By Louise M. Klebanoff, MD

Assistant Professor of Clinical Neurology, Weill Cornell Medical College

Dr. Klebanoff reports no financial relationships relevant to this field of study.

SYNOPSIS: In this observational, cross-sectional survey performed via an online questionnaire, researchers confirmed that alcohol consumption is a common trigger for migraine, and red wine is the type of alcohol cited as a trigger most frequently.

SOURCE: Onderwater GLJ, van Oosterhout WPJ, Schoonman GG, et al. Alcoholic beverages as trigger factor and the effect on alcohol consumption behavior in patients with migraine. Eur J Neurol 2019;26:588-595.

Migraine is a common disabling primary headache disorder that affects 12% of the population of the western world. As part of their treatment regimen, patients with migraine are advised to identify and avoid triggers. Alcoholic beverages, especially red wine, frequently are included as a top 10 trigger. However, very few, small, retrospective studies focus on alcoholic beverages as potential migraine triggers. Onderwater et al used data from the Leiden University Migraine Neuro-Analysis (LUMINA) project to identify which alcoholic beverages are reported as migraine triggers frequently, to estimate trigger consistency and time to attack onset, and to explore the effect on alcohol consumption. In this observational study, investigators used cross-sectional data collection via a web-based questionnaire sent by email. All patients with migraine included in LUMINA between February 2008 and January 2013 were sent an alcohol trigger questionnaire. Of 3,785 patients who received the questionnaire, 2,424 responded. Non-responders were older, had a longer disease duration, and reported higher attack frequency and number of migraine days. There was no significant difference in gender or migraine subtype. Data from 2,197 patients were available for analysis.

Overall, 783 patients reported alcohol as a migraine trigger. Of the 1,547 participants with migraine who consumed alcohol, 658 reported that alcohol was a trigger, 694 did not report alcohol as a trigger, and 195 were not sure. Patients who reported alcohol as a trigger were more likely to have migraine without aura, experienced a higher frequency of attacks, reported more migraine days, drank slightly more per occasion, and consumed more vodka and significantly less red wine. Red wine was the most frequent beverage specifically mentioned as a migraine trigger, with 512 of 658 alcohol-consuming migraine patients reporting red wine as a trigger. Vodka was the trigger mentioned least frequently, with only 56 of 658 patients reporting vodka as a trigger. Patients estimated that 2.18 ± 1.3 standard glasses of red wine or 2.16 ± 1.9 standard glasses of vodka were required to trigger a migraine. The time of onset was rapid, within three hours, in one-third of the patients. Ninety percent of patients reported an onset in less than 10 hours. Of the 650 patients with migraine who did not consume alcohol, 165 stopped consuming alcohol because either it triggered migraines or they were told by others that it could be a potential trigger.

COMMENTARY

In this large migraine cohort, Onderwater et al found that alcoholic beverages were reported as a migraine trigger in more than one-third of patients, with red wine as the most frequently mentioned trigger and vodka as the least. The study provides additional support for advising migraine patients to observe if alcoholic beverages, especially red wine, trigger their migraine attacks. Trigger awareness allows patients to modify their behavior to improve their quality of life.