Hangover is the collection of physical and mental symptoms that occur after a person drinks excessive amounts of alcohol.
Hangovers have probably been experienced since prehistoric time when alcohol was first discovered. A survey found that about 75% of the persons who drank enough to be intoxicated (drunk) sometimes experienced hangover. Although very prevalent, hangovers have not been extensively studied. It is known that ethanol is the primary chemical component of alcohol to produce the effects associated with drinking.
Whether hangover affects complex mental tasks and the performance of simple tasks is unclear. Studies on these areas have yielded conflicting results, presumably due to differences in methods. Clearly, alcohol consumption can affect sleep, and sleep deprivation is known to affect performance.
Causes & symptoms
The cause of hangover is believed to be multifactorial. Hangover is likely caused by a combination of direct effects of ethanol, effects of ethanol removal, effects of ethanol breakdown products, effects of other components of the alcoholic beverage, personal characteristics, and behaviors associated with alcohol use.
Direct effects of ethanol
Ethanol can directly affect the body by causing dehydration (loss of fluids), electrolyte (body chemicals) imbalance, stomach and intestinal irritation, low blood sugar, and sleep disruption. In addition, alcohol directly affects the circadian rhythm (internal 24-hour clock) causing a feeling similar to jet lag . Ethanol causes vasodilation (enlarged blood vessels) and affects bodily chemicals, like serotonin and histamine, which may contribute to the headache associated with hangover.
Effects of ethanol removal
Because hangover symptoms peak at around the same time that the blood alcohol concentration falls to zero, some researchers propose that hangover is actually a mild form of withdrawal. Excessive drinking causes changes in the chemical messenger system of the brain and, when the alcohol is removed, the system becomes unbalanced. Many of the symptoms of hangover are similar to those associated with mild withdrawal. Some differences exist, however, between hangover and withdrawal; specifically, hangover symptoms do not include the hallucinations, seizures, and the lengthy impairment of withdrawal.
Effects of ethanol breakdown products
In the body, ethanol is first broken down to acetaldehyde and then to acetate. Acetaldehyde is a reactive chemical that, at high concentrations, can cause sweating, rapid pulse, skin flushing, nausea , and vomiting . Some researchers believe that acetaldehyde causes hangover. Although there is no acetaldehyde in the blood when the blood alcohol concentration reaches zero, the toxic effects of acetaldehyde on the body may still persist.
Most alcoholic beverages contain small amounts of other active compounds besides ethanol. These compounds add to the smell, taste, and appearance of the beverage. Gin or vodka, which contain almost pure ethanol, produce fewer hangover symptoms than alcoholic beverages that contain other alcohol compounds (such as red wine, brandy, or whiskey). For example, methanol is implicated in contributing to hangover. Red wine, whiskey, and brandy all contain high levels of methanol.
Some inherent personal traits place persons at risk of experiencing hangover. In some persons, high levels of acetaldehyde accumulate (because of a deficient enzyme) which causes them to experience more severe hangovers. Persons who are neurotic, angry, or defensive, feel guilty about drinking, experience negative life events, or have a family history of alcoholism have increased hangover symptoms.
Certain behaviors associated with drinking increase the chance of experiencing hangover. These include drug use, disruption of normal sleep patterns, restricted food intake, and cigarette use.
Hangover symptoms begin within several hours after a person has stopped drinking and may last up to 24 hours. The specific symptoms experienced may vary depending upon the individual, the occasion, and the type and amount of alcohol consumed. The physical symptoms of hangover include headache, fatigue , light and sound sensitivity, muscle aches, eye redness, thirst, nausea, vomiting, and stomach pain . Hangover can cause rapid heartbeat, tremor, increased blood pressure, and sweating. Mental symptoms associated with hangover are decreased sleep, changes in sleep stages, decreased attention, decreased concentration, depression, dizziness, anxiety , irritability, and a sense that the room is spinning (vertigo).
Eating balanced meals, drinking extra water, and limiting total alcohol help to reduce or avoid hangover. There are also many alternative treatments to prevent or reduce hangover symptoms. Drinking additional alcohol to relieve hangover, although it reduces short-term symptoms, is not recommended. Some experts believe that drinking alcohol to relieve hangover is a sign of impending alcoholism. The primary measure to fight hangover is to drink plenty of water while drinking alcoholic beverages, before going to bed, and the day after. Sweating from exertion, exercise , sauna, or massage may also help.
Hangover symptoms may be reduced by taking in lots of extra water and fluids and by eating foods that are high in vitamin C and the B vitamins, which are believed to speed the removal of alcohol from the body. Oranges, guava, grapefruit, and strawberries are rich in vitamin C and beans, fish, and whole grains are rich in the B vitamins. A cocktail prepared from orange juice (1 cup), pineapple juice (1 cup), kiwi fruit (one), vitamin-B-enriched nutritional yeast (1 tablespoon), and honey (1 tablespoon) provides important nutrients which the body needs to recover from hangover. Juice therapists recommend drinking a mixture of carrot juice (8 oz), beet juice (1 oz), celery juice (4 oz), and parsley juice (1 oz) twice during hangover. The Chinese drink fresh tangerine juice and eat 10 strawberries to treat hangover.
Eating bland complex carbohydrates, such as crackers or toast, is easy on the stomach and helps to raise blood sugar levels. Drinking tea or coffee can relieve fatigue and possibly the headache. Throughout the world, traditional food remedies for hangover have certain things in common. These include eggs, tripe, hot spices, hearty soups, and fruit and vegetable juices. These foods all serve to replenish vitamins, minerals, and other nutrients lost by the body as it detoxifies alcohol.
Ayurvedic practitioners believe that hangover reflects the symptoms of excess pitta. Immediate relief may be found after drinking water containing lime juice (1 teaspoon), sugar (one half teaspoon), salt (pinch), and baking soda (one half teaspoon). Orange juice containing cumin (pinch) and lime juice (1 teaspoon) helps hangover. Drinking cool lassi, water containing yogurt (1 tablespoon) and cumin powder (pinch), three or four times daily may relieve nausea, headache, and drowsiness.
The following herbal remedies are useful in treating hangover symptoms:
- An Ayurvedic remedy is to take one half teaspoon of a mixture of shatavari (5 parts), shanka bhasma (one eighth part), kama dudha (one eighth part), and jatamamsi (3 parts) with water 2–3 times daily.
- An Ayurvedic antidote for alcohol toxicity is one half teaspoon of tikta (or myrrh, aloe vera, or sudharshan ) with warm water three times during the day.
- Barberry (Barberis vulgaris ) tea reduces hangover symptoms.
- Dandelion (Taraxacum officinale ) and burdock (Arctium lappa ) tea (with gentian extract, powdered ginger , and honey) can ease the nausea.
- Evening primrose (Oenothera biennis ) oil helps to replenish lost gamma-linoleic acid.
- Milk thistle (Silybum marinum ) reduces alcohol toxicity on the liver.
- Nux vomica (Strychnos nux vomica ) is a homeopathic antidote for alcohol overconsumption.
- Siberian ginseng (Eleutherococcus senticosus ) helps the body adjust to the stress of alcohol toxicity.
- Wintergreen (Gaultheria procumbens ) tea with hot pepper (Capsicum ) sauce relieves the headache.
Other hangover remedies
Various other remedies for hangover include:
- Acupressure. Point LI 4 (between the thumb and index finger) relieves headache and stomach ailments and the B2 points (upper edge of the eye socket) relieves headache accompanied by light sensitivity.
- Aromatherapy. The nausea of hangover may be relieved by drinking an aromatic cocktail of water, lemon juice, and a drop of fennel essential oil before breakfast.
- Imagery. The hangover sufferer may visualize being on a ship in a stormy ocean. The ocean gradually becomes calm until the ship is gently bobbing in the water.
- Probiotics. The bacteria Bifidobacterium bifidus is able to remove alcohol breakdown products. To fight hangover, naturopaths recommend taking B. bifidus before going to bed and again the following day.
- Supplements. Taking 50 mg of vitamin B3 before going to bed may relieve hangover.
- Hydrotherapy. Drinking a glass of water containing activated charcoal powder before going to bed may absorb alcohol in the stomach and reduce hangover symptoms.
Hangover symptoms may be relieved by taking antacids for nausea and stomach pain and aspirin or a nonsteroidal anti-inflammatory drugs (ibuprofen or naproxen) for headache and muscle pains. Acetaminophen (Tylenol) should be avoided while drinking or during hangover because alcohol enhances acetaminophen's toxic effects on the liver. Caffeine , usually taken as coffee, is historically used to treat hangover, although this has not been studied.
There is no cure for hangover. Left untreated, hangover will resolve within several hours. Treatments may reduce the severity of certain symptoms.
Hangover may be prevented by limiting the intake of alcohol, or drinking alcoholic beverages with a lesser incidence of causing hangover such as gin, vodka, or pure ethanol. Getting adequate sleep may reduce the fatigue associated with hangover. Drinking nonalcoholic beverages, both during and after drinking alcohol, may reduce dehydration and reduce hangover symptoms. Taking 120 mg of milk thistle before drinking can help the liver detoxify the alcohol.
"Hangover." In New Choices in Natural Healing: Over 1,800 of the Best Self-Help Remedies from the World of Alternative Medicine. edited by Bill Gottlieb, et al. Rodale Press, Inc., 1995.
Cameron, Elizabeth. "Help for Hangovers." Natural Health 27 (November 1997): 58+.
Finnigan, Frances, Richard Hammersley, and Tracy Cooper. "An Examination of Next-Day Hangover Effects After a 100 mg/100 ml Dose of Alcohol in Heavy Social Drinkers." Addiction 93 (1998):1829-1838.
O'Neill, Molly. "Get Over It: Hangover Remedies for the Morning After." New York Times Magazine 149 (26 December 1999): 51+.
Maeder, Thomas. "After the Party." Health 13 (November/December 1999): 106+.
Swift, Robert and Dena Davidson. "Alcohol Hangover." Alcohol Health & Research World 22 (1998): 54+.
He lay sprawled, too wicked to move, spewed up like a broken spider-crab on the tarry shingle of the morning. The light did him harm, but not as much as looking at things did; he resolved, having done it once, never to move his eyeballs again. A dusty thudding in his head made the scene before him beat like a pulse. His mouth had been used as a latrine by some small creature of the night, and then as its mausoleum. During the night too, he'd somehow been on a cross-country run and then been expertly beaten up by secret police. He felt bad.
The long list of symptoms, documented in numerous medical and literary sources and abundant in personal accounts, can be grouped into eight categories: constitutional (fatigue, weakness, and thirst); pain (headache and muscle aches); gastrointestinal (nausea, vomiting, and stomach pain); sleep and biological rhythms (less sleep, and more disturbed sleep); sensory (vertigo, and sensitivity to light and sound); cognitive (decreased attention and concentration); mood (depression, anxiety, and irritability); sympathetic hyperactivity (tremor, sweating, and increased pulse rate and systolic blood pressure).
Some hangover symptoms are due to the direct effects of alcohol on the body — as a diuretic for example, increasing urination, dehydrating the body, and increasing thirst. Other symptoms result from the body's efforts to cope with the removal of alcohol and counteract its depressant effects on the central nervous system. Unpleasant sensations such as tremors, sweating, and rapid heartbeat plague the sufferer. Behaviours associated with the previous evening's drinking, such as eating too little, having less sleep than usual, or overdoing it on the dance floor, may also account for some of the aches and pains.
The experience of a hangover is not the same for everyone. If your hangovers seem worse than other people's, it may be because your personality or how you feel about your life is contributing to the symptoms. Researchers have suggested that personality traits, such as anger, defensiveness, and neuroticism, feelings of guilt about drinking, and experiencing negative life events (such as divorce, death, loss of employment, or other stressful events) can increase the experienced severity of hangovers. Other factors are involved too. We probably all know people who say they can drink certain kinds of alcohol without ill effect whereas other kinds result in misery the morning after. Red wine, for instance, is more likely to result in a severe hangover than white wine; bourbon and port are more likely to than gin or vodka. The ‘culprits’ responsible for these differences are known as ‘congeners’ — the toxins present in the organic chemicals used to colour and flavour alcoholic beverages (examples are methyl alcohol, aldehydes, and tannins). Research studies indicate that people vary in their tolerance of alcohol and of the congeners in different drinks, so that bodily reactions to ‘detoxifying’ — getting rid of poisonous substances — will reflect individual differences in the ways in which alcohol is metabolized and the body clears itself of toxins. Seasoned heavy drinkers may cope more easily with this process, possibly because their metabolism adjusts more quickly or because they have become less sensitive to the effects than the occasional or less heavy drinker.
So what can you do to enjoy the pleasures of alcohol and avoid the pain? There are steps you can take to alleviate the discomfort. Drinking plenty of water before going to bed helps counteract dehydration and dilutes the congeners; replacing lost fluids by drinking water, fruit juices, or tea the morning after might also reduce the intensity of a hangover. Although a strong cup of coffee will certainly not get rid of the alcohol in your body, caffeine is a stimulant and might perk you up. If you can face it, bland foods such as toast or crackers may relieve feelings of nausea. Medication can provide symptomatic relief, but needs to be used with caution, since some kinds of medication are likely to exacerbate symptoms or add to the toxicity in the body, and other kinds appear to be ineffective in reducing headaches and other hangover symptoms.
Down the ages, there have been numerous ‘folk’ cures and remedies for hangovers, one of the best known being ‘the hair of the dog that bit you’ — another drink on waking. It is the likely base of the ‘tissue restorer’ favoured by P. G. Woodhouse's Bertie Wooster and prepared by his manservant Jeeves:
He returned with the tissue restorer. I loosed it down the hatch, and after undergoing the passing discomfort, unavoidable when you drink Jeeve's patent morning revivers, of having the top of the skull fly up to the ceiling and the eyes shoot out of their sockets and rebound from the opposite wall like raquet balls, felt better.The remedy works — temporarily! But the body still has to clear itself of the after-effects of the drinking bout, and morning drinks, if taken too often, can signal problem drinking. Time, sleep, and rest are the best ‘cure’ for a hangover.
Rae, S. (ed.) (1991). The Faber book of drink, drinkers and drinking. Faber and Faber, London.
Swift, R. and and Davidson, D. (1998). Alcohol hangover mechanisms and mediators. Alcohol World Health and Research, 22(1), 54–60.
See also alcoholism.