Hangover

Did You Know?

• A French idiomatic expression for hangover is 'mal aux cheveux', literally 'sore hair'.
• In German, the hangover is known as a 'Kater', literally a tomcat, likely originating as a pun on catarrh.
• The Alcohol Hangover Research Group had its inaugural meeting in June 2010 as part of the Research Society on Alcoholism 33rd Annual Scientific Meeting in San Antonio, Texas.

Signs and symptoms

A hangover sets in as blood alcohol levels drop sharply, with symptoms peaking once they hit zero. The most common issues are drowsiness and trouble thinking clearly. Other validated effects include a general feeling of being unwell, thirst, headache, dizziness or faintness, tiredness, loss of appetite, nausea, stomach ache, and a racing heart. Some problems, like disrupted sleep and stomach upset, stem directly from intoxication or withdrawal. The full list of possible symptoms also covers dry mouth, sweating, hyper-excitability, and a vague discomfort that can linger beyond 24 hours. About 12% of people experience hangxiety—a mix of worry, stress, and unease. This can show up as racing thoughts, dread, a fast heartbeat, or guilt and regret over things done while drunk. The cause is unknown, and while anyone can get it, those with existing anxiety or mental health conditions may be more prone.

Causes

Hangovers are usually caused by alcohol consumption, but other components of alcoholic beverages may contribute. Congeners, compounds produced during fermentation that contribute to taste and smell, are found in higher levels in darker spirits such as bourbon and can worsen hangover symptoms. Sulfites added to wine as preservatives may cause headache in sensitive individuals. Several pathophysiological changes may give rise to hangover, including increased levels of acetaldehyde, hormonal alterations of cytokine pathways, decreased glucose availability, dehydration, metabolic acidosis, disturbed prostaglandin synthesis, increased cardiac output, vasodilation, sleep deprivation, and insufficient eating. After ingestion, ethanol is converted to acetaldehyde by alcohol dehydrogenase and then to acetic acid, converting NAD+ to NADH and disrupting the NAD+/NADH redox system, making normal bodily functions more difficult. Consequences include increased triglyceride production, increased amino acid catabolism, inhibition of the citric acid cycle, lactic acidosis, ketoacidosis, hyperuricemia, disturbance in cortisol and androgen metabolism, and increased fibrogenesis. Alcohol also induces the CYP2E1 enzyme, which in binge drinking creates oxidative stress that can lead to cell death.

Management

According to NIAAA, there is no magic potion for beating hangovers; only time can help, as the body must clear toxic byproducts, rehydrate, heal irritated tissue, and restore immune and brain activity. No compelling evidence exists that any conventional or complementary intervention is effective for preventing or treating alcohol hangover; the most effective way to avoid symptoms is to avoid drinking. Most remedies do not significantly reduce overall hangover severity, though some reduce specific symptoms. Drinking water before bed or during hangover may relieve thirst, dizziness, dry mouth, and headache. Tolfenamic acid, an inhibitor of prostaglandin synthesis, reduced headache, nausea, vomiting, and irritation in a 1983 study of 30 people but had no effect on tiredness. Large doses of Pyritinol, a synthetic Vitamin B6 analog, helped reduce hangover symptoms in a 1973 study, but possible side effects include hepatitis and acute pancreatitis. Yeast-based extracts showed statistically significant changes in discomfort, restlessness, and impatience but no significant differences in blood chemistry parameters or general well-being.

Common misconceptions

Alcohol consumption increases urine production, leading to dehydration, which is a common contributor to hangover symptoms, but dehydration represents only one aspect. Excessive alcohol intake induces systemic inflammation, gastrointestinal irritation, disruptions in sleep cycles, and hypoglycemia, and the metabolism of alcohol generates acetaldehyde, a toxic byproduct that may damage cells and tissues. Products such as sports drinks, vitamin supplements, or rehydration solutions may aid rehydration but generally fail to alleviate other symptoms like inflammation or metabolic disturbances. Experts recommend consuming water or non-alcoholic beverages intermittently while drinking to maintain hydration and promote moderation. The practice of 'hair of the dog'—consuming alcohol the morning after—temporarily elevates blood alcohol levels and may mask symptoms, but does not resolve underlying causes; symptoms reemerge once alcohol is metabolized. NIAAA notes that a hangover may represent a mild form of alcohol withdrawal, and continued consumption delays recovery, risking exacerbation of dehydration and metabolic strain. Using NSAIDs such as ibuprofen, naproxen, or aspirin alongside alcohol elevates the risk of gastrointestinal bleeding by about 37%.