© Ben Wiseman

Red wine is a wonderful thing—unless you're among the unlucky victims of wine-induced headaches. We break down the science to find out why some suffer and others don't, and—more importantly—whether it's possible to raise a glass without paying the price.

March 20, 2017

Sometimess it begins with a dull forehead throb, 
a warp in the corners of my vision. Then the pain spreads until it feels like my mind is unsticking itself from my brain. It’s a headache, a vicious one, and why do I have it? Because someone asked 
me a simple question—“Red or white?”—and, despite knowing the possible consequences, I chose red. 


I’m not alone. According to a 2013 study, more than a third of regular wine drinkers report occasional headaches from wine—and not from overindulgence. Even a single glass can trigger one. But as those of us who suffer are well aware, not every red causes a headache every time. 


Last year, for instance, I was at a dinner party thrown by 
a glamorous friend. She’d brought up a couple of rare bottles of Burgundy from her cellar. The wine was the color of 
rubies. It undoubtedly cost a fortune. “I’ve also got some sort of Riesling in the fridge,” she said. I hesitated. It should have been an easy choice—undistinguished Riesling versus grand 
cru Burgundy. For me, it was a gamble. I rolled the dice and wound up enduring a throbbing, grin-and-bear-it rest of the night. Which raises that crucial question: How can I, 
or anyone, tell a headachy red from a headache-free one?


Sulfites: Innocent Or Evil?


A lot of people might be thinking as they read this: Wait 
a minute—I already know the answer. Isn’t the culprit sulfites?


The short answer is no. Those compounds have been used 
in wine production since antiquity to prevent spoilage and to keep reds bright and whites from browning. They’re also 
a natural by-product of fermentation, so a truly sulfite-free wine is actually an impossibility. Since 1987, wine labels in 
the US have been required to disclose whether bottles contain sulfite levels of 10 parts per million or greater, a measure introduced to protect the small percentage of the population—about one person in a hundred—that is truly allergic to sulfites. But scientists have found no link between sulfites in wine and headaches. In fact, for people who have this allergy, the typical response is not a headache but hives and difficulty breathing. What’s more, white wines generally have more added sulfites than reds.


Skin in the Game

So if sulfites aren’t to blame, what is? Scientists are divided on the matter, but the main suspects are two categories of naturally occurring compounds found in red wines: phenolic flavonoids and biogenic amines.


Explaining these compounds risks getting into chemistry-class-level geekiness, but, basically, phenolic flavonoids include many of the molecules that give a wine its color, flavor and mouthfeel, all of which are concentrated in the skin, seeds and stems of grapes (and all of which contain good-for-you antioxidants). Once ingested, these molecules can pinball through your body, disabling certain enzymes in your gut, triggering the release of serotonin in your brain and causing reactions that have been linked to headaches.


When it comes to phenolic flavonoids, red wines generally contain higher levels than whites. But not all red wines 
are created equal. Dr. Abouch Krymchantowski and Dr. Carla Jevoux at The Headache Center of Rio, in Brazil, ran a study where 28 people, all prone to red wine headaches, were given four half-bottles of Cabernet Sauvignon—two from Bordeaux and two from South America. They were asked to drink the wines on different nights and record their experiences. Sixty percent of the Bordeaux drinkers reported headaches, but only 40 percent of the South American Cabernet drinkers suffered.


The difference? How the wines were made. Winemakers in the Médoc and Haut-Médoc regions (where the Bordeaux 
used in the study were from) tend to extract a large proportion of the tannins and phenolic flavonoids found in the Cabernet Sauvignon grape because those compounds help develop flavors and also add aging potential. But many South American wines—such as some Cabernets from Chile, Dr. Krymchantowski says—are made to be drunk upon release; they’re more “approachable.” To that end, fewer tannins and other flavonoids are extracted during production, making these wines potentially friendlier for the headache-prone. 


The small size of the study makes it difficult to say anything conclusive about its findings. However, Dr. Krymchantowski, a wine lover himself, says that those results align with what 
he has observed during 30-plus years of treating headache patients. Wines with higher levels of tannins and other flavonoids, he says, “like those made with the grape Tannat, or Cabernet Sauvignon, especially from the parts of Bordeaux on the left bank of the Gironde, and perhaps some Syrahs from South America, are worse than others.”


But he notes that it’s not easy to draw 
rigid lines. His favorite Napa Valley Cabernet Sauvignon, from the Stags Leap District, invariably gives his wife a headache. However, 
a similar Cabernet from a nearby winery doesn’t bother her 
at all. “So what do you do?” I asked him. He replied, wisely, 
“I always try to buy the second wine.” 


It's All in the Genes

Biogenic amines, a group of chemicals produced during fermentation, include headache-linked substances such 
as histamine and tyramine. While amine content varies 
widely in wine, it tends to be higher in reds than whites. 
So are these compounds the villains?


Dr. Sami Bahna, at the Allergy & Immunology department of the Louisiana State University Health Sciences Center, explains that genetics (and certain medications such as MAO inhibitors) may impair some drinkers’ ability to metabolize histamine and its brethren. This means more amines make their way from the belly to the bloodstream, which can lead 
to symptoms such as facial flushing and, indeed, headaches.


But if you’re amine-sensitive, you also have other foods to worry about: Aged cheeses, cured meats and dried fruits can all trigger reactions. Which means the next time you go to a party, that sexy charcuterie platter overflowing with runny Taleggio and gamey soppressata—and so nice with a glass of red—may only work to intensify the headache you’re headed toward.


The Sum of the Parts

To avoid headaches, some people swear by drinking only natural wines, which are made without any added chemicals. But since all of these problematic compounds occur naturally, science doesn’t support that theory. In fact, it is extremely difficult to provide a one-size-fits-all solution because the alchemy of a red wine headache depends not only on the chemical content of the wine, but also on the idiosyncrasies of your body, the circumstances of your life—even the weather.


Dr. Audrey Halpern, an assistant professor of neurology 
at NYU’s Langone Medical Center who specializes in headaches, explains that people prone to migraines are more likely to 
be adversely affected by red wine, but that multiple triggers are usually required to bring on a full-blown attack: “It’s 
not just the glass of red wine. It’s the red wine and the slice of pepperoni pizza and the barometric pressure dropping because there’s 
a hurricane on its way.”


Complicating matters further, your tendency to develop a headache varies with your physiology. Hormonal changes “may make the brain more susceptible,” Dr. Halpern says. 
“Or if you’re stressed out or not sleeping well.” 


The Takeaway

After a New Year’s Eve run-in this year with 
a beautiful bottle of Quintarelli Valpolicella—a remarkably luscious, intense Italian red—left me with a few hours of wincing pain, I decided that was it. Wine headaches and I were done. Or, at the very least, I’d try some wines created 
with headache sufferers in mind.


When his mother was diagnosed with a histamine intolerance, Italian winemaker (and very good son) Sebastiano Ramello set out to make a wine that wouldn’t trigger her symptoms. Using a system of exacting controls 
in the fields and in the cellars, he created a Dolcetto and 
a Barbera for Piedmont’s Veglio winery that each have 
a tenth the histamines found in an average bottle of red. 


I spent a recent rainy afternoon sampling both. The great news: no headache. On the other hand, a bottle of Bruno Giacosa Dolcetto that I opened next also didn’t cause 
a headache—and was an even better wine. Dolcetto and Barbera are low in histamines anyway, as red wine grapes go, which is partly why Ramello chose to work with them. So perhaps my wine-drinking future will be full of those varieties...or I’ll 
just have to accept that pleasure sometimes comes at a price. 
My husband and I have three more bottles of that spectacular Quintarelli wine from New Year’s left. And regardless of the consequences, I intend to enjoy every last one of them.