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Researchers Say More Tannins May Mean More Headache Pain
By Brenda Goodman, MA
WebMD Health News
Reviewed by Laura J. Martin, MD
June 20, 2012 -- Many migraine sufferers find that the pleasure of a having a glass of red wine is soon followed by the pain of a headache. Now a small new study suggests that when it comes to migraines, some types of red wine may be more likely to trigger a headache than others.
"My suggestion is the more tannins the wine has, [the] more migraine attacks it triggers," says researcher Abouch V. Krymchantowski, MD, PhD, of the Rio Headache Center in Rio de Janeiro, Brazil, in an email to WebMD.
Tannins are flavonoids in red wine that give it a drying, sometimes puckering quality. The more tannins a wine has, the more it will dry out your mouth after you sip it.
No one is quite sure why red wine may trigger headaches, but some studies have shown that tannins may boost production of the brain chemical serotonin. Changes in serotonin levels may trigger migraines in susceptible individuals.
Krymchantowski asked 40 patients at his headache clinic to try an experiment. The patients had said their migraines were triggered by drinking red wine.
He gave them half-bottles of four different kinds of wine: a malbec, a tannat, a cabernet sauvignon, and a merlot. All the wines were from South America. The malbec and the tannat were high in tannins, while the carbernet and the merlot had lower tannin levels. He asked people to wait at least four days after drinking one of the half-bottles before they tried another.
Thirty-three patients completed the study. Nearly 90% had at least one migraine attack within 12 hours of drinking one of the half-bottles of red wine. About half of the people in the study had at least two migraine attacks after drinking the various reds. About a third of patients got a migraine after every half-bottle. Four people didn't get a migraine after drinking any of the wines.
Among the 18 patients who had at least two migraine attacks after drinking the red wines, Krymchantowski says the wines with the highest tannin content, the tannat and the malbec, were the most likely to have been the apparent triggers of those attacks.
The study was presented at the 54th Annual Meeting of the American Headache Society in Los Angeles.
Is the Red Wine Dilemma Solved?
Does that mean people who love red wine but fear it may bring on a headache should just stick to a cabernet or merlot? Alas, the answer is not so clear cut.
Krymchantowski says cabernet sauvignon wines from France, for example, have much higher tannin levels than any of the wines he tested from South America, making it tough for consumers to compare wines grape-to-grape if they come from different countries.
Headache experts who reviewed the study for WebMD praised the research for looking into something that's a common problem for patients, but one that's had very little attention from science.
"We hear quite often that wine, specifically red wine, is a trigger for people," says Brian Grosberg, MD, director of the Montefiore Headache Center in New York City.
But Grosberg says the study also leaves many important questions unanswered.
"Usually it's a combination of two or more triggers that precipitates a [migraine] attack. Many women will notice that their menstrual period is a very strong trigger. Or it may be that, 'Oh, I didn't get enough sleep, and I had that glass of wine the night before,'" he says. "I'd like to know if they were looking at any of these other variables."
Grosberg says there are other substances in wine that may cause problems for people, such as sulfites, and he wonders if the researchers looked at sulfite levels in the wines.
Other experts agree that the study is interesting but offers limited information.
"My feeling, if I had to put money on it, is that it has something to do with the sulfite level," not just the tannins, says Gayatri Devi, MD, an attending neurologist at Lenox Hill Hospital in New York City.
Sulfites are chemicals that are added to wine to increase its shelf life. Some people find that when they drink wine without sulfites, Devi says, they don't get headaches.
"It's certainly possible that different types of wine are more or less likely to trigger headaches. It's something I think is worth exploring down the road."
This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
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