A hangover is the experience of various unpleasant physiological and psychological effects following the consumption of alcohol, such as wine, beer and distilled spirits. Hangovers can last for several hours or for more than 24 hours. Typical symptoms of a hangover may include headache, drowsiness, concentration problems, dry mouth, dizziness, fatigue, gastrointestinal distress (e.g., vomiting), absence of hunger, depression, sweating, nausea, hyper-excitability and anxiety.
While the causes of a hangover are still poorly understood, several factors are known to be involved including acetaldehyde accumulation, changes in the immune system and glucose metabolism, dehydration, metabolic acidosis, disturbed prostaglandin synthesis, increased cardiac output, vasodilation, sleep deprivation and malnutrition. Beverage-specific effects of additives or by-products such as congeners in alcoholic beverages also play an important role. The symptoms occur typically after the intoxicating effect of the alcohol begins to wear off, generally the morning after a night of heavy drinking.
Though many possible remedies and folk cures have been suggested, there is no compelling evidence to suggest that any are effective for preventing or treating alcohol hangover. Avoiding alcohol or drinking in moderation are the most effective ways to avoid a hangover. The socioeconomic consequences and health risks of alcohol hangover include workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement. A hangover may also compromise potentially dangerous daily activities such as driving a car or operating heavy machinery.
Signs and Symptoms
An alcohol hangover is associated with a variety of symptoms that may include drowsiness, headache, concentration problems, dry mouth, dizziness, gastrointestinal complaints, fatigue, sweating, nausea, hyper-excitability, anxiety, and a feeling of general discomfort that may last more than 24 hours. Alcohol hangover symptoms develop when blood alcohol concentration falls considerably and peak when it returns to almost zero. Hangover symptoms validated in controlled studies include general malaise, thirst, headache, feeling dizzy or faint, tiredness, loss of appetite, nausea, stomach ache, and feeling as though one’s heart is racing. Some symptoms such as changes in sleep pattern and gastrointestinal distress are attributed to direct effects of the alcohol intoxication, or withdrawal symptoms. Drowsiness and impaired cognitive function are the two dominant features of alcohol hangover.
Hangovers are poorly understood from a medical point of view. Health care professionals prefer to study alcohol abuse from a standpoint of treatment and prevention, and there is a view that the hangover provides a useful, natural and intrinsic disincentive to excessive drinking.
Within the limited amount of serious study on the subject, there is debate about whether a hangover may be prevented or at least mitigated. There is also a vast body of folk medicine and simple quackery. A four-page literature review in the British Medical Journal concludes: “No compelling evidence exists to suggest that any conventional or complementary intervention is effective for preventing or treating alcohol hangover. The most effective way to avoid the symptoms of alcohol induced hangover is to avoid drinking.” Most remedies do not significantly reduce overall hangover severity. Some compounds reduce specific symptoms such as vomiting and headache, but are not effective in reducing other common hangover symptoms such as drowsiness and fatigue.
There is no evidence that any treatments for hangovers are effective.
Rehydration: Drinking water before going to bed or during hangover may relieve dehydration-associated symptoms such as thirst, dizziness, dry mouth, and headache.
Non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen have been proposed as a treatment for the headaches associated with a hangover. There however is no evidence to support a benefit, and there are concerns that taking alcohol and aspirin together may increase the risk of stomach bleeding and liver damage.
Tolfenamic acid, an inhibitor of prostaglandin synthesis, in a 1983 study reduced headache, nausea, vomiting, irritation but had no effect on tiredness in 30 people.
Pyritinol: A 1973 study found that large doses (several hundred times the recommended daily intake) of Pyritinol, a synthetic Vitamin B6 analog, can help to reduce hangover symptoms. Possible side effects of pyritinol include hepatitis (liver damage) due to cholestasis and acute pancreatitis.
Yeast-based extracts: The difference in the change for discomfort, restlessness, and impatience were statistically significant but no significant differences on blood chemistry parameters, blood alcohol or acetaldehyde concentrations have been found, and it did not significantly improve general well-being.
Recommendations for foods, drinks and activities to relieve hangover symptoms abound. The ancient Romans, on the authority of Pliny the Elder, favored raw owl’s eggs or fried canary, while the “prairie oyster” restorative, introduced at the 1878 Paris World Exposition, calls for raw egg yolk mixed with Worcestershire sauce, Tabasco sauce, salt and pepper. By 1938, the Ritz-Carlton Hotel provided a hangover remedy in the form of a mixture of Coca-Cola and milk (Coca-Cola itself having been invented, by some accounts, as a hangover remedy). Alcoholic writer Ernest Hemingway relied on tomato juice and beer. Other purported hangover cures include cocktails such as Bloody Mary or Black Velvet (consisting of equal parts champagne and stout). A 1957 survey by an American folklorist found widespread belief in the efficacy of heavy fried foods, tomato juice and sexual activity.
Other untested or discredited treatments include:
Hair of the dog: The belief is that consumption of further alcohol after the onset of a hangover will relieve symptoms, based upon the theory that the hangover represents a form of alcohol withdrawal and that by satiating the body’s need for alcohol the symptoms will be relieved. Social drinkers and alcoholics claim that drinking more alcohol gives relief from hangover symptoms, but research shows that the use of alcohol as a hangover cure seems to predict current or future problem drinking and alcohol use disorder, through negative reinforcement and the development of physical dependence. While the practice is popular in tradition and promoted by many sellers of alcoholic beverages, medical opinion holds that the practice merely postpones the symptoms, and courts addiction. Favored choices include a Corpse Reviver, Fernet Branca and Bloody Mary.
Kudzu (Pueraria montana var. lobata): The main ingredient in remedies such as kakkonto. A study concluded, “The chronic usage of Pueraria lobata at times of high ethanol consumption, such as in hangover remedies, may predispose subjects to an increased risk of acetaldehyde-related neoplasm and pathology. … Pueraria lobata appears to be an inappropriate herb for use in herbal hangover remedies as it is an inhibitor of ALDH2.”
Artichoke: Research shows that artichoke extract does not prevent the signs and symptoms of alcohol-induced hangover.
Sauna or steam-bath: Medical opinion holds this may be dangerous, as the combination of alcohol and hyperthermia increases the likelihood of dangerous cardiac arrhythmias.
Oxygen: There have been anecdotal reports from those with easy access to a breathing oxygen supply – medical staff, and military pilots — that oxygen can also reduce the symptoms of hangovers sometimes caused by alcohol consumption. The theory is that the increased oxygen flow resulting from oxygen therapy improves the metabolic rate, and thus increases the speed at which toxins are broken down. However, one source states that (in an aviation context) oxygen has no effect on physical impairment caused by hangover.
Fructose and glucose: Glucose and fructose significantly inhibit the metabolic changes produced by alcohol intoxication, nevertheless they have no significant effect on hangover severity.
Vitamin B6: No effects on alcohol metabolism, peak blood alcohol and glucose concentrations have been found and psychomotor function is not significantly improved when using Vitamin B6 supplements.
Caffeinated drinks: No significant correlation between caffeine use and hangover severity has been found.
Hangovers occur commonly.
A study in college students found that 25% had experienced a hangover in the previous week and 29% reported losing school time for hangover recovery.
15% of men and women who have consumed alcohol experience hangovers at least monthly and ten percent of British men reported hangover-related problems at work at least monthly.
An estimated 9.23% (11.6 million workers) of the U.S. labor force work with a hangover.
About 23% of drinkers do not report any hangover after drinking to intoxication.
Society and culture
A somewhat dated French idiomatic expression for hangover is “mal aux cheveux”, literally “sore hair” (or ” my hair hurts”).
Alcohol hangover has considerable economic consequences. A British study found that alcohol use accounted for 3.3 billion (USD) in lost wages each year, as a result of work missed because of hangovers. In Canada 1.4 billion (USD) is lost each year because of decreased occupational productivity caused by hangover-like symptoms. In Finland, a country with a population of 5 million persons, over 1 million workdays are lost each year because of hangovers. The average annual opportunity cost due to hangovers are estimated as 2000 (USD) per working adult. The socioeconomic implications of an alcohol hangover include workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement. Potentially dangerous daily activities such as driving a car or operating heavy machinery are also negatively influenced.
In mid-2017, it was reported that one company in the UK allows sick days when hung over.
Psychological research of alcohol hangover is growing rapidly. The Alcohol Hangover Research Group had its inaugural meeting in June 2010 as part of the Research Society on Alcoholism (RSA) 33rd Annual Scientific Meeting in San Antonio, Texas.
In 2012, Éduc’alcool, a Quebec-based non-profit organization that aims to educate the public on the responsible use of alcohol, published a report noting hangovers have long-lasting effects that inhibit the drinker’s capabilities a full 24 hours after heavy drinking.
In 2012, Las Vegas based Hangover Heaven, a mobile hangover treatment clinic, opened along with its Hangover Research Institute, which studies the treatment of hangovers.