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Dear Dr. Vinny,

What causes the headache by drinking some red wines? I have heard it is the sulfites, and I have also heard that it is a histamine reaction. Can you set the record straight?


Dear Michael,

I wish I could set the record straight on red-wine-induced headaches, but the jury is still out on exactly what causes them. If you're suffering from red-wine headaches (and you're certain it's not just from drinking too much), please see your real doctor, not just the one I play on the Internet.

Most people are quick to blame sulfites, but there's evidence that sulfites are mostly harmless—except to the very small percentage of the population that's allergic to them. Even then, sulfite allergies tend to manifest themselves like asthma attacks, not as headaches. Furthermore, there are more sulfites in some white (and sweet) wines than in reds, so it doesn't really explain the whole red-wine headache phenomenon.

Histamines are a likely culprit, especially because red wines are higher in histamines than white wines. Some folks are histamine-intolerant because they have a diamine oxidase deficiency, which means histamines aren't broken down easily. But even then, the link between headaches and histamines is unclear.

Tannins are another consideration (again, red wines are higher in tannins than white), and some experiments show that tannins provoke blood platelets into releasing serotonin, and high serotonin levels can cause headaches. Chocolate releases serotonin too, and some people complain about chocolate headaches.

Whether it's any one of these, or any combination of these factors, the fact that wine contains alcohol complicates matters. Alcohol is a well-known precipitant of migraine headaches, and red-wine headaches seem to overlap with migraines. You can always blame your parents, as susceptibility to these headaches seems to be genetic.

You could try different things to avoid red-wine headaches. Look for wines that don't have any added sulfites (all wines have some sulfites, which are a natural byproduct of winemaking), and try red wines that are naturally lower in tannins. Approach drinking red wines with caution—have half a glass and wait—if it's going to give you a headache, it will most likely do so within 15 or 20 minutes. If there's no reaction to that wine, you should be okay.

—Dr. Vinny

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