How can I avoid wines that are more likely to give me a headache?

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Dear Dr. Vinny,

How do you avoid wines that have a tendency to leave you with a headache the next morning, even though you’ve only had one glass of it? I’ve been told that Pinot Noirs are safer to drink. What do I look for, and how can I avoid those wines?

—Richard B., St. Petersburg, Fla.

Dear Richard,

Wine headaches—and in particular, red-wine headaches—are still a mystery to doctors, fake (like myself) or real. Since no one is sure what exactly causes them, it’s tough to tell you what to avoid.

Sulfites are often blamed. Wine sold in the U.S. draws attention to the presence of sulfites with the legally required “contains sulfites” wording on every bottle. But 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 rather than as headaches. If you believe you have a sulfite sensitivity, you can’t avoid sulfites entirely in wine; they’re a natural byproduct of winemaking. But you can look for wines that don’t have any added sulfites.

Outside of sulfites, histamines and tannins are the next possible headache culprits. Some people are histamine intolerant because they have a diamine oxidase deficiency, which means the histamines that they take in aren’t broken down as easily. But even then, the link between headaches and histamines is unclear. Some experiments show that tannins (which are present in the skins and seeds of grapes, as well as in oak barrels) provoke blood platelets into releasing serotonin, and high serotonin levels can be associated with headaches. (Chocolate releases serotonin too, and some people complain about chocolate headaches—and I weep for those people.) You can try wines that are naturally lower in tannins, such as white wines in general, as well as red wines from grapes that are typically thinner-skinned and lower in tannins, like Pinot Noir.

Even beyond all this, the fact that wine contains alcohol complicates matters. Alcohol is a well-known precipitant of migraine headaches, and red-wine headaches can overlap with migraines. You could always blame your parents, as susceptibility to these headaches seems to be genetic.

If you suffer from red-wine headaches, please talk to your doctor about it. (Your real one, not just a cartoon doctor on the Internet.) And approach red wines with caution. Have half a glass and wait—if it’s going to give you a headache, it’ll most likely do so within 15 or 20 minutes. If there’s no reaction, you should be OK as long as you don’t overdo it.

—Dr. Vinny

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