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Symptoms and Signs of Hangover

Symptoms of hangover may appear within several hours after stopping drinking, when blood alcohol concentration (BAC) is falling; they may be worst when BAC is zero and may continue for more than 24 hours afterwards and may include:

  • Headache
  • Loss of appetite, nausea, vomiting, abdominal pain, diarrhea
  • Fatigue, muscle aches
  • Dry mouth, thirst
  • Depression, anxiety, irritability, sleeplessness or drowsiness
  • Dizziness, vertigo, increased sensitivity to light and sound
  • Red (bloodshot) eyes
  • Sweating, tremor, rapid heartbeat, possibly increased blood pressure
  • Decreased working performance and driving ability
  • References: [1,2,3]
Seizures and hallucinations can occur during alcohol withdrawal but not likely during hangover.

Causes and Mechanism of Hangover

According to some studies, the amount of alcohol drunk is not necessary related to severity of hangover [5]. Light and moderate drinkers more likely experience hangover than chronic heavy drinkers [4-p.393]. Possible causes of hangover include:

  • Feeling guilty about drinking, neurotic personality, recent negative life events [5]
  • Lack of sleep, strong emotions, physical activity, unusual meals and passive or active smoking during drinking
  • Stomach irritation by alcohol
  • Congeners – substances other than ethanol in alcoholic drinks, such as acetone, glycols, polyphenols and histamine (in red wine), methanol (in burbone whiskey). In one study, the severity of hangover decreased with the decreasing amounts of congeners in alcoholic beverages (from high to low): brandy, red wine, rum, whiskey, white wine, gin, vodka, beer and pure ethanol [5,6].
  • Dehydration (due to vomiting) may cause thirst, weakness and dizziness.
  • Activation of the immune system resulting in increased levels of inflammatory substances, such as prostaglandins [6,7].

What May Help in Hangover

After you were drinking during the night, try to have some sleep.

Over-the-counter painkillers, such as aspirin, ibuprofen, ketoprofen or naproxen, may relieve headache but may also irritate your stomach [8,9]Avoid acetaminophen (paracetamol), which may be toxic for liver when taken during or after drinking [2]Antacids containing calcium carbonate, may relieve nausea. Meclizine or bismuth subsalicylate may prevent vomiting [9]. In one 1973 study, vitamin B6 derivative pyritinol taken before, during and after drinking (3 x 400 mg), decreased hangover symptoms by about 50% [3].

A light carbohydrate meal, such as whole-meal bread or crackers can make you sated and may help you sleep.

After drinking only spirits and not non-alcoholic beverages or after vomiting, drinking water should prevent dehydration. Regular tea or coffee drinkers who skip their morning dose may experience caffeine withdrawal symptoms, including headache. Coffee before bed may make someone fall asleep harder, though. Fruit juices or carbonated beverages may irritate your stomach. Hangover is not always associated with dehydration anyway, so drinking loads of water after drinking beer or wine may just make you visit the toilet frequently.

What Does Not Likely Help in Hangover

Bacon with eggs or other greasy foods can worsen nausea or trigger gastric reflux and heartburn.

The “hair of the dog that bit you,” a small amount of various alcoholic mixtures, such as Bloody Mary, drunk at the time when hangover is about to start, may postpone the onset of hangover, but it does not likely prevent it.

Exercising may aggravate headache and nausea.

A shower may be refreshing, but it does not relieve hangover.

According to a review of few studies, the following substances, herbs and drugs are not proven effective in curing hangover: artichoke, borage, fructose, glucose, prickly pear, propranolol, tropisetron and a yeast based preparation [10]. There is lack of evidence about beneficial effect of asparagus extract.

Conditions That May Mimic Hangover

  • Migraine headache
  • Headache and nausea caused by drinking alcohol after taking disulfiram
  • A flush reaction within minutes of drinking alcohol in Asians with ALDH2 deficiency
  • Electrolyte imbalance (hyponatremia due to water intoxication, hypocalcemia, hypercalcemia)
  • Deficiency of vitamin B1, folate
  • Pneumonia
  • Early stage of meningitis

  1. Hangovers symptoms  Mayo Clinic
  2. Swift R, 1998, Alcohol hangover; mechanisms and mediators  National Institute on Alcohol Abuse and Alcoholism
  3. Jeffrey G et al, 2000, The alcohol hangover  Annals of Internal Medicine
  4. Barceloux DG, 2012, Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants, p.393
  5. Calder I, Hangovers  The BMJ
  6. Kim DJ et al, 2003, Effects of alcohol hangover on cytokine production in healthy subjects  PubMed
  7. Penning R et al, 2010, The pathology of alcohol hangover  PubMed
  8. Verster JC et al, 2010, Treatment and prevention of alcohol hangover  PubMed
  9. Hangover home care  FreeMD
  10. Pitler MH et al, 2005, Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials  The BMJ

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