Hangover

A hangover is characterized by the constellation of unpleasant physical and mental symptoms that occur after a bout of heavy alcohol drinking.

Symptoms of Hangover
Class of Symptoms Type
Constitutional Fatigue, weakness, and thirst
Pain Headache (alcohol intoxication results in vasodilatation,
which may induce headaches.) and muscle aches
Gastrointestinal Nausea, vomiting, and stomach pain
Sleep and biological rhythms Decreased sleep, decreased REM,1
and increased slow-wave 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
and systolic blood pressure

The particular set of symptoms experienced and their intensity may vary from person to person and from occasion to occasion. In addition, hangover characteristics may depend on the type of alcoholic beverage consumed and the amount a person drinks.


Symptoms usually peak about the time BAC is zero and may continue for up to 24 hours thereafter. Overlap exists between hangover and the symptoms of mild alcohol withdrawal(AW), leading to the assertion that hangover is a manifestation of mild withdrawal. Hangovers, however, may occur after a single bout of drinking, whereas withdrawal occurs usually after multiple, repeated bouts. Other differences between hangover and AW include a shorter period of impairment (i.e., hours for hangover versus several days for withdrawal) and a lack of hallucinations and seizures in hangover.

Possible Contributing Factors to Hangover

Direct effects of alcohol
• Dehydration-
Sweating, vomiting, and diarrhea also commonly occur during a hangover, and these conditions can result in additional fluid loss and electrolyte imbalances. Symptoms of mild to moderate dehydration include thirst, weakness, dryness of mucous membranes, dizziness, and lightheadedness.

• Electrolyte imbalance

• Gastrointestinal disturbances-
Alcohol causes inflammation of stomach lining, delayed stomach emptying, increase in production of stomach acid, pancreatic and intestinal secretions which causes the upper abdominal pain, nausea and vomitting.

• Low blood sugar-
Because glucose is the primary energy source of the brain, hypoglycemia can contribute to hangover symptoms such as fatigue, weakness, and mood disturbances. However, it
has not been documented whether it contributes to hangover symptomatically.

• Sleep and biological rhythm disturbances-
Results from alcohol’s effects on sleep. Alcohol induced
sleep may be of shorter duration and poorer quality, decreasing the time spent in the dreaming
state (i.e., rapid eye movement [REM] sleep) and increasing the time spent in deep (i.e., slow-wave) sleep. This leads on to fatigue.

Alcohol withdrawal-
Sympathetic nervous system hyperactivity accounts for the tremors, sweating, and tachycardia.

Alcohol metabolism (i.e., acetaldehyde toxicity)-
Acetaldehyde binds to proteins and other biologically important compounds. At higher concentrations, it causes toxic effects, such as a rapid pulse, sweating, skin flushing, nausea, and vomiting.

Nonalcohol effects
• Compounds other than alcohol in beverages, especially methanol
Products of methanol metabolism (i.e., formaldehyde and formic acid) are extremely toxic and in high concentrations may cause blindness and death. Distilled spirits that are more frequently associated with the development of a hangover contain the highest concentrations of methanol.
Methanol persisted for several hours after ethanol was metabolized, which corresponded to the time course of hangover symptoms as ethanol competitively inhibited methanol metabolism and administration of ethanol fends off hangover effects.
Recent research finds that red wine can increase plasma serotonin and plasma histamine levels which can cause headaches.

• Use of other drugs, especially nicotine
Although certain drugs can themselves produce hangover symptoms and affect alcohol intoxication, the effects of the various alcohol and other drug combinations on alcohol hangover are unknown

• Personality type
Negative life events and feelings of guilt about drinking also are associated with experiencing more hangovers (Harburg et al. 1993).

• Family history for alcoholism
History of alcoholism in a person’s family is associated with a decreased sensitivity to the intoxicating effects of alcohol and a greater risk for developing alcoholism (Schuckit and Smith 1996). Newlin and Pretorius (1990) suggested that a positive family history for alcoholism may be associated with a tendency for increased hangover symptoms as well.


Treatments for Hangover
Many treatments to prevent hangover, shorten its duration, and reduce the severity of its symptoms.
Conservative management offers the best course of treatment. Hangover symptoms will usually abate over 8 to 24 hours.
Attentiveness to the quantity and quality of alcohol consumed can have a significant effect. Hangover symptoms are less likely to occur if a person drinks only small, nonintoxicating amounts. Even among people who drink to intoxication, those who consume lower amounts of alcohol appear less likely to develop a hangover than those who drink higher amounts. Hangovers have not been associated with drinking beverages with a low alcohol content or with drinking nonalcoholic beverages.
The type of alcohol consumed also may have a significant effect on reducing hangover (Chapman 1970; Pawan 1973). Alcoholic beverages that contain few congeners are associated with a lower
incidence of hangover than are beverages that contain a number of congeners.
Consumption of fruits, fruit juices, or other fructose-containing foods is reported to decrease hangover intensity (Seppala et al. 1976).
Bland foods containing complex carbohydrates, such as toast or crackers, can counter low blood sugar levels in people subject to hypoglyemia and can possibly relieve nausea.
Adequate sleep may ease the fatigue associated with sleep deprivation, and drinking nonalcoholic beverages during and after alcohol consumption may reduce alcohol-induced dehydration.
Antacids may alleviate nausea and gastritis. Aspirin and other nonsteroidal anti-inflammatory medications (e.g., ibuprofen or naproxen) may reduce the headache and muscle aches but should be used cautiously, particularly if upper abdominal pain or nausea is present.
Caffeine (often taken as coffee) is commonly used to counteract the fatigue and malaise associated with the hangover condition.
Readministration of alcohol reportedly cures a hangover, but people experiencing a hangover should avoid further alcohol use. Additional drinking will only enhance the existing toxicity of the alcohol consumed during the previous bout and may increase the likelihood of even further drinking.


Alcohol Hangover: Mechanis and Mediators, Robert Swift, M.D., Ph.D.; and Dena Davidson, Ph.D.
Alcohol Health and Research World, Vol. 22, No. 1, 1998