I suffer from migraines. I love wine with dinner, but red wine always gives me migraines, while white wine does not. Why is there a difference?

Your Menopause Question: I suffer from migraines. I love wine with dinner, but red wine always gives me migraines, while white wine does not. Why is there a difference?

Our Response: You asked about a link between red wine and migraines that often is described among many women. So, what do we know about the negative interaction of red wine and migraines? First, let’s talk about migraines.

The biology of migraines is quickly becoming better understood. Originating in the trigeminal and cervical ganglia that serve the jaw, face, and head, nerve impulses are transmitted to terminal receptors that release a number of inflammatory proteins, the most recognized being calcitonin gene‐related peptide or CGRP. These inflammatory proteins dilate tiny blood vessels that serve our meninges, the thin membrane that covers our brain and spinal cord. Because each woman is unique in the way her blood vessels distribute across the meninges, her migraines may start in the back of the head or in one eye. Worse, while many women suffer from headaches alone, others also experience parasympathetic symptoms leading to nausea and diarrhea, or changes in voiding (Cortell, 2012). However, there is hopeful news for migraine sufferers. A number of medicines now are being developed to block the specific inflammatory proteins or their receptors.

But why red wine? There are many books on wine, but a good reference is A 5 oz Glass: The Health Secrets of Red Wine for Women, Westfall Park Publishing Group, NY (2012), written by Henry Hess, M.D., Ph.D., gynecologist and chemist. Many of the following comments are based on information from that reference.

All alcoholic wines are produced through fermentation of the sugar in grapes using yeast, resulting in about 15% of alcohol and 85% water. Further fermentation kills the yeast, thus creating a ceiling for alcohol content in wine. Other drinks with higher alcohol are created by adding back alcohol or distilling to reduce the water content.

Why is alcohol more a problem for women than men? Given the same amount of wine intake:

• women have more body fat, which stores alcohol, so there is less dilution in the blood,
• women experience dehydration from increased urination, because alcohol acts as a diuretic, and
• women have lower alcohol dehydrogenase (the enzyme that metabolizes alcohol) in their blood.

However, alcohol alone as a cause of headaches is a controversial area for discussion. In one small study, 11 participants who were tested because they believed red wine caused their headaches were blinded to receive either red wine or vodka. The incidence of headaches was equal (Littlewood, 1989), suggesting that perception of events may influence actual outcome.

In a larger study of 2,197 participants, 77.8% thought that red wine caused migraines, while only 8.5% believed the alcohol in vodka was the trigger. In fact, only 8.8% of those who were given red wine experienced headaches compared with 10.7% of those receiving vodka (Onderwater, 2018).

So, what is good about red wine? The principle antioxidants in wine that promote health are the polyphenols, primarily containing procynidins and hocyanidines, which give the deep red color to red wine. (Note that dark chocolate also has high procynidins).

But, old versus young red wines differ in their polyphenol components. Young reds contain a single (oligomeric) procyanidin complex. Old red wines with longer storage merge these molecular structures through polymerization, thus forming the sediment in the bottom of old red wine bottles. Finally, these wines contain other chemicals. Histamines, which also are present in cheese and processed meats, dilate blood vessels. Tyramine, present in beer, red wine, and other liqueurs causes dilation as well as constriction of blood vessels. And sulfites (sulfur dioxide), a byproduct of fermentation that preserves and prevents bacterial growth, can cause allergic reactions (Panconesi, 2008). Tannins, found both in grape skins and the seeds of younger red wines, give them a bitter or astringent flavor. See why it is difficult to narrow the cause? And what is the risk anyhow?

Alcohol often is at the top of the list of modifiable causes of breast cancer, since estimates show an increase in breast cancer as high as 30% to 50%, even for those with moderate alcoholic intake, (McDonald, 2013). This relationship has been seen both in case control and cohort studies (Seitz, 2021). Alcohol appears to boost one’s estradiol levels, which
could be one explanation (Martin, 2008). A link between alcohol intake and increased density of breast tissue, a marker of breast cancer risk, also has been identified (Boyd, 2011). Because the relationship of alcohol to breast cancer now is becoming better publicized, this medical issue has emerged as a critical public health target (Meadows, 2015).

In the past, the advice that a single, five‐ounce glass of wine taken occasionally with dinner probably carries a low risk of breast cancer for those 75 years or older was widely accepted. But excessive alcohol intake, coupled with obesity and smoking, was a different matter.

A reasonable conclusion to this controversy should end with a bottom line: moderation, as with all of life’s activities, is the best solution. And staying with white wine would seem to be a logical choice.

Not so fast. Science always seems to intervene to spoil life’s pleasures. A just released global study of alcohol risk from 204 countries concludes that, for those age 15 to 39, alcohol offers no real health benefits. And after 40, only moderate alcohol consumption should be the rule (Lancet news release, 2022). While this sounds unrealistic, it speaks to a real biology. Alcohol addiction represents a permanent damage to the brain but begins with binge drinking in early life. Worse, the damage establishes the craving that drives addiction.

Apart from trying to explain the controversy, healthcare providers have an additional challenge. Most patients don’t tell the truth about how much they drink. And most care providers are not skilled in counseling patients who seek help for their addiction. As with most of medicine, a good listener may be the best provider of care.

A note for young wine drinkers: Wine drinkers often ask to see the cork, apparently to determine if it was cracked. But in old red wine bottles, it usually is impossible even to get the cork out without filtering the wine to remove the cork pieces. But, the inspection of the cork does tell you one thing, which is that the wine inside actually is from the vineyard whose name is on the cork. It removes any concern that the original wine was removed, a cheaper wine put in the bottle, and then the bottle re-corked with a plain cork.

James Woods | 9/1/2022