Hangover cures – a 7-step medical review

Hangovers are ugly beasts – if you don’t believe me, re-watch that insta-Hollywood-classic, The Hangover for a brutal refresher course (keeping mind that chemical results, like so many things in Hollywood, were artificially augmented). Bertie Wooster, in The Mating Season, described the more vintage experience: “I am told by those who know that there are six varieties of hangover – the Broken Compass, the Sewing Machine, the Comet, the Atomic, the Cement Mixer and the Gremlin Boogie, and his manner suggested that he had got them all.”

Ooh, my aching head...

Ooh, my aching head…

New Year’s Eve festivities loom, with New Year’s DAY inevitably to follow. Which means you may be asking yourself – can you actually cure or prevent a hangover? Medically, that is? Other than with that vilest (but proven most effective) of interventions (gasp) teetotaling?

Here are some proposed hangover treatments, the science behind whether they work or not, and some tips on keeping yourself safe this New Year’s Eve.

1) Does it matter which alcohol you drink? The data is, well, murky, on this question. While there are many beliefs and anecdotes about which drinks are more likely to cause a hangover (the cloudier a drink is, the more it causes a hangover, is one theory), the science just hasn’t kept up. Research DOES show that, in general, the darker the drink (as in red wine, port, etc.), the more likely it is to cause migraines in those people susceptible to them. But, keep in mind, for many migraineurs, any alcohol at all can induce a splitting headache (which may be mistaken for a hangover). Finally, many people avoid certain drink combinations, purely for fear of what the drink might taste like on its way back up (shudder).

2) Does it help to “pre-treat” a hangover? By “pre-treat,” we’re talking about taking a medicine before you start drinking (such as an aspirin) in the hopes that it will fend off hangover symptoms before they begin. In general, the answer, again, is no, although there is a tiny bit more science to support that claim. You should be aware that, in particular, taking acetaminophen (the active ingredient in, for example, Tylenol) before OR after a drinking bout can actually be very tough on your liver. In fact, several case reports have documented people who accidentally died while taking relatively low doses of acetaminophen in the setting of large amounts of alcohol (especially chronic alcohol ingestion). So if you want to treat that pounding headache on New Year’s Day, clearly the safest thing (if you can’t turn back time and refuse your third martini) is a cold compress and a dark room. Personally, if you need to take a medicine, I’d recommend taking good old aspirin instead of acetaminophen (as long as aspirin is not contraindicated for you). Sure, aspirin can irritate your stomach, but in its most brutal terms (which is how we doctors tend to think), it’s a heck of a lot easier to treat a GI bleed, than it is to get a new liver.

3) How many drinks does it take to cause a hangover? Keeping in mind the uncertainties about which drinks cause more hangover symptoms (see #1, above), there are some general numbers thrown around by researchers, based on gender. Physiologic gender differences exist when it comes to alcohol metabolism. These metabolic differences exaggerate existing differences due to larger/smaller body mass. When it comes to alcohol, drinking is an area where the girls actually should never try to keep up with the boys. Additionally, women are also much more likely (many times over) to get migraines, which can be precipitated by alcohol of all types, complicating the incidence of reported hangover symptoms. Further, a binge drinker is defined differently for men and women. For women, a binge drinker is anyone drinking 4 or more drinks on one occasion, and 5-6 or more for a man. However, at least one study shows that these numbers, while useful, are (as you might expect) variable for individuals – the larger the number picked, the greater the likelihood of long-term alcohol problems. For health benefits, recommendations are that women drink no more than 0-2 drinks a day (no more than 7 total per week), and men no more than 2 a day, but even staying within those numbers, some people will, over the long-term, develop drinking problems. On the opposite end of the spectrum, you may be wondering why your buddy never seems to get a hangover, no matter how much he/she drinks. It’s annoying, isn’t it? But is it real? Studies have shown that approximately 20-30% of the population is resistant to hangover. And paradoxically, the people resistant to hangover may actually also be more resistant to developing drinking problems. Hangover symptoms may be a form of short-term alcohol withdrawal (even in people who don’t drink consistently). Withdrawal symptoms typically induce cravings, which lead to addictions (you get the idea…see “hair of the dog,” below). So experiencing hangovers (for ANY small or large number of drinks) can be a warning sign to take seriously.

4) Can you do anything while drinking to reduce future hangover symptoms? A rigorous look at hangover treatments of all kinds in the British Medical Journal in 2005 found that, of many proposed hangover-prevention treatments, including “propranolol, tropisetron, tolfenamic acid, fructose or glucose, and the dietary supplements Borago officinalis (borage),Cynara scolymus (artichoke), Opuntia ficus-indica (prickly pear), and a yeast based preparation.” The results? Nada. Nothing worked, with the authors concluding that “The most effective way to avoid the symptoms of alcohol induced hangover is to practise abstinence or moderation.” All that being said, more recent research shows two area of promise. One study shows that asparagus may ameliorate hangover symptoms – especially the younger shoots and leaves (but you do get, however, asparagus pee as a normal side-effect). Second (and more promising) are physiologic studies of the effects of alcohol which indicate a massive disruption of many your body’s mediators, including your ADH (anti-diuretic hormone) function. In other words, when you drink alcohol, your hydration hormone gets screwed. Kind of like a Greek myth, you’re drinking and drinking but your body is getting thirstier and thirstier. That’s probably the reason why re-hydrating a person with fluids has been a mainstay of improving hangover symptoms (just check out New Year’s Day ERs and count the number of IV poles). Dehydration also makes nausea much worse – but if you’re hangover puking, how can you rehydrate? One suggested approach is to, the night before, alternate drinking a large glass of something non-alcoholic between each and every alcoholic beverage you drink. While the rigorous data is not yet in, this approach definitely at least slows down the rate of alcohol consumption, and some swear by its effectiveness at preventing hangover symptoms the next day, even for the same number of alcoholic drinks ingested. Finally, some researchers indicate taking B6 may help prevent hangover symptoms, but rigorous studies are lacking.

5)What about taking a little “hair of the dog”? Drinking alcohol the next morning to alleviate hangover symptoms (“the hair of the dog that bit you”), is more and more recognized as a marker of alcohol problems, rather than an effective “cure” for hangover symptoms. Studies also show that, while gross tests of psychomotor function are within normal limits during a hangover, judgment can be impaired (and this study also). The “hair of the dog” is definitely going to impair those judgments more, as well as possibly prolonging future alcohol withdrawal symptoms into the next day.

6) Doesn’t a hangover teach you a lesson? Um, sorry, but the data are kind of scary in this regard. People who drink heavily, including college students, are the MOST likely to underestimate both the number of drinks it takes to impair their judgment AND to significantly underestimate the actual bad outcomes they have personally experienced while impaired. These bad outcomes run the gamut of everything from severe hangovers to unintended higher-risk sexual encounters. The more you drink, the less likely you are to comprehend, much less learn from, the impact of your drinking. As an explicit example, one case report noted an unusual cause of a patient’s reported hangover headache – a “retained knife blade” found lodged inside the brain tissue.

7) Dodging death – how do I tip the odds in my favor? First, studies show that binge drinking is a significant predictor of future alcohol problems. But many people may not know that it’s also a predictor of death. When you think about it, that’s not a surprise – when you’re drunk, you’re more likely to stumble into traffic, get behind a wheel, or wander down the wrong alley. More and more studies also show the effect of impaired judgment on unsafe behaviors, like regretted sexual choices. When you head out to party, get your personal dodging death packet ready. Pack some condoms, a Plan B pack of pills (yes guys, even you – studies show men are more likely to report condom breakage and reduce unwanted pregnancies if they have a set of Plan B pills on hand). Also make sure you’ve got your travel plans safely arranged. Taxi numbers, transit cards, spare cash – make sure you’re ready to avoid getting behind a wheel (or piling in a car with an impaired driver behind a wheel). Finally be especially careful to NOT mix and match your ingestions. Make a vow to yourself before the evening begins – no mixing substances. Even the most experienced user can die from an unholy cocktail, taken while your judgment is impaired. Finally, never forget that a person can die purely from an alcohol overdose. Read these Doc Gurley tips on managing a friend who’s overdone it. It’s also extremely important to remember that “hangover” can be a mistaken diagnosis – a sign of severe medical problems, including liver damage and infections. If anything about your symptoms seems abnormal or severe, seek medical help.

New Year’s is a time to celebrate new beginnings. Be safe out there, folks.

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