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Alcohol Hangover

Mechanisms and Mediators

Robert Swift, M.D., Ph.D.; and Dena Davidson, Ph.D.

Hangovers are a frequent, though unpleasant, experience among people who drink to
intoxication. Despite the prevalence of hangovers, however, this condition is not well
understood scientifically. Multiple possible contributors to the hangover state have been
investigated, and researchers have produced evidence that alcohol can directly promote
hangover symptoms through its effects on urine production, the gastrointestinal tract, blood
sugar concentrations, sleep patterns, and biological rhythms. In addition, researchers
postulate that effects related to alcohol’s absence after a drinking bout (i.e., withdrawal),
alcohol metabolism, and other factors (e.g., biologically active, nonalcohol compounds in
beverages; the use of other drugs; certain personality traits; and a family history of
alcoholism) also may contribute to the hangover condition. Few of the treatments commonly
described for hangover have undergone scientific evaluation. K EY WORDS : post AOD
intoxication state; symptom; urinalysis; gastrointestinal disorder; hypoglycemia; sleep
disorder; circadian rhythm; ethanol metabolite; disorder of fluid or electrolyte or acid-base
balance; nutrient intake; headache; vomiting; neurotransmitter receptors; congenors;
multiple drug use; personality trait; family AODU (alcohol and other drug use) history;
drug therapy; literature review

“My first return of sense or recol-

he British writer William Hickey its aftereffects, or a combination of
lection was upon waking in a wrote these words in the year both. Similarly, investigators are uncer-
strange, dismal-looking room, my 1768, vividly describing the tain about the degree to which hangover
head aching horridly, pains of a aftermath of a bout of heavy alcohol affects a person’s thinking and mentally
violent nature in every limb, and drinking—an experience commonly controlled motor functions, a question
deadly sickness at the stomach. referred to as a “hangover.” Similar with serious implications for activities
From the latter I was in some descriptions of hangovers appear in the
degree relieved by a very copious writings of ancient Egypt and Greece
vomiting. Getting out of bed, I as well as in the Old Testament. No ROBERT SWIFT, M.D., PH.D., is associate
looked out of the only window in doubt, prehistoric people also experi- professor in the Department of Psychiatry
the room, but saw nothing but enced hangovers soon after they and Human Behavior at Brown Univer-
the backs of old houses, from discovered alcohol. sity, Providence, Rhode Island, and
which various miserable emblems Despite its long history, however, associate chief of staff for research and
of poverty were displayed . . . . At hangover has received relatively scant education at Providence Veterans
that moment I do not believe in formal attention from researchers. Affairs Medical Center.
the world there existed a more Little is known about the physiology
wretched creature than myself. underlying the hangover condition. For DENA DAVIDSON, PH.D., is assistant
I passed some moments in a example, it is unclear whether hangover professor of psychiatry at Indiana
state little short of despair . . . .” signs and symptoms are attributable University of Medicine, Indianapolis,
—William Hickey (Spenser 1913) to alcohol’s direct effects on the body, Indiana.

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such as job performance and driving. toms include dizziness; a sense of the zero were tested following alcohol
In addition, researchers know little room spinning (i.e., vertigo); and intoxication with peak BAC’s in the
about hangover prevention and treat- possible cognitive and mood distur- range of 50 to 100 milligrams per
ment. Although folk remedies for bances, especially depression, anxiety, deciliter (mg/dL), most of them did
hangovers abound, their efficacy in and irritability. The particular set of not show significant impairments in
reducing the intensity and duration symptoms experienced and their inten- the performance of simple mental
of a hangover has not received system- sity may vary from person to person tasks, such as reaction time (Lemon et
atic study. In fact, some researchers and from occasion to occasion. In al. 1993). Similarly, several studies
and clinicians question whether finding addition, hangover characteristics may that investigated the hangover effects
an effective treatment for hangovers depend on the type of alcoholic beverage on a more complex mental task (i.e.,
is desirable, given that the hangover consumed and the amount a person simulated automobile driving) did not
experience may deter some people drinks. Typically, a hangover begins report impaired performance (Streufert
from engaging in subsequent episodes within several hours after the cessation et al. 1995; Tornros and Laurell 1991).
of heavy drinking. of drinking, when a person’s blood In contrast, a study of military pilots
Although gaps clearly remain in alcohol concentration (BAC) is falling. completing a simulated flying task
scientific knowledge about hangovers, Symptoms usually peak about the revealed significant decrements in
research has elucidated several aspects. time BAC is zero and may continue some performance measures (particu-
This article describes what is known for up to 24 hours thereafter. larly among older pilots) 8 to 14 hours
about the hangover condition, the Overlap exists between hangover and after they had consumed enough alco-
possible physiological factors contribut- the symptoms of mild alcohol with- hol to be considered legally drunk
ing to it, and treatment options. drawal (AW), leading to the assertion (Yesavage and Leirer 1986).
that hangover is a manifestation of
mild withdrawal. Hangovers, how-
What Is a Hangover? ever, may occur after a single bout of Prevalence of Hangover
drinking, whereas withdrawal occurs
A hangover is characterized by the usually after multiple, repeated bouts. Generally, the greater the amount
constellation of unpleasant physical Other differences between hangover and duration of alcohol consumption,
and mental symptoms that occur after and AW include a shorter period of the more prevalent is the hangover,
a bout of heavy alcohol drinking (see impairment (i.e., hours for hangover although some people report experi-
table 1). Physical symptoms of a versus several days for withdrawal) encing a hangover after drinking low
hangover include fatigue, headache, and a lack of hallucinations and seizures levels of alcohol (i.e., one to three
increased sensitivity to light and in hangover. alcoholic drinks), and some heavy
sound, redness of the eyes, muscle People experiencing a hangover feel drinkers do not report experiencing
aches, and thirst. Signs of increased ill and impaired. Although a hangover hangovers at all. A survey by Harburg
sympathetic nervous system activity may impair task performance and and colleagues (1993) on the preva-
can accompany a hangover, including thereby increase the risk of injury, lence of hangovers found that approx-
increased systolic blood pressure, equivocal data exist on whether hang- imately 75 percent of the subjects
rapid heartbeat (i.e., tachycardia), over actually impairs complex mental who drank to intoxication reported
tremor, and sweating. Mental symp- tasks. When subjects with a BAC of experiencing a hangover at least some
of the time. In a study of 2,160 Finnish
men, researchers found an association
Table 1 Symptoms of Hangover between increased weekly alcohol
consumption and the frequency of
Class of Symptoms Type hangover: 43.8 percent of the group
of heaviest drinkers (i.e., study subjects
Constitutional Fatigue, weakness, and thirst who drank more than 106 grams [g]
Pain Headache and muscle aches of alcohol per week or approximately
Gastrointestinal Nausea, vomiting, and stomach pain 9 drinks) reported experiencing a hang-
Sleep and biological rhythms Decreased sleep, decreased REM,1 over monthly or more often, compared
and increased slow-wave sleep with 6.6 percent of the remaining
Sensory Vertigo and sensitivity to light and sound
study subjects (Kauhanen et al. 1997).
Cognitive Decreased attention and concentration
Mood Depression, anxiety, and irritability
Similarly, in a study of 1,041 drinkers
Sympathetic hyperactivity Tremor, sweating, and increased pulse in New York State, 50 percent of the
and systolic blood pressure subjects who drank two or more drinks
per day reported experiencing hang-
REM = rapid eye movements. overs in the previous year, whereas
subjects who consumed lower levels

Vol. 22, No. 1, 1998 55

of alcohol reported fewer hangovers hormone (i.e., antidiuretic hormone, these factors can result in the upper
(Smith and Barnes 1983). Other reports, or vasopressin) from the pituitary gland. abdominal pain, nausea, and vomiting
however, claim that hangovers occur In turn, reduced levels of antidiuretic experienced during a hangover.
less often in heavy drinkers. In a study hormone prevent the kidneys from
of 43 alcoholic drinkers admitted for reabsorbing (i.e., conserving) water Low Blood Sugar. Several alterations
inpatient treatment, 50 percent of the and thereby increase urine production. in the metabolic state of the liver and
subjects reported experiencing no hang- Additional mechanisms must be at other organs occur in response to the
overs within the previous year and 23 work to increase urine production, presence of alcohol in the body and
percent reported never experiencing a however, because antidiuretic hormone can result in low blood sugar levels
hangover (Pristach et al. 1983). levels increase as BAC levels decline to (i.e., low glucose levels, or hypoglycemia)
zero during hangover (Eisenhofer et al. (National Institute on Alcohol Abuse
1985). Sweating, vomiting, and diarrhea and Alcoholism 1994). Alcohol metab-
Physiological Factors also commonly occur during a hang- olism leads to fatty liver (described
Contributing to Hangover over, and these conditions can result in earlier) and a buildup of an intermediate
additional fluid loss and electrolyte metabolic product, lactic acid, in body
Hangover symptoms have been imbalances. Symptoms of mild to mod- fluids (i.e., lactic acidosis). Both of these
attributed to several causes (see table erate dehydration include thirst, weak- effects can inhibit glucose production.
2), including the direct physiological ness, dryness of mucous membranes, Alcohol-induced hypoglycemia
effects of alcohol on the brain and dizziness, and lightheadedness— all generally occurs after binge drinking
other organs; the effects of the removal commonly observed during a hangover. over several days in alcoholics who have
of alcohol from these organs after alco- not been eating. In such a situation,
hol exposure (i.e., withdrawal); the Gastrointestinal Disturbances. Alcohol prolonged alcohol consumption, cou-
physiological effects of compounds directly irritates the stomach and pled with poor nutritional intake, not
produced as a result of alcohol’s intestines, causing inflammation of only decreases glucose production but
metabolism (i.e., metabolites), espe- the stomach lining (i.e., gastritis) and also exhausts the reserves of glucose
cially acetaldehyde; and nonalcohol delayed stomach emptying, especially stored in the liver in the form of glyco-
factors, such as the toxic effects of when beverages with a high alcohol gen, thereby leading to hypoglycemia.
other biologically active chemicals (i.e., concentration (i.e., greater than 15 Because glucose is the primary energy
congeners) in the beverage, behaviors percent) are consumed (Lieber 1995). source of the brain, hypoglycemia can
associated with the alcohol-drinking High levels of alcohol consumption contribute to hangover symptoms
bout (e.g., other drug use, restricted also can produce fatty liver, an accu- such as fatigue, weakness, and mood
food intake, and disruption of normal mulation of fat compounds called disturbances. Diabetics are particularly
sleep time), and certain personal char- triglycerides and their components sensitive to the alcohol-induced alter-
acteristics (e.g., temperament, person- (i.e., free fatty acids) in liver cells. In ations in blood glucose. However, it
ality, and family history of alcoholism). addition, alcohol increases the produc- has not been documented whether
Although current evidence suggests that tion of gastric acid as well as pancreatic low blood sugar concentrations con-
more than one factor most likely con- and intestinal secretions. Any or all of tribute to hangover symptomatically.
tributes to the overall hangover state,
the following sections address each of
the postulated causes in turn. Table 2 Possible Contributing Factors to Hangover

Direct effects of alcohol

Direct Alcohol Effects • Dehydration
Alcohol may directly contribute to a • Electrolyte imbalance
hangover in several ways, including • Gastrointestinal disturbances
the following. • Low blood sugar
• Sleep and biological rhythm disturbances
Dehydration and Electrolyte Imbal- Alcohol withdrawal
ance. Alcohol causes the body to increase
urinary output (i.e., it is a diuretic). Alcohol metabolism (i.e., acetaldehyde toxicity)
The consumption of 50 g of alcohol in
250 milliliters (mL) of water (i.e. approx- Nonalcohol effects
imately 4 drinks) causes the elimination • Compounds other than alcohol in beverages, especially methanol
of 600 to 1,000 mL (or up to 1 quart) • Use of other drugs, especially nicotine
of water over several hours (Montastruc • Personality type
1986). Alcohol promotes urine pro- • Family history for alcoholism
duction by inhibiting the release of a

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Disruption of Sleep and Other the most common type of headache AW overlap considerably. The revised
Biological Rhythms. Although alcohol reported (Rasmussen and Olesen 1992). Clinical Institute Withdrawal Assess-
has sedative effects that can promote Alcohol intoxication results in vasodi- ment for Alcohol (CIWA-Ar) scale, an
sleep onset, the fatigue experienced latation, which may induce headaches. instrument widely used to assess the
during a hangover results from alcohol’s Alcohol has effects on several neuro- severity of a withdrawal episode in
disruptive effects on sleep. Alcohol- transmitters and hormones that are alcohol-dependent patients, measures
induced sleep may be of shorter duration implicated in the pathogenesis of head- 10 withdrawal-associated items: nausea
and poorer quality because of rebound aches, including histamine, serotonin, and vomiting; tremor; sweating; anxi-
excitation (see the section “Effects of and prostaglandins (Parantainen 1983). ety; agitation; headache; disturbances
Alcohol Withdrawal”) after BAC’s fall, However, the etiology of hangover in the sense of touch, hearing, and
leading to insomnia (Walsh et al. 1991). headache remains unknown. vision (e.g., hallucinations); and orien-
Furthermore, when drinking behavior tation (e.g., awareness of the date and
takes place in the evening or at night location) (Sullivan et al. 1989, see also
(as it often does), it can compete with
Effects of Alcohol Withdrawal p. 8 of the article by Saitz for a sample
sleep time, thereby reducing the length The AW syndrome following the of the assessment form). Several of
of time a person sleeps. Alcohol also cessation of excessive drinking results these items also are usually present
disrupts the normal sleep pattern, from compensatory changes in the during a hangover, including nausea
decreasing the time spent in the dream- central nervous system that take place and vomiting, tremor, sweating, anxiety,
ing state (i.e., rapid eye movement [REM] in response to chronically administered headache, and sensory disturbances.
sleep) and increasing the time spent depressant substances (in this case, Second, Begleiter and colleagues
in deep (i.e., slow-wave) sleep. In alcohol, or more specifically, ethanol). (1974) present evidence that the
addition, alcohol relaxes the throat These changes include alterations in hangover condition is actually a state
muscles, resulting in increased snoring two types of receptors embedded in of central nervous system excitation,
and, possibly, periodic cessation of nerve cell membranes. One receptor despite the perceived sedation and
breathing (i.e., sleep apnea). type binds with an important chemi- malaise. Support for this view comes
Alcohol interferes with other biolog- cal messenger (i.e., neurotransmitter) from the research of Pinel and Mucha
ical rhythms as well, and these effects called gamma-aminobutyric acid (1980), which shows that single doses
persist into the hangover period. For (GABA), and the other type binds of alcohol decrease seizure thresholds
example, alcohol disrupts the normal with another neurotransmitter, gluta- in animals several hours later. Their
24-hour (i.e., circadian) rhythm in body mate. Both GABA and glutamate are finding indicates rebound excitation,
temperature, inducing a body temper- critical in regulating nerve cell activity: a phenomenon noted to occur after
ature that is abnormally low during GABA is the body’s primary means short-term administration of some
intoxication and abnormally high during of inhibiting nerve cell activity, and sedatives that can quickly clear the
a hangover. Alcohol intoxication also glutamate is the primary means of body, including alcohol and certain
interferes with the circadian nighttime exciting it. benzodiazepine drugs.
secretion of growth hormone, which Following chronic alcohol exposure, Third, the observation that alcohol
is important in bone growth and the body decreases (i.e., downregulates) readministration alleviates the unpleas-
protein synthesis. In contrast, alcohol the number or sensitivity of GABA antness of both AW syndrome and
induces the release of adrenocortico- receptors and increases (i.e., upregulates) hangovers suggests that the two expe-
tropic hormone from the pituitary the number or sensitivity of glutamate riences share a common process.
gland, which in turn stimulates the receptors in an effort to counterbalance
release of cortisol, a hormone that plays alcohol’s sedative effects. When alcohol
a role in carbohydrate metabolism and is removed from the body, however, the
Effects of Alcohol Metabolites
stress response; alcohol thereby disrupts central nervous system and the portion Alcohol undergoes a two-step process
the normal circadian rise and fall of of the nervous system that coordinates in its metabolism (see figure). First, an
cortisol levels. Overall, alcohol’s disrup- response to stress (i.e., the sympathetic enzyme (i.e., alcohol dehydrogenase)
tion of circadian rhythms induces a nervous system) remain in an unbal- metabolizes alcohol to an intermediate
“jet lag” that is hypothesized to account anced “overdrive” state (Tsai et al. 1995). product, acetaldehyde; then a second
for some of the deleterious effects of a Sympathetic nervous system hyperac- enzyme (aldehyde dehydrogenase
hangover (Gauvin et al. 1997). tivity accounts for the tremors, sweating, [ALDH]) metabolizes acetaldehyde to
and tachycardia observed in both hang- acetate. Acetaldehyde is a chemically
over and AW syndrome. reactive substance that binds to pro-
Alcohol and Headache Several lines of evidence suggest that teins and other biologically important
In a large epidemiological survey of a hangover is a mild manifestation of compounds. At higher concentrations,
headache in Danish 25- to 64-year-olds, the AW syndrome in non-alcohol- it causes toxic effects, such as a rapid
the lifetime prevalence of hangover dependent drinkers. First, the signs pulse, sweating, skin flushing, nausea,
headache was 72 percent, making it and symptoms of hangover and mild and vomiting. In most people, ALDH

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metabolizes acetaldehyde quickly and One specific congener implicated metabolism and thereby slow the pro-
efficiently, so that this intermediate in hangover effects is methanol, which duction of formaldehyde and formic acid.
metabolite does not accumulate in high is an alcohol compound found in Certain people develop headaches
concentrations, although small amounts alcoholic beverages along with ethanol. soon after drinking red wine but not
are present in the blood during alcohol The two compounds differ slightly in after drinking white wine or vodka.
intoxication. In some people, however, chemical structure in that methanol Recent research finds that red wine, but
genetic variants of the ALDH enzyme contains one less carbon atom and two not white wine or vodka, can increase
permit acetaldehyde to accumulate. fewer hydrogen atoms than ethanol. plasma serotonin and plasma histamine
Those people routinely flush, sweat, The same enzymes that metabolize levels. The specific agents in wine
and become ill after consuming small ethanol, alcohol dehydrogenase, and responsible for these increased levels
amounts of alcohol. aldehyde dehydrogenase also metabo- are not known. Increased plasma sero-
Because of the similarity between lize methanol; however, the products tonin and histamine can trigger head-
the acetaldehyde reaction and a hang- of methanol metabolism (i.e., formalde- aches in susceptible people (Pattichis
over, some investigators have suggested hyde and formic acid) are extremely et al. 1995; Jarisch and Wantke 1996).
that acetaldehyde causes hangovers. toxic and in high concentrations may
Although free acetaldehyde is not pre- cause blindness and death. Use of Other Drugs. The use of other
sent in the blood after BAC’s reach Support for methanol’s contribution drugs often accompanies heavy alcohol
zero, the toxic effects of acetaldehyde to hangovers comes from several sources. consumption. Most heavy drinkers
produced during alcohol metabolism For example, distilled spirits that are smoke cigarettes, and some also use
may persist into the hangover period. more frequently associated with the marijuana, cocaine, or other drugs.
development of a hangover, such as Although certain drugs can themselves
brandies and whiskeys, contain the produce hangover symptoms and affect
Effects of Factors Other highest concentrations of methanol. alcohol intoxication, the effects of the
Than Alcohol Moreover, in an experimental study various alcohol and other drug combina-
Factors other than alcohol also may with four subjects who consumed red tions on alcohol hangover are unknown.
contribute to a hangover. These factors wine containing 100 milligrams per
include the following possibilities. liter (mg/L) of methanol, Jones (1987) Personal Influences. Some evidence
found that elevated blood levels of exists that increased hangover symptoms
Congeners. Among other reasons, methanol persisted for several hours occur more often in people possessing
people consume alcoholic beverages after ethanol was metabolized, which certain personality traits, such as neu-
for their ethanol content. Most alcoholic corresponded to the time course of roticism, anger, and defensiveness.
beverages contain smaller amounts of hangover symptoms. Methanol lingers Negative life events and feelings of guilt
other biologically active compounds, after ethanol levels drop, because ethanol about drinking also are associated with
however, including other alcohols. competitively inhibits methanol metab- experiencing more hangovers (Harburg
These compounds, known as congeners, olism. The fact that ethanol readmin- et al. 1993). In addition, Earleywine
contribute to the taste, smell, and istration fends off hangover effects (1993a,b) reports greater hangover
appearance of alcoholic beverages. may be further evidence of methanol’s symptoms in people who have a higher
Congeners may be produced along contribution to the hangover condition, personality risk for the development of
with ethanol during fermentation, given ethanol’s ability to block methanol alcoholism (as measured by the Mac-
generated during aging or processing
through the degradation of the bever-
age’s organic components, or added
to the beverage during the production Ethanol Acetaldehyde Acetate
process. Investigators now believe
that congeners may contribute to a
beverage’s intoxicating effects and to
a subsequent hangover. Research
has shown that beverages composed
of more pure ethanol, such as gin NAD NADH NAD NADH
or vodka, induce fewer hangover
effects than do beverages containing
The metabolism of beverage alcohol (i.e., ethanol) by the alcohol dehydrogenase
a large number of congeners, such
(ADH) pathway.
as whiskey, brandy, or red wine
(Chapman 1970; Pawan 1973). A NOTE: ADH = alcohol dehydrogenase; ALDH = aldehyde dehydrogenase; NAD = nicotinamide adenine
hangover also may occur when pure dinucleotide; NADH = reduced NAD.

ethanol is administered, however.

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Andrew Scale [MacAndrew 1965]). Attentiveness to the quantity and enhances acetaminophen’s toxicity to
Those studies suggest that people who quality of alcohol consumed can have the liver (Girre et al. 1993).
have an elevated personality risk for a significant effect on preventing hang- Propranolol, a beta-adrenergic
alcoholism experience more acute over. Hangover symptoms are less antagonist1 used to treat high blood
withdrawal and hangover symptoms likely to occur if a person drinks only pressure and migraine headaches, re-
and may initiate further drinking in an small, nonintoxicating amounts. Even duces the sympathetic hyperactivity
effort to find relief. among people who drink to intoxication, of AW; however, a small, double-blind,
Research has shown that a history those who consume lower amounts of placebo-controlled study did not find
of alcoholism in a person’s family (i.e., alcohol appear less likely to develop a propranolol to be effective in reducing
a positive family history) is associated hangover than those who drink higher hangover symptoms, including headache
with a decreased sensitivity to the intox- amounts. Hangovers have not been (Bogin et al. 1987). Antagonists at the
icating effects of alcohol and a greater associated with drinking beverages with serotonin-3 receptor,2 such as ondan-
risk for developing alcoholism (Schuckit a low alcohol content or with drinking setron and tropisetron, are antiemetics
and Smith 1996). Newlin and Pretorius nonalcoholic beverages. (i.e., they control nausea and vomiting)
(1990) suggested that a positive family The type of alcohol consumed also and block certain alcohol effects; how-
history for alcoholism may be associated may have a significant effect on reduc- ever, a small clinical trial did not show
with a tendency for increased hangover ing hangover (Chapman 1970; Pawan efficacy in alleviating hangover (Muh-
symptoms as well. Their research 1973). Alcoholic beverages that contain onen et al. 1997). Caffeine (often taken
compared the self-reported hangover few congeners (e.g., pure ethanol, vodka, as coffee) is commonly used to counter-
symptoms in college-age sons of alco- and gin) are associated with a lower act the fatigue and malaise associated
holic fathers with symptoms in sons incidence of hangover than are beverages with the hangover condition. Although
of nonalcoholic fathers and found that contain a number of congeners this traditional practice lacks scientific
that the subjects with a positive fam- (e.g., brandy, whiskey, and red wine). support, William Hickey, quoted at the
ily history for alcoholism had had Other interventions may reduce the beginning of this article, wrote that
greater hangover symptoms during the intensity of a hangover but have not “very strong coffee proved of infinite
previous year. The amount of drink- been systematically studied. Consump- benefit” (Spenser 1913).
ing was comparable between the two tion of fruits, fruit juices, or other Readministration of alcohol—the
groups, although the subjects with a fructose-containing foods is reported “hair of the dog that bit you” remedy—
positive family history reported con- to decrease hangover intensity, for reportedly cures a hangover, but people
suming significantly more mixed example (Seppala et al. 1976). Also, experiencing a hangover should avoid
drinks than the group with a negative bland foods containing complex car- further alcohol use. Additional drink-
family history. bohydrates, such as toast or crackers, ing will only enhance the existing
can counter low blood sugar levels in toxicity of the alcohol consumed during
people subject to hypoglycemia and the previous bout and may increase the
Treatments for Hangover can possibly relieve nausea. In addition, likelihood of even further drinking.
adequate sleep may ease the fatigue
Many treatments are described to pre- associated with sleep deprivation, and
vent hangover, shorten its duration, drinking nonalcoholic beverages during Areas for Future Study
and reduce the severity of its symptoms, and after alcohol consumption may
including innumerable folk remedies reduce alcohol-induced dehydration. Several topics related to hangovers
and recommendations. Few treatments Certain medications may provide warrant research attention. The effect
have undergone rigorous investigation, symptomatic relief for hangover symp- of congeners, especially methanol, on
however. Conservative management toms. For example, antacids may alleviate the occurrence of hangover needs closer
offers the best course of treatment. nausea and gastritis. Aspirin and other examination, for example. Such research
Time is the most important compo- nonsteroidal anti-inflammatory medi- could help determine whether it is
nent, because hangover symptoms cations (e.g., ibuprofen or naproxen) ethanol or congeners that produce the
will usually abate over 8 to 24 hours. may reduce the headache and muscle major signs and symptoms of hangover,
aches associated with a hangover but and an answer to this key question
An antagonist is an agent that interferes with or should be used cautiously, particularly would advance our understanding of
blocks the action of another agent, disease, or if upper abdominal pain or nausea is hangover pathophysiology.
structure. A beta-adrenergic antagonist blocks the present. Anti-inflammatory medications A particularly intriguing observation
action of certain neurotransmitters governing the
sympathetic nervous system.
are themselves gastric irritants and is that people with traits associated with
will compound alcohol-induced gas- an increased risk for alcoholism (e.g.,
Serotonin antagonists block the actions of tritis. Although acetaminophen is a certain personality factors or a positive
serotonin, a neurotransmitter that can affect
mood as well as inhibit gastric secretion and
common alternative to aspirin, its use family history for alcoholism) experience
stimulate smooth muscle, such as that governing should be avoided during the hangover more severe hangovers. Although logic
the contractions of the digestive system. period, because alcohol metabolism dictates that enduring more severe or

Vol. 22, No. 1, 1998 59

more frequent hangovers would deter, Ten Years of Progress, New York: Plenum Press, PATTICHIS, K.; LOUCA, L.; JARMAN, J.; SANDLER,
1993. pp. 281–304. M.; AND GLOVER, V. 5-hydroxytryptamine
rather than promote, further alcohol release from platelets by different red wines:
drinking, mild AW symptoms are also GAUVIN, D.V.; BRISCOE, R.J.; BAIRD, T.J.; VALLETT, Implications for migraine. European Journal of
associated with an increased craving M.; CARL, K.L.; AND HOLLOWAY, F.A. Cross- Pharmacology 292:173–177, 1995.
generalization of an EtOH “hangover” cue to
for alcohol (Littleton and Little 1994). endogenously and exogenously induced stimuli. PAWAN, G.L. Alcoholic drinks and hangover effects.
Future investigations could focus on Pharmacology Biochemistry and Behavior 57(1/2): Proceedings of the Nutrition Society 32(1):15A, 1973.
whether people can be biologically 199–206, 1997.
PINEL, J.P.J., AND MUCHA, R.F. Increased suscep-
predisposed to experience more severe GIRRE, C.; HISPARD, E.; PALOMBO, S.; N’GUYEN, tibility to seizures following brief exposure to
AW and whether such a tendency in C.; AND DALLY, S. Increased metabolism of aceta- alcohol: Hangover or artifact. In: Eriksson, K.,
turn predisposes them to increased minophen in chronically alcoholic patients. ed. Animal Models in Alcohol Research. New York:
alcohol consumption. Alcoholism: Clinical & Experimental Research 17(1): Academic Press, 1980. pp. 413–418.
Animal models of hangover have 170–173, 1993.
been developed and may provide in- HARBURG, E.; GUNN, R.; GLEIBERMAN, L.; DIFRAN- R.B. Alcohol withdrawal syndromes: Prediction
sights into the physiological and behav- CEISCO, W.; AND SCHORK, A. Psychosocial factors, from detailed medical and drinking histories.
alcohol use, and hangover signs among social Drug and Alcohol Dependence 11(2):177–199, 1983.
ioral changes that occur in the period
drinkers: A reappraisal. Journal of Clinical Epidemiology
immediately after intoxication (Gauvin 46(5):413–422, 1993.
et al. 1993, 1997). These animal models and non-symptomatic headaches in a general
JARISCH, R., AND WANTKE, F. Wine and headache. population. Neurology 42(6):1225–1231, 1992.
could be used to explore the effects of
International Archives of Allergy and Immunology
early withdrawal and of congeners and to 110(1):7–12, 1996.
determine whether hangovers predispose follow-up of 450 sons of alcoholic and control
JONES, A.W. Elimination half-life of methanol subjects. Archives of General Psychiatry 53(3):
to or deter further alcohol consumption. 202–210, 1996.
during hangover. Pharmacology & Toxicology
In summary, hangover is a complex 60(3):217–220, 1987.
state that probably cannot be under- SEPPALA, T.; LEINO, T.; LINNOILA, M.; HUTTUNEN,
KAUHANEN, J.; KAPLAN, G.A.; GOLDBERG, D.D.; M.O.; AND YLIKAHRI, R.H. Effects of hangover
stood by a unitary explanation. Under- on psychomotor skills related to driving: Mod-
standing the hangover condition, how- Frequent hangovers and cardiovascular mortality in ification by fructose and glucose. Acta Pharm-
ever, will lead to a better comprehension middle-aged men. Epidemiology 8(3):310–314, 1997. acologia Toxicologia 38:209–218, 1976.
of the physiological effects of alcohol SMITH, C.M., AND BARNES, G.M. Signs and
and the adaptive responses that alco- AND NABKE, C. Investigation of the hangover symptoms of hangover: Prevalence and relationship
hol engenders. ■ effects of an acute dose of alcohol on psychomo- to alcohol use in a general adult population. Drug
tor performance. Alcoholism: Clinical and Exper- and Alcohol Dependence 11(3/4):249–269, 1983.
imental Research 17(3):665–668, 1993.
SPENSER, A., ED. Memoirs of William Hickey. Lon-
References LIEBER, C.S. Medical disorders of alcoholism. New don: Hurst & Blackett Ltd., 1913. pp. 103–104.
England Journal of Medicine 333:1058–1065, 1995.
C. Excitability cycle of somatosensory evoked LITTLETON, J., AND LITTLE, H. Current concepts D.; KANTNER, A.; LANDIS, R.; LONARDI, L.; ROACHE,
potentials during experimental alcoholization and of ethanol dependence. Addiction 89(11):1397– J.; AND SEVERS, W. Alcohol hangover and man-
withdrawal. Psychopharmacologia 37(1):15–21, 1974. 1412, 1994. agerial effectiveness. Alcoholism: Clinical and
Experimental Research 19(5):1141–1146, 1995.
BOGIN, R.M.; NOSTRANT, T.T.; AND YOUNG, MACANDREW, C. The differentiation of male
M.J. Propranonol for the treatment of alcoholic alcoholic outpatients from nonalcoholic psychiatric SULLIVAN, J.T.; SYKORA, K.; SCHNEIDERMAN, J.;
hangover. American Journal of Drug & Alcohol outpatients by means of the MMPI. Quarterly NARANJO, C.A.; AND SELLERS, E.M. Assessment
Abuse 13(1&2):175–180, 1987. Journal of Studies on Alcohol 26(2):238–246, 1965. of alcohol withdrawal: The revised Clinical
Institute Withdrawal Assessment for Alcohol scale
CHAPMAN, L.F. Experimental induction of hang- MONTASTRUC, P. L’alcool exagere la soif. (Alcohol (CIWA-Ar). British Journal of Addiction 84(11):
over. Quarterly Journal of Studies on Alcohol exaggerates thirst). HCEIA Informations 4:41–42, 1353–1357, 1989.
5(Suppl. 5):67–86, 1970. 1986.
TORNROS, J., AND LAURELL, H. Acute and hang-
EARLEYWINE, M. Hangover moderates the associ- MUHONEN, T.; JOKELAINEN, K.; HOOK-NIKANNE, over effects of alcohol on simulated driving per-
ation between personality and drinking problems. J.; METHUEN, T.; AND SALASPURO, M. Tropisetron formance. Blutalkahol 28(1):24–30, 1991.
Addictive Behaviors 18(3):291–297, 1993a. and hangover. Addiction Biology 2(4):461–462, 1997.
EARLEYWINE, M. Personality risk for alcoholism National Institute on Alcohol Abuse and Alcoholism. The glutamatergic basis of human alcoholism.
covaries with hangover symptoms. Addictive Alcohol Alert No. 26: Alcohol and Hormones. PH American Journal of Psychiatry 152(3):332–340, 1995.
Behaviors 18(4):415–420, 1993b. 352. Bethesda, MD: the Institute, 1994.
AND JOHNSON, R.H. Vasopressin concentrations alcoholics report greater hangover symptoms than sons effects of ethanol at night. Journal of Studies on
during alcohol withdrawal. British Journal of of nonalcoholics: A pilot study. Alcoholism: Clinical Alcohol 52(6):597–600, 1991.
Addiction 80(2):195–199, 1985. and Experimental Research 14(5):713–716, 1990.
GAUVIN, D.V.; CHENG, E.Y.; AND HOLLOWAY, PARANTAINEN, J. Prostaglandins in alcohol intol- effects on aircraft pilots 14 hours after alcohol
F.A. Biobehavioral correlates. In: Galanter, M., erance and hangover. Drug and Alcohol Dependence ingestion: A preliminary report. American Journal
ed. Recent Developments in Alcoholism: Volume 11. 11(3–4):239–248, 1983. of Psychiatry 143(12):1546–1550, 1986.

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