As the holiday season begins this week, many will be making a consequential dinner choice: red wine or white wine? And if you choose red, will you risk a headache? The fact that red wine can sometimes cause headaches in some people (especially those prone to migraines) is common knowledge—so much so that the phenomenon (“RWH”) has its own Wikipedia page. The Roman encyclopedist Celsus wrote his treatise In Medicine about the pain felt after drinking wine, while six centuries later, Paul of Aegina mentions that drinking wine causes headaches.
But science so far is not clear which components of red wine are responsible, as well as the mechanisms behind the phenomenon. A group of California scientists narrowed down the likely causes of a flavonol called quercetin, according to a new paper published in the journal Scientific Reports, although they have not yet run experiments on participants who were prone to RWH to test their hypothesis.
This is a knotty issue due to the complexity of wine and human genetics/physiology. Wine is primarily water and alcohol, along with acids, dissolved sugars, and other compounds that provide color and flavor. For example, tannins in wine are polyphenolic compounds responsible for most of the bitterness and astringency of a given wine; it comes from the skins and vines, or as a result of aging in oak barrels.
Red wine usually contains a lot of amines, sulfites, flavonoids, and tannins, especially a phenolic compound with antioxidant properties called resveratrol, which is also found in grape skins and leaves. That’s because red wines are usually made by soaking grape skins in mash (maceration), while producing white wines involves immediately draining the juice from the grape skins. Grape skins also contain anthocyanins, which give wine its red color.
Drink enough alcohol of any kind and you’ll probably get a hangover that includes a headache and at least some nausea. What is unusual about RWH is that even small to moderate amounts of red wine can cause headaches. It’s common these days to blame sulfites, a preservative that is a natural product of fermentation, but white wine and many other foods contain sulfites. In fact, white wine often contains more sulfites than red wine. There is a small percentage of the population who are allergic to sulfites, but they usually have hives and breathing problems instead of headaches.
Then there are biogenic amines, another product of fermentation that contains things like histamine and tyramine, both of which are linked to headaches. Genetics is a factor here; Some people simply cannot metabolize histamine very effectively, for example, because they cannot produce enough of the enzyme responsible for breaking it down in the small intestine. And alcohol prevents the enzyme from starting, resulting in higher levels of histamine in the blood. It can dilate the blood vessels, causing headaches. There are also amines in aged cheeses, cured charcuterie, and dried fruits—all of which are commonly used in red wine, exaggerating the effects. However, at least one study found no correlation between histamine and RWH, although the sample size was small.