug -- whether aspirin or an NSAID," she says. "A lot have caffeine; and a lot have sugar byproducts in them.

"But most people might just as well drink in moderation, eat, get enough sugar, and maybe get some caffeine," she counsels. Along with that old standby, aspirin (or an NSAID), if you're not at risk of side effects, she says.

SOURCES: Sun, C. and Lay, C. Headache, 2007; manuscript received ahead of publication. Kaivola, S. Cephalalgia, March 1983; vol 3: pp. 31-36. Christine Lay, MD, The Headache Institute, Roosevelt Hospital, New York City.

By Daniel DeNoon
Reviewed by Louise Chang
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