June 5, 2000 - Everyone has his or her own hangover remedy. Ancient Romans said eat fried canaries. Modern Greeks in college fraternities say drink more "hair of the dog that bit you" -- meaning more alcohol. But although many people swear by their personal hangover cure, a review of more than 100 studies finds that, other than time, only a few things may actually help.
Hangovers may actually be more of a headache than previously thought, according to Jeffrey G. Wiese, MD. Medical problems associated with hangovers can be severe for some people. People with heart problems can be at greater risk for heart attacks, says Wiese, because hangovers put people in a situation "that is very similar to high stress, and that is an increase in blood pressure, a high heart rate."
He adds that there is some evidence that blood cells involved in clotting called platelets become "stickier," thus making blood clots more likely. Other studies have shown that thinking and performance can be impaired.
Wiese and colleagues from the General Internal Medicine Section of the Veterans Affairs Medical Center in San Francisco reviewed more than 4,700 medical journal articles written about alcohol intoxication since 1965, and found 108 that addressed the hangover. Their findings were published in a recent issue of the journal Annals of Internal Medicine.
"It's something that here and there, people toyed with, but nobody ever really got around to saying how big of a problem this is," Wiese tells WebMD, adding many people simply view the hangover as penance, nothing more, nothing less.
One "big purpose" of the review, says Wiese, was to not only alert the public to the problem of hangovers, but also to raise awareness among physicians that this is something worth asking your patients about "to try to assess those who might be at greater risk for alcoholism.
"We need to get over the social sentiment, 'well, that's what you deserve,' if this is really putting people at risk, and do a better job of raising awareness so people know that this can cause medical problems," Wiese tells WebMD.
But more common than potential medical problems is the muddleheaded feeling the day after. Robert Cloninger, MD, a well-known researcher in alcohol studies, defines a hangover quite simply as "feeling bad after drinking." But it does go beyond just that, Cloninger tells WebMD.
"You don't think as well; you're achy; you're slower; you're really not functioning a 100%," he says. Cloninger is a professor of psychiatry, genetics, and psychology at Washington University in St. Louis, Mo.
Wiese writes about the common symptoms of hangovers, predominantly a headache, then a poor sense of overall well-being, diarrhea, loss of appetite, shakiness, fatigue, and nausea. The alcohol causes the bad feelings because it leaves a person dehydrated and malnourished. One debatable theory, Wiese writes, is that a hangover is the first stage of alcohol withdrawal.
Wiese affirms Cloninger's definition, saying multiple studies show decreased reaction times, less ability to concentrate, lower managerial skills, and increased risk for injury, even after some of the more obvious hangover symptoms are gone and alcohol can no longer be detected in the blood.
Wiese describes one study looking at airline pilots, where pilots drank enough one night to meet the criteria for having a hangover the next day. The pilots followed an eight-hour "bottle to throttle" standard before entering a flight simulator. Wiese says even though half of the pilots didn't feel like they had a hangover, their thought, or cognitive, functions were clearly reduced.
"The point being is that many people see being hungover as having a headache or just not feeling great, but don't recognize that their cognitive function is actually impaired," says Wiese, "and that may have implications for whether people decide to work with heavy machinery, decide to drive, or operate aircraft, for example. People should be aware that their cognitive function may not be optimal, even though they may not be feeling the most severe symptoms."
Wiese says 75% of all drinkers will have a hangover in a year, and 15% will have a hangover at least monthly, which has a large economic impact. "You're talking about a big part of the American workforce, and if each of those [people] misses work one or two times a year, and then if you toss on the decreased productivity from the cognitive decline ... it starts to become a fairly large opportunity cost, a large loss in productivity," Wiese says.
Some studies have put the annual cost in the U.S. at a whopping $148 billion per year, while another researcher estimated the average annual loss to be about $2,000 per working adult, Wiese writes. Light-to-moderate drinkers cause 87% of all alcohol-related problems in the workplace and, paradoxically, this same group suffers more hangovers than heavier drinkers.
So, the million-dollar question is, what can be done about hangovers? Humorist and writer Robert Benchley said, "there is no cure for the hangover, save death." He was close. Wiese says "prevention" is the only surefire hangover cure, followed closely by moderation and not drinking on an empty stomach.
Some studies also have found the only other effective remedies are drinking plenty of nonalcoholic fluids to rehydrate you, vitamin B6, and prostaglandin inhibitors -- the class of anti-inflammatory drugs that include ibuprofen and aspirin, according to Wiese. These should be taken at the time you drink the alcohol for a small effect in reducing hangover severity.
There was one study of an herbal preparation called Liv.52 that was shown to reduce hangover symptoms, but Wiese writes the results are suspect because of the way the study was conducted and because the manufacturer sponsored the study.
Wiese also points out that darker drinks, such as red wine or scotch, contain more impurities, called congeners, thereby increasing the frequency and severity of hangovers. And as for "hair of the dog," well, that hangover you are trying to avoid is going to still bite you sooner or later.
"Nobody has a cure for hangover. These are completely symptomatic treatments, much like taking over-the-counter drugs for a flu and a cold. You know, it's very questionable whether it really does anything," Cloninger tells WebMD.
Overall, Cloninger says the findings in Wiese's review are "not novel," since they are based on published studies, but the findings are "well-appreciated and well-recognized." Cloninger took issue with the cost figures because they "are based on a world where no one's going to drink at all, and that's not going to happen." He also says it's difficult to pigeonhole people, because every one reacts to alcohol differently, and not uniformly.
"Obviously, we're not going to go back to prohibition, but look what's happening with cigarette smoking. ... We may be attacking some of the wrong things, because there's certainly a lot of [death] associated with alcohol on roads, and so on, comparable to what you get with cigarettes," Cloninger tells WebMD. "So we need to maybe have a more balanced approach."
- People have been dealing with hangovers throughout history, but doctors haven't done much to research the medical issues they raise.
- From the research that is available, experts say hangovers impair thinking and performance, in addition to making sufferers feel terrible. Overall, loss of productivity has economic effects on society as well.
- There isn't a cure for a hangover, but severity may be lessened by using ibuprofen or aspirin and drinking plain water while you are drinking alcohol. Also, doctors should be asking patients about hangover frequency, which hints at one's risk of alcoholism.