What is hangover?
Hangover — also known as alcohol hangover, or, medically, as veisalgia — is defined by the Alcohol Hangover Research Group as “the combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero”.[1] Specific symptoms are not listed due to the variability in how individuals experience hangovers. However, the presence of hangover symptoms, regardless of their nature, is often sufficient to disrupt the performance of daily tasks and responsibilities.
What are the main signs and symptoms of hangover?
Over 47 symptoms of hangover have been identified. While many hangover symptoms are common, there is immense variation in the subjective experience of hangover: people with hangover may experience any of the hangover symptoms, or any combination of them, to any degree. Among the most common symptoms of hangover are fatigue, thirst, drowsiness, headache, and problems with concentration and memory.[2]
Physical signs of hangover may include tachycardia (rapid heartbeat), increased blood pressure, tremor, sensitivity to noise and light, and muscle cramps. Sleep disturbances, including an increase in slow-wave sleep and a decrease in both rapid eye movement (REM) sleep and total sleep time, are also associated with hangover.[3]
How is hangover diagnosed?
There currently is no objective assessment or biomarker that can be used to reliably “diagnose” hangover or to determine the severity of hangover symptoms. Thus, the diagnosis of hangover relies on the subjective reporting of symptoms. Three commonly-used hangover symptom scales include the Hangover Symptom Scale (HSS), the Acute Hangover Scale (AHS), and the Alcohol Hangover Severity Scale (AHSS). Each scale asks participants to rate the presence or absence of a variety of hangover symptoms, along with their severity (typically on a 0–10 scale).[4]
Alternatively, research has suggested that a 1-item score — rating hangover from absent (0) to extreme (10) — may be more effective for accurately “diagnosing” and assessing the severity of hangover by encompassing all of the individual symptoms experienced by the drinker and their perceived impact on daily activities, mood, and function.[4]
What are some of the main medical treatments for hangover?
It is public consensus that abstaining from, or moderating, alcohol consumption is the main way to prevent a hangover, and the passage of time is the main way to alleviate it. Medical professionals should inform individuals that if they drink alcohol, they should do so within safe drinking limits; they should also provide clinically-appropriate screening for the diagnosis of suspected alcohol use disorder.[5] So far only one medication has shown some benefit for hangover in clinical research — tolfenamic acid (brand names: Clotam, Tufnil), which is a nonsteroidal anti-inflammatory drug used in the treatment of migraine headache. However, the evidence is only very-low-certainty,[5] and this medication is neither prescribed nor indicated for this purpose.
Drinking water with or without electrolytes, eating a snack, taking over-the-counter pain-relief medications, and going to sleep are also common advice to reduce hangover symptoms. Remarkably, common pain-relief medications like aspirin and acetaminophen have not been studied for hangover symptoms in clinical trials;[5] however, the product SJP-001, a combination of naproxen and fexofenadine (an antihistamine), was shown to improve hangover severity compared to placebo in a small study.[6]
Have any supplements been studied for hangover?
Despite the high demand and potential productivity-saving applications of hangover treatments, there is currently a lack of evidence to support any such remedies. Though several different supplements and herbal compounds have been studied for their ability to reduce hangover symptoms, most have very little research to support their efficacy. A systematic review published in 2022 concluded that some supplements may reduce hangover symptoms compared to placebo. These include clove extract, pyritinol (a chemically-altered vitamin B6), Hovenia dulcis fruit extract, L-cysteine, red ginseng, and Korean pear juice. However, the evidence to support any of these supplements was rated as very low quality[5], mostly due to a lack of well-controlled studies.
How could diet affect hangover?
Despite the commonly-held belief that eating bread or greasy food will help to prevent a hangover by “soaking up” the alcohol, there’s no scientific evidence to support this effect. However, eating food (especially high-energy meals) before or during a drinking episode will help to mitigate the rate and magnitude of the rise in BAC, decrease the absorption of alcohol, and slow the metabolism of alcohol — leading to less intoxication and perhaps a less-severe hangover. Dietary intake of nicotinic acid and zinc is known to play a role in the metabolism of alcohol (ethanol) into acetaldehyde. Studies have found that social drinkers with higher intakes of zinc and nicotinic acid have a lower hangover severity. The intakes of other nutrients, including fat, carbohydrates, protein, fiber, salt, or vitamins B, D, C, and E, are not associated with hangover severity.[7]
Are there any other treatments for hangover?
Recent treatments for hangover have targeted the inflammation- and oxidative stress-inducing effects of alcohol, although much more research is needed to know if these products help hangover, as the current evidence is limited. A product containing the amino acid L-cysteine along with B and C vitamins failed to improve hangover severity or associated biomarkers compared to placebo.[8] Simple carbohydrates and Vitamin B6 have also shown some effectiveness for treating cognitive symptoms and hangover symptom severity, respectively.[9]
Contrary to popular belief, drinking more alcohol does not cure a hangover.
What causes hangover?
It’s a popular yet unproven belief that dehydration is one of the main causes of hangover. While dehydration can contribute to symptoms of a hangover, it may not be the cause of hangovers per se — see below.
Rather, hangover seems to be the result of the direct effects of alcohol (ethanol) on the production of reactive oxygen species (ROS) — which are generated during the breakdown of alcohol. ROS elicit mitochondria damage and oxidative stress throughout the body and central nervous system (CNS). ROS also activate the immune system, initiating both pro- and anti-inflammatory cytokine responses in the body and CNS. Symptoms such as nausea, vomiting, headache, confusion, tremor, and learning and memory deficits occur in the presence of elevated levels of inflammatory cytokines, and higher levels of inflammation and ROS are associated with a greater hangover severity, directly implicating them in the pathology of hangover.[10]
Other factors contributing to hangover include: an alteration in neurotransmitters such as GABA, glutamate, dopamine, serotonin, and the endocannabinoids; disturbances in sleep quality or quantity due to alcohol consumption; and alterations in hormones and electrolytes.[11]
Examine Database: Hangover
Research FeedRead all studies
Frequently asked questions
Hangover — also known as alcohol hangover, or, medically, as veisalgia — is defined by the Alcohol Hangover Research Group as “the combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero”.[1] Specific symptoms are not listed due to the variability in how individuals experience hangovers. However, the presence of hangover symptoms, regardless of their nature, is often sufficient to disrupt the performance of daily tasks and responsibilities.
Although a significant amount of overlap exists in the symptoms of hangover and alcohol withdrawal, the two conditions are not the same. Hangover symptoms occur after a single bout of heavy drinking; alcohol withdrawal occurs when someone who regularly drinks alcohol suddenly stops drinking or begins to drink less. Regular alcohol consumption results in neurochemical changes: increased excitatory N-methyl-D-aspartate (NMDA) neuroreceptors and decreased responsiveness of the inhibitory gamma-aminobutyric acid (GABA) receptors in the brain. Without the regular dose of alcohol, NMDA receptors are excessively excited by glutamate and GABA receptors cannot adequately inhibit this excitation. This presents as symptoms of alcohol withdrawal — which include anxiety, confusion, exhaustion, headaches, irritability, shaking and tremors, and sleeplessness — and in the worst case, as hallucinations and seizures that can become severe enough to lead to death.[12]
There are other major differences between alcohol withdrawal and hangover. Hangover symptoms typically begin within hours of drinking cessation (when BAC reaches zero) and can resolve within 24 hours. In contrast, symptoms of alcohol withdrawal can begin several hours to days after someone stops drinking, and symptoms can last for a week or longer, though they’re typically at their worst around days 2–3.[12]
In summary, while anyone can experience an alcohol hangover, only individuals who have developed a tolerance for alcohol can experience alcohol withdrawal and the associated symptoms.
Over 47 symptoms of hangover have been identified. While many hangover symptoms are common, there is immense variation in the subjective experience of hangover: people with hangover may experience any of the hangover symptoms, or any combination of them, to any degree. Among the most common symptoms of hangover are fatigue, thirst, drowsiness, headache, and problems with concentration and memory.[2]
Physical signs of hangover may include tachycardia (rapid heartbeat), increased blood pressure, tremor, sensitivity to noise and light, and muscle cramps. Sleep disturbances, including an increase in slow-wave sleep and a decrease in both rapid eye movement (REM) sleep and total sleep time, are also associated with hangover.[3]
There currently is no objective assessment or biomarker that can be used to reliably “diagnose” hangover or to determine the severity of hangover symptoms. Thus, the diagnosis of hangover relies on the subjective reporting of symptoms. Three commonly-used hangover symptom scales include the Hangover Symptom Scale (HSS), the Acute Hangover Scale (AHS), and the Alcohol Hangover Severity Scale (AHSS). Each scale asks participants to rate the presence or absence of a variety of hangover symptoms, along with their severity (typically on a 0–10 scale).[4]
Alternatively, research has suggested that a 1-item score — rating hangover from absent (0) to extreme (10) — may be more effective for accurately “diagnosing” and assessing the severity of hangover by encompassing all of the individual symptoms experienced by the drinker and their perceived impact on daily activities, mood, and function.[4]
It is public consensus that abstaining from, or moderating, alcohol consumption is the main way to prevent a hangover, and the passage of time is the main way to alleviate it. Medical professionals should inform individuals that if they drink alcohol, they should do so within safe drinking limits; they should also provide clinically-appropriate screening for the diagnosis of suspected alcohol use disorder.[5] So far only one medication has shown some benefit for hangover in clinical research — tolfenamic acid (brand names: Clotam, Tufnil), which is a nonsteroidal anti-inflammatory drug used in the treatment of migraine headache. However, the evidence is only very-low-certainty,[5] and this medication is neither prescribed nor indicated for this purpose.
Drinking water with or without electrolytes, eating a snack, taking over-the-counter pain-relief medications, and going to sleep are also common advice to reduce hangover symptoms. Remarkably, common pain-relief medications like aspirin and acetaminophen have not been studied for hangover symptoms in clinical trials;[5] however, the product SJP-001, a combination of naproxen and fexofenadine (an antihistamine), was shown to improve hangover severity compared to placebo in a small study.[6]
Despite the high demand and potential productivity-saving applications of hangover treatments, there is currently a lack of evidence to support any such remedies. Though several different supplements and herbal compounds have been studied for their ability to reduce hangover symptoms, most have very little research to support their efficacy. A systematic review published in 2022 concluded that some supplements may reduce hangover symptoms compared to placebo. These include clove extract, pyritinol (a chemically-altered vitamin B6), Hovenia dulcis fruit extract, L-cysteine, red ginseng, and Korean pear juice. However, the evidence to support any of these supplements was rated as very low quality[5], mostly due to a lack of well-controlled studies.
Despite the commonly-held belief that eating bread or greasy food will help to prevent a hangover by “soaking up” the alcohol, there’s no scientific evidence to support this effect. However, eating food (especially high-energy meals) before or during a drinking episode will help to mitigate the rate and magnitude of the rise in BAC, decrease the absorption of alcohol, and slow the metabolism of alcohol — leading to less intoxication and perhaps a less-severe hangover. Dietary intake of nicotinic acid and zinc is known to play a role in the metabolism of alcohol (ethanol) into acetaldehyde. Studies have found that social drinkers with higher intakes of zinc and nicotinic acid have a lower hangover severity. The intakes of other nutrients, including fat, carbohydrates, protein, fiber, salt, or vitamins B, D, C, and E, are not associated with hangover severity.[7]
Recent treatments for hangover have targeted the inflammation- and oxidative stress-inducing effects of alcohol, although much more research is needed to know if these products help hangover, as the current evidence is limited. A product containing the amino acid L-cysteine along with B and C vitamins failed to improve hangover severity or associated biomarkers compared to placebo.[8] Simple carbohydrates and Vitamin B6 have also shown some effectiveness for treating cognitive symptoms and hangover symptom severity, respectively.[9]
Contrary to popular belief, drinking more alcohol does not cure a hangover.
It’s a popular yet unproven belief that dehydration is one of the main causes of hangover. While dehydration can contribute to symptoms of a hangover, it may not be the cause of hangovers per se — see below.
Rather, hangover seems to be the result of the direct effects of alcohol (ethanol) on the production of reactive oxygen species (ROS) — which are generated during the breakdown of alcohol. ROS elicit mitochondria damage and oxidative stress throughout the body and central nervous system (CNS). ROS also activate the immune system, initiating both pro- and anti-inflammatory cytokine responses in the body and CNS. Symptoms such as nausea, vomiting, headache, confusion, tremor, and learning and memory deficits occur in the presence of elevated levels of inflammatory cytokines, and higher levels of inflammation and ROS are associated with a greater hangover severity, directly implicating them in the pathology of hangover.[10]
Other factors contributing to hangover include: an alteration in neurotransmitters such as GABA, glutamate, dopamine, serotonin, and the endocannabinoids; disturbances in sleep quality or quantity due to alcohol consumption; and alterations in hormones and electrolytes.[11]
There are several factors that are known to contribute to alcohol hangover, though they’re probably not a direct cause.
Excessive alcohol consumption leads to dehydration, fluctuations in electrolyte levels, and alterations in blood glucose which in turn can lead to thirst, dizziness, headaches, and problems with memory and concentration – all of which are symptoms that have been reported during hangover.
Alcohol also reduces sleep quantity and quality, which may explain the symptom of next-day drowsiness in people experiencing hangovers.[13]
Genetic factors may also influence a person’s propensity to be “hangover-resistant” or “hangover-prone”; anywhere from 5–23% of the population are reported to be “hangover-resistant”.[11] One study found that genetic factors accounted for 40–45% of the variation in hangover frequency and 16–24% of the variation in hangover susceptibility among individuals.[14]
Congeners are naturally occurring compounds in most alcoholic beverages produced during the distilling and fermenting process; examples include methanol, esters, tannins, histamines, and aldehydes.[15] Some theories posit that congeners may compete with alcohol metabolism and/or cause inflammation. Some studies suggest that alcohols with more congeners (i.e., brandy, red wine, rum, bourbon) may lead to worse hangovers than those with the least congener content (i.e., vodka, beer, gin, white wine), but not all evidence suggests that this is true.[16]
Alcohol is a diuretic — it increases the production of urine. These effects occur because alcohol suppresses the production of a hormone known as antidiuretic hormone (ADH), which normally helps our body retain water. Because alcohol-induced diuresis is often out of proportion with the amount of fluid ingested, dehydration can occur. Interestingly, there is very little evidence that electrolyte imbalances contribute to or are associated with hangovers.[9][17]
The lack of a direct causal role of dehydration in hangover is evidenced by the fact that hydration is insufficient to completely resolve hangover symptoms. It should be noted that few studies have investigated the effects of hydration and/or electrolyte supplementation on hangover symptoms. That being said, alcohol-induced dehydration, although distinct from a hangover, does frequently co-occur with a hangover and is very important to treat.[18]
People seem to experience fewer hangovers less often as they get older, and this isn’t just because older people drink less with age.
Furthermore, the severity of hangovers seems to decline with age, regardless of the amount of alcohol consumed or BAC. Older adults also seem to experience lower subjective intoxication. The reasons why aging is associated with a lower frequency and severity of hangover haven’t been investigated, but some research suggests that older adults may have a lower pain sensitivity, which could result in their reporting a lower hangover symptom severity.[19] Additional reasons why older adults may experience less-severe hangovers may include a longer drinking experience or greater alcohol tolerance, the preference of older adults to drink pricier liquors that contain fewer congeners and toxins, or differences in neurological development and alcohol metabolism.[20]
References
- ^Verster JC, Scholey A, van de Loo AJAE, Benson S, Stock AKUpdating the Definition of the Alcohol Hangover.J Clin Med.(2020-Mar-18)
- ^Penning R, McKinney A, Verster JCAlcohol hangover symptoms and their contribution to the overall hangover severity.Alcohol Alcohol.(2012)
- ^Prat G, Adan A, Sánchez-Turet MAlcohol hangover: a critical review of explanatory factorsHum Psychopharmacol.(2009 Jun)
- ^Verster JC, van de Loo AJAE, Benson S, Scholey A, Stock AKThe Assessment of Overall Hangover Severity.J Clin Med.(2020-Mar-13)
- ^Roberts E, Smith R, Hotopf M, Drummond CThe efficacy and tolerability of pharmacologically active interventions for alcohol-induced hangover symptomatology: a systematic review of the evidence from randomised placebo-controlled trials.Addiction.(2022-Aug)
- ^Verster JC, Dahl TA, Scholey A, Iversen JMThe Effects of SJP-001 on Alcohol Hangover Severity: A Pilot Study.J Clin Med.(2020-Mar-31)
- ^Verster JC, Vermeulen SA, Loo AJAEV, Balikji S, Kraneveld AD, Garssen J, Scholey ADietary Nutrient Intake, Alcohol Metabolism, and Hangover Severity.J Clin Med.(2019-Aug-27)
- ^Scholey A, Ayre E, Stock AK, Verster JC, Benson SEffects of Rapid Recovery on Alcohol Hangover Severity: A Double-Blind, Placebo-Controlled, Randomized, Balanced Crossover Trial.J Clin Med.(2020-Jul-09)
- ^Wiese JG, Shlipak MG, Browner WSThe alcohol hangover.Ann Intern Med.(2000-Jun-06)
- ^van de Loo AJAE, Mackus M, Kwon O, Krishnakumar IM, Garssen J, Kraneveld AD, Scholey A, Verster JCThe Inflammatory Response to Alcohol Consumption and Its Role in the Pathology of Alcohol Hangover.J Clin Med.(2020-Jul-02)
- ^Palmer E, Tyacke R, Sastre M, Lingford-Hughes A, Nutt D, Ward RJAlcohol Hangover: Underlying Biochemical, Inflammatory and Neurochemical MechanismsAlcohol Alcohol.(2019 May 1)
- ^Bayard M, McIntyre J, Hill KR, Woodside JAlcohol withdrawal syndrome.Am Fam Physician.(2004-Mar-15)
- ^van Schrojenstein Lantman M, Mackus M, Roth T, Verster JCTotal sleep time, alcohol consumption, and the duration and severity of alcohol hangoverNat Sci Sleep.(2017 Jun 29)
- ^Slutske WS, Piasecki TM, Nathanson L, Statham DJ, Martin NGGenetic influences on alcohol-related hangover.Addiction.(2014-Dec)
- ^Rohsenow DJ, Howland JThe role of beverage congeners in hangover and other residual effects of alcohol intoxication: a reviewCurr Drug Abuse Rev.(2010 Jun)
- ^Verster JCThe alcohol hangover--a puzzling phenomenonAlcohol Alcohol.(2008 Mar-Apr)
- ^Ylikahri RH, Pösö AR, Huttunen MO, Hillbom MEAlcohol intoxication and hangover: effects on plasma electrolyte concentrations and acid-base balance.Scand J Clin Lab Invest.(1974-Dec)
- ^Penning R, van Nuland M, Fliervoet LA, Olivier B, Verster JCThe pathology of alcohol hangoverCurr Drug Abuse Rev.(2010 Jun)
- ^Verster JC, Severeijns NR, Sips ASM, Saeed HM, Benson S, Scholey A, Bruce GAlcohol Hangover Across the Lifespan: Impact Of Sex and Age.Alcohol Alcohol.(2021-Aug-30)
- ^Huntley G, Treloar H, Blanchard A, Monti PM, Carey KB, Rohsenow DJ, Miranda RAn event-level investigation of hangovers' relationship to age and drinking.Exp Clin Psychopharmacol.(2015-Oct)
Examine Database References
- Estrogen - Low plasma testosterone values in men during hangoverJournal of Steroid Biochemistry.()