Almost everyone who drinks alcohol has had the unpleasant experience of “the morning after.” According to the Alcohol Hangover Research Group, technically, hangover symptoms develop when an individual’s BAC (blood alcohol concentration) drops substantially, and the symptoms peak when the individual’s BAC is near zero. According to Scientific American, it is estimated that nearly three-quarters of individuals who use alcohol will experience some hangover effects at one time or another.
According to a review in the journal Alcohol and Alcoholism, controlled studies have listed the following symptoms of a hangover:
- Impaired cognitive functioning
- Drowsiness as a result of the effect of alcohol on REM sleep
- Feelings of general malaise
- Headache, nausea, stomach ache, and other flulike symptoms
- Feeling dizzy or faint
- Extreme thirst, most likely due to the diuretic effects of alcohol
- Extreme fatigue
- Other autonomic nervous system symptoms, such as racing heart, jitteriness, and perspiration
- Potential symptoms of alcohol withdrawal in individuals with serious alcohol use disorders
- Numerous individual reactions
What Causes a Hangover?
According to a review published in the journal Human Psychopharmacology, despite numerous explanations for hangovers, the research that has been done to understand hangovers indicates that the causes of a hangover remain relatively poorly understood. There may be several different physiological alterations that result in the experience of a hangover in different individuals. These pathophysiological alterations include:
- Increasing levels of acetaldehyde as a result of the breakdown of alcohol
- Dehydration as a result of alcohol use
- Metabolic acidosis, a condition that occurs when the balance of bases and acids in an individual’s bloodstream is thrown off, resulting in too much acid in the system
- Alterations in hormones as a result of alcohol use that decreases the availability of glucose in the system
- Increased burden on the cardiovascular system as a result of alcohol use
- Congeners, which are organic molecules that are found in some alcoholic beverages that may also lead to the effects of an alcohol hangover
Some of these factors may help to explain why hangovers occur in some individuals. For instance, the production of acetaldehyde is the first step in the metabolic process when the liver breaks down the alcohol in the system, and this substance is extremely toxic. Levels of acetaldehyde can remain elevated in an individual system for hours after they have consumed alcohol.
The substance is broken down to acetic acid by acetaldehyde dehydrogenase, and the efficiency and speed of this process is known to have a significant genetic component to it. For instance, Asians have a slower metabolic breakdown of alcohol than many other groups. High concentrations of acetaldehyde lead to more severe hangovers, and individuals with inefficient metabolisms that break down alcohol more slowly are less likely to become problem drinkers due to the adverse reactions they incur as a result of using even moderate amounts of alcohol; this explanation has been used to explain why fewer Asians have alcohol use disorders compared to other groups. In addition, the drug Antabuse (disulfiram) that interferes with the metabolism of alcohol in an individual’s system, resulting in a significant buildup of acetaldehyde and an extreme reaction, including nausea, vomiting, headache, flushing, etc., is used to discourage drinking in individuals with alcohol abuse issues.
According to numerous sources, such as a review in the journal Current Drug Abuse Reviews, congeners are present in many different types of alcoholic beverages as a result of a byproduct of fermentation or added as flavoring or color enhancers. The ethanol in alcoholic beverages is not sufficient to produce most of the hangover effects that people experience, but the addition of congeners may aggravate hangovers. Congeners include numerous substances depending on the beverage, and research indicates that they may have an effect on the symptoms of a hangover.
Dark liquors have a higher concentration of congeners than clear liquids. Research has shown that darker liquors are reported to produce worse hangover symptoms than clear liquids regardless of the alcohol content in the beverage. Methanol, a type of congener, is formed during fermentation, and its presence in alcohol can vary substantially depending on the distillation technique; thus, less expensive liquors, wines, etc., may be associated with higher levels of methanol. High levels of methanol are associated with more severe hangovers, metabolic acidosis, and even the slower breakdown of ethanol in the system, which could affect the severity of an individual’s hangover.
Finally, according to the book Alcohol and Cardiovascular Disease, some other factors that may influence hangover severity include individual demographic factors, such as personality, gender, overall health, and age. The use of tobacco or other drugs while drinking can worsen the symptoms of a hangover. Physical activity while drinking alcohol may lessen hangover effects (e.g., dancing). A person’s general quality of sleep will also affect the severity of a hangover, such that individuals who are “light sleepers” may be more likely to develop hangover symptoms of higher severity.
According to a review in the journal Human Psychopharmacology: Clinical and Experimental, there is no real effective “cure” for a hangover other than time (letting the symptoms wear off) or to avoid alcohol use altogether, although some approaches may affect some symptoms to a small degree. From a prevention standpoint, some people actually regard hangovers as a potentially useful form of deterrence to alcohol abuse and the development of alcohol use disorders.
According to the book The Science of Drinking: How Alcohol Affects Your Body and Mind, there are various well-known treatments for hangovers.
- The infamous “hair of the dog” approach that consuming more alcohol (e.g., having a Bloody Mary) will relieve the symptoms of a hangover is based on the belief that a hangover is actually a form of alcohol withdrawal. However, research indicates that this approach is more likely to produce an alcohol use disorder.
- Various food recommendations, such as eating fried foods or drinking tomato juice, are actually not effective.
- Taking a sauna or steam bath to “sweat it out” may actually be a dangerous practice due to dehydration.
- The use of oxygen has been reported to speed up the metabolic rate and reduce alcohol symptoms; however, research has indicated that this is not the case.
- The use of vitamins, such as vitamin B6, has not been shown to be effective except in some cases where extremely high doses may have a mild effect (see below).
- The use of caffeinated beverages, such as coffee, has not been demonstrated to affect the severity of an alcohol hangover. Although caffeine does have stimulant effects, which may result in an individual feeling a little more energetic and less “cloudy,” it is also a diuretic that can result in further dehydration.
- Numerous “miracle cures” are constantly being advertised. These “cures” are based on anecdotal evidence and should not be taken seriously. There may be substances in some of these “miracle cures” that can be potentially harmful, especially herbal substances that are manufactured in countries overseas, such as China and India, where there is little supervision on what goes into them.
There may be some strategies that can assist in recovery from an alcohol hangover, but their effects are most likely minimal.
- According to a review in The Annals of Internal Medicine, remaining hydrated before or during drinking, or before going to bed, may assist in flushing out toxins and reducing the symptoms associated with dehydration, such as dry mouth, headache, thirst, etc.
- An article in the journal Current Drug Abuse Reviews reported that the use of nonsteroidal anti-inflammatory drugs (e.g., aspirin or Tylenol) can reduce certain symptoms, such as headache, muscle ache, etc., but they do not prevent hangovers. However, abuse and overuse of these drugs is associated with potential damage to the liver.
- Using other medications for specific symptoms may reduce their severity, such as anti-nausea medication.
- The use of extremely high doses of synthetic vitamin B6 (e.g., from a substance known as pyritinol) may have some minor effects, but there are significant risks in taking extremely high doses of the substance that include acute pancreatitis and even liver damage. Thus, the cure may be as potentially harmful as the use of alcohol.
The only surefire way to decrease the symptoms of a hangover is to let them run their course, drink plenty of fluids, relax, and take it easy. For most people, the symptoms of a hangover are resolved within 24 hours after they have stopped drinking.
There are some practical strategies that may reduce the intensity of hangovers.
- Pay attention to the type of alcohol one consumes. Alcohol hangover severity may be reduced to some extent with the use of clear alcoholic beverages.
- Pay strict attention to the amount of alcohol one consumes. Consuming less alcohol will result in less severe hangovers.
- As mentioned above, remaining hydrated may have some utility in dealing with dehydration.
- Know your body and know your limits.
- Simply do not use alcohol.
The bottom line is quite simple: There are no reliable cures for hangovers due to alcohol use and abuse other than waiting for the symptoms to subside on their own or simply not engaging in the use of alcohol.