Red Wine Headache (RWH) syndrome is real, and sufferers would love to know exactly what causes the splitting headache they get whenever they attempt to enjoy a glass or two of red wine. But, RWH seems to be a poorly understood subject. While sulfites and histamines are often cited as the culprits, evidence indicates otherwise. Tannins and tyramine are also among the accused. It seems that no one, not even the experts, are really sure what causes RWH.
Sulfite allergies can be very serious and even life threatening. Over 20 years ago, the Food and Drug Administration in the U.S. determined that about 1% of the population suffered from a sulfite allergy. Ever since, “contains sulfites” warnings have been printed on the labels of wine in the U.S. that contain a certain level of sulfites. These warning labels seem to have sparked a fear that the sulfite levels in wine are hazardous to everyone.
Dr. Frederick G. Freitag, associate director of the Diamond Headache Clinic in Chicago, and an RWH sufferer, is unsure of what actually causes Red Wine Headaches in some people, but he is sure it is not sulfites. He states that, “Sulfites can cause an allergic reaction, but they give headaches only to some asthmatics. The more common reaction to sulfites is a breathing problem.” Some people may also get a bad skin rash.
The fact that many RWH sufferers can drink white wine with no adverse effects also points the finger in a different direction. Sulfites are a natural bi-product of fermentation and are also often added to wine as an antioxidant and microbial agent. All wine contains some sulfites, but white wine and sweet wine actually contain more than red. White wine is more susceptible to oxidation and tends to lose its freshness faster, so it requires the addition of more sulfites during the winemaking process and prior to bottling.
It’s also a fact that wine contains a very small amount of sulfites compared to some other foods including dried fruit, packaged baked goods, and pickled vegetables. In fact, a serving of dried apricots contains 10 times the amount of sulfites as a serving of wine. (It’s interesting to note that these products do not need to carry the government warning in the U.S.). If a person has breathing difficulties or breaks out in a rash after eating these foods and drinking red, white, and sweet wines they may indeed have an allergy to sulfites.
Histamine is a biogenic amine that is produced by the body and can also be ingested through the food and drink we consume. Histamine is a mediator of allergic reactions. On contact with or ingestion of a substance to which a person is “allergic”, histamine is released in the body. If a person ingests something that also contains histamine, the concentration of histamine in the blood can be increased. Foods that contain high amounts of this substance can result in symptoms similar to an allergic reaction in some individuals. Dr. Freitag states that it is more common for individuals to react with a stuffy nose than a headache. Some people may also react with a cough, rash, or stomach ailments.
Red wine contains more histamine than white wine due to several different vinification processes; however, histamine in wine is a minor constituent when compared to many other foods we consume on a daily basis. Foods such as aged cheese, chocolate, fish, meat, yeast extract and products, strawberries, eggplant, spinach, and tomatoes all have a significant amount of histamine – many of them contain as much as 10 times the amount of histamines as red wine.
A study conducted in 2001 and reported on in the Journal of Allergy and Clinical Immunology (Volume 107, Issue 2) concluded that there is no correlation between wine intolerance and histamine content of wine. Sixteen people with an intolerance to wine were tested and showed no difference in reaction to low or high levels of histamine in the wine.
The tannins found in red wines may be a cause of RWH. Tannins contribute the bitter and astringent characteristics to red wine, giving a drying sensation in the mouth. They are found in the grape skins, seeds, and stems, and are absorbed into red wine during the maceration and fermentation process. They can also be leached into wine from the oak barrels the wine is aged in. Jamie Goode defines tannins as:
“…polyphenolic compounds that bind to and precipitate proteins…Tannins themselves are found principally in the bark, leaves and immature fruit of a wide range of plants. They form complexes with proteins and other plant polymers such as polysaccharides. It is thought that the role of tannins in nature is one of plant defence: they have an astringent, aversive taste that is off-putting to wannabe herbivores.” (wineanorak.com)
Experiments have shown that tannins cause the release of a neurotransmitter, serotonin, and that high levels of serotonin can cause headaches, usually in people susceptible to migraines. This does not explain why people who do not get migraines may suffer from RWH. People who are sensitive to tannins should also get headaches from tea, chocolate, soy, and walnuts, but very few people complain about headaches from these foods. People who believe they are sensitive to tannins should look for red wines that are naturally lower in tannins, such as Gamay and Pinot Noir.
Tyramine, may indeed be a major player in RWH syndrome. Tyramine is an amine that is produced naturally from the breakdown of protein as food ages. More specifically it is formed by the decarboxylation (a chemical reaction that releases carbon dioxide) of the amino acid tyrosine. It is found in aged, fermented, and spoiled foods. Everyday foods we consume including aged cheeses, overripe and dried fruit, sauerkraut, soy, and many processed foods contain high levels of tyramine. Tyramine is suspected of inducing migraine headaches in about 40% of migraine sufferers, according to Dr. Freitag.
Dr. Lynn Gretkowski, co-founder of WineDoctors.com states that tyramine could be the cause of RWH. Two years ago, she told The Wine Spectator, “Tyramine is thought to be a vassal active substance that causes the dilation and contraction of blood vessels – the squeezing and relaxation component of headaches” (Wine Spectator, May 31, 2009). She goes on to say that younger wines and wines that have not been extensively racked or filtered will tend to have higher rates of tyramine. Not all wine has the same level of tyramine present so not all red wine causes RWH symptoms.
However, tyramine has not yet been definitely proven as the source of the Red Wine Headache either.
Advice for RWH Sufferers
Dr. Freitag also suffers from RWH and, like many other RWH sufferers, states that he can drink some red wines and not others. Generally for him, California reds are okay, but only certain French wines will not cause him to have a roaring headache. Other sufferers have told him that they can only drink French wines. Dr. Freitag advises that if you really love red wine then test one by drinking about half a glass. If it’s going to give you a headache, it should occur within about 15 minutes. If that wine seems to be okay, then only drink 2 glasses at most and keep a diary for future reference.
(The above post is an altered version of my article, “The Causes of Red Wine Headaches,” first published a year ago on Suite101.com.)