Why do I get headaches from wine? It’s a question I’ve been asked at least a thousand times.
Why do I get headaches from wine: Intro
This is a summary of the latest research into what causes headaches after drinking wine. It is the first post of 2. The second post is aimed at winemakers who want to prevent the compound that causes headaches from forming in their wine.
Much of what is presented here was compiled by Sophie Parker-Thomson MW (Master of Wine) who wrote her MW thesis on this topic. Parker-Thomson and others such as Dr. Patrick Lucas shared their findings during a Master of Wine webinar earlier this year.
I’ll do my best to simplify and explain the specialized terms involved. If anything needs further explanation, please let me know in the comments at the bottom!
And if you are a winemaker, stay posted for the next installation where I will share recommended best practices to prevent your customers from getting headaches from your wine.
Now, buckle up, kids! Get ready for some science.
The Confusion about Sulphites and Wine
For years, consumers have been (wrongly) assuming that wines with added sulphites were causing them headaches. So I first need to dispel this myth.
What are sulphites?
Sulphites or sulfites are a chemical and is more commonly known as sulphur dioxide or SO2. SO2 is naturally present in wine and is produced during the fermentation process.
Sulphur is also spelled sulfur and can be referred to as sulphites or sulfites. These are all the same thing.
But SO2 can also be added by the winemaker to wine and is used for two main purposes.
Why are sulphites added to wine?
The first is as an anti-oxidant to prevent wine from ageing too fast. Simply put, sulphites prevent wines from browning. It keeps the wine tasting like fresh fruit instead of ‘past-its-time’ bruised or cooked fruits.
When a wine tastes like bruised or cooked fruit when it should taste fresh, we say the wine is oxidized and this is considered a fault.
Sulphites are also anti-microbial and used as a preservative to stabilize wine. This prevents them from say, fermenting again in bottle. Wines that have re-fermented will have a light spritz to them when opened.
Sulphur also makes sure that the wines don’t develop unevenly after bottling.
So if you’ve ever purchased many bottles of the same wine and they all tasted the same, you can thank sulphites for that.
Unfortunately, people have incorrectly linked their headaches to the presence of added sulphites in wine.
How did we confuse sulphites as (wrongly) causing headaches from drinking wine?
During the 1970’s and 1980’s, use of sulphites was unregulated and some producers overused it. This did lead to some hospitalizations and fatalities. Of course, this gave sulphites some bad publicity.
Now, use of sulphites is tightly regulated by all countries.
Furthermore, the science about determining the precise amount of SO2 required is now completely understood. It’s calculated by figuring out the amount of free to bound forms SO2 in each specific wine. And although this may sound complicated, it’s not for winemakers.
Even people who make wine at home can access ways to measure the exact amount of SO2 they need to stabilize their wine.
As a result very few wines run the risk of being over-sulphated as they were in the past.
Only 1 in 100 people are sensitive to sulphites. But many more have adverse reactions after consuming wine
In fact, the US Food and Drug Administration says only 1% of people are sensitive to sulphites. These people tend to be asthmatics. Fewer still will have a life-threatening response.
So you could be part of that 1% having a reaction to sulphites. But, if you are not an asthmatic, then your negative reaction to wine is likely caused by something else.
However, there is another small group of people who are not asthmatics but who react to sulphites. These people break out into hives and swell. It’s a response called urticaria and angiooedema and it can last for weeks.
Furthermore, we know that as many as 10% of the population has a reaction to wine regularly.
So the question becomes, why is an additional 9% of the population is reacting poorly to wine?
Still not convinced that your headaches are not from the sulphites? There’s more…!
As many as 10% of the population has a reaction to wine regularly.
But only 1% of the population has a reaction to sulphites.
What kind of response do people have when they have an allergic-like response to sulphites?
For those who are indeed sensitive to sulphites, Parker-Thomson says that the reaction is mostly a respiratory one. One that is experienced most often by acute asthmatics. In fact the OIV (the International Organization of Vine and Wine) says that sulphite sensitivity is only expressed by 1.7% of asthmatics. Steroid dependent asthmatics are most at risk of having a reaction to sulphites.
In rare cases, the person may have a serious anaphalactic response where the entire body has a sudden and severe reaction. Constriction of the airways, chest pain, cramps, and anxiety or sense of doom may be felt. Soon, a dangerous drop in blood pressure can occur and water may fill up the lungs.
If you have a severe allergic-like reaction to sulphites, carrying an Epi-Pen is the antidote. Epi-Pens are essentially adrenaline (epinephrin).
Of course, then there is that other group of people who break out into hives after consuming sulphites.
Collectively, these two groups make up the 1% who react to sulphites.
But the take-away point here is that people who are allergic to sulphites do not get migraines or headaches.
Here are the medical management guidelines from the US Center for Disease Control for assessing reactions from sulphite sensitivity and what to do about it.
People who react to sulphites do not get migraines or headaches!
I’m going to reiterate this just incase you are skimming and missed the main point presented here.
People who react to sulphites do not get migraines or headaches.
Mainly it’s acute asthmatics who have poor reactions to sulphites. Their reaction is purely a respiratory one meaning, it makes it hard for them to breathe. The other people who react to sulphites, break out into hives.
Why do I get headaches from wine?
So then, what is causing headaches when we consume wine?
In short, it’s biogenic amines that are causing headaches in wine. Precisely, only 2 of the 14 biogenic amines out there cause headaches (and other allergic responses). These are histamine and tyramine.
Histamine, is the most researched of the two. In fact, histamine levels in food is already highly regulated throughout the world because it’s been known to cause headaches when consumed.
Conclusive research is still lacking on whether tyramine is also an offender. Yet scientists believe this is one of the culprits causing your head to feel like a football too.
What are biogenic amines?
So, what are biogenic amines?
Amines are organic compounds that play an important role in living organisms. Biogenic means ‘produced by living organisms or biological processes’. Or for the science nerds out there, biogenic amines are naturally occuring lightweight nitrogen compounds.
For the rest of us non-science types, you may have already heard of seratonin and histamine? These are 2 biogenic amines that are also neurotransmitters in the brain.
Other biogenic amines, such as epinephrine (commonly known as adrenaline) are hormones and can be used as medicine. Coincidentally, this is the hormone in Epi-Pens, the known cure for severe anaphalactic responses to sulphites.
The point is, plants and humans produce biogenic amines naturally and most of the time, they help to regulate our bodies in healthy ways.
Why do biogenic amines cause headaches when drinking wine?
But although important for our body functions, histamine and tyramine are undesirable in foods and beverages. Moreover when consumed at high concentrations, they cause headaches.
Let’s take histamine as an example. In normal circumstances within the body, histamine produces an immune response: it dilates blood vessels; excites the gastrointestinal muscles; and promotes the secretion of gastric acid and mucus. These are all good things.
But in a toxic situation – such as when biogenic amines are ingested with food and wine – histamine mimics an allergic reaction. This is bad.
What reactions do people who consume dangerous levels of biogenic amines have?
Allergic responses include things such as migraines, headaches, flushing (when your face turns red), hives, nausea, vomiting, stomach ache, nasal congestion, and constriction of your bronchus muscles making it hard to breathe.
You can see how many of the reactions to biogenic amines overlap with the negative responses to sulphites. However, there is one main exception.
Biogenic amines can cause headaches or migraines whereas sulphites do not.
Are histamine and tyramine the only things causing problems in wine?
According to Dr. Lucas from the University of Bordeaux, there are in fact a total of 4 biogenic amines that are causing problems in wine. But it’s only 2 of those that are causing headaches.
As mentioned above, histamine and tyramine are the biogenic amines that scientists think are causing headaches and some other allergic reactions.
So although wine producers should seriously pay attention to cadaverine and putrescine, they don’t hurt people. They just make wine smell and taste less, or make them smell bad.
In fact, current research suggests that when we smell brettanomyces in wine, it may sometimes actually be cadaverine or putrescine that we are smelling. Brettanomyces is the compound responsible for the smelly poo or stinky barnyard animal aroma. It’s an aroma that takes away the fruity quality in the wine. Therefore, controlling biogenic amine buildup is also a way to prevent wines from smelling like poo. But that topic is for another post.
So, if it's histamine in wine that causes me to have a headache, can I take an anti-histamine to prevent a headache?
Nope… dammit! It just doesn’t work that way.
Biogenic Amines and the Food Industry
Fermented Foods have long been known to potentially carry dangerous levels of biogenic amines
It’s long been known that fermented foods have the potential to contain dangerous levels of histamine. Canned fish, vegetables, and even dairy products such as yoghurt and blue cheese are usual suspects. Tomatoes, aubergine (eggplant), and strawberries can be problematic too.
So it’s easy to understand why the food industry tests fermented and canned products routinely and has allowable histamine limits for each product.
We just haven’t established those limits for wine yet.
Challenges to regulating biogenic amines in the wine industry
Since these 4 biogenic amines are so probematic for wine, the wine industry should be regulating and testing for them in their wines. Unfortunately, this is not an easy thing to do.
One challenge of regulating histamine levels, is that the known levels of biogenic amines in wine are tiny in comparison to the allowable levels in food. Therefore, we cannot simply transfer the histamine levels in food regulations over to wine.
For example, Dr. Lucas from the University of Bordeaux compared the histamine toxicity levels from a few studies and found this comparison:
Toxic levels of histamine in tuna
- After eating tuna that contained 100 mg of histamine, 1 out of 8 subjects experienced flushing and mild headaches.
- After consuming 150 mg, 2 out of 8 subjects experienced flushing and mild headaches.
- But after consuming 180 mg of histamine, 4 out of every 8 subjects experienced flushing and headaches.
*** All of these subjects reported being healthy with no intolerance of histamine.
Toxic levels of histamine in wine
- after drinking wine with 100 mg of histamine, people with no reported intolerance of histamine were fine (this study used only 2 people though)
- after drinking wine with between 0.12 – 4.2 mg histamine, there was no statistically noticeable effects on patients (on 20 volunteers)
- for those with an intolerance to histamine, only 4 mg in sparkling wine was enough to cause headaches in (12 out of 40 patients)! 😱
Why tiny levels of histamine in wine cause headaches when those same levels would be harmless in food?
The problem here is alcohol exacerbates the allergic response. This is because alcohol as well as other compounds in wine inhibit the mono amine oxidases (MOA) and the diamine oxidases (DOA) that break histamine down. To sum it up, the effects of histamine toxicity are stronger when you ingest it with alcohol.
In another study with sparkling wine, only 4 mg of histamine was enough to cause flushing and headaches in 12 out of 40 patients who have an intolerance to histamine. So, it only takes tiny amounts to make some people ill.
We consume more wine in one sitting than other foodstuffs
In fact, in Naples, six young healthy adults aged 22-27 were recently sent to hospital after drinking about 3 glasses each (450 ml) of sparkling red wine on tap. (see Esposito et al. 2019 link below)
It’s also true that we have to count the accumulated amounts of histamine and biogenic amines in everything you are consuming and get the grand total of each of these substances to know if it will cause adverse affects. So, histamine in the fish + histamine in the cheese + histamine in the wine = the amount of histamine in your body.
Therefore, there may be no biogenic amine buildup in the wine. But if you are drinking wine (which obviously has alcohol in it), then only 4 mg of histamine in food could cause sensitive people to feel ill.
This brings me pause when I think of the trend of serving canned fish in restaurants. Canned fish holds some of the highest allowable histamine levels for foodstuffs. It’s a frightening prospect for the wine industry to think we cannot recommend a wine to drink with this.
Challenges with regulating biogenic amines in wine
Currently, no country has set legal limits restricting the level of biogenic amines in wine. However, a handful of countries have ‘recommended limits’ that range between 2 – 10 mg/l.
Both Switzerland and Australia have recommended limits up to 10 mg/l. However, we know (see above) that people who have an intolerance to histamine are still affected by as little as 4 mg/l when consuming wine.
Finally, toxicity levels is from the accumulated amounts of histamine (and possibly tyramine) in products consumed.
So there would have to be a collaboration between the food and alcohol industries to label all products with the tested amount of histamine on the container. Then there would need to be a concerted effort to educate consumers that they have to add up the level of histamines in everything they consume in one setting. Furthermore, restaurant staff would need to know the histamine levels in their cheese plate, for example. Finally, consumers would then need to callibrate that amount to factor in whether they are consuming alcohol or to if they have a known intolerance to histamine and tyramine.
Biogenic Amine Recommended Limits by Country
*in milligrams per litre
- 2 – Germany
- 3.5 – Netherlands
- 6 – Belgium
- 5-9 Finland
- 8 France
- 10 Switzerland + Australia
*** these are recommended amounts only and not mandatory. Notice the range!
How can I tell which wines have biogenic amines in them?
The jaw-dropping conclusion is that natural, low intervention and organic wines where sulphur dioxide or SO2 has not been added are likely the biggest culprits causing wine headaches!
What wines are causing headaches?
Here are the wine styles that are (kindof) more likely to be harmful...
- with low or no sulphur additions (natural wines, low-intervention wines, organic wines), Certified USDA Organic Wines
- sparkling wines, especially organic sparkling wines
- red wines with low acidity (because they have a higher pH)
- wines that have gone through the malolactic fermentation (all red wines and some white wines)
But this recommendation is such a stretch and not great for making real-life buying choices because it’s by no means fully accurate.
Currently, there is no legal definition of ‘natural’ or ‘low-intervention’ wines. Therefore, no consumer knows what the sulphur regime is of any winemaker. And although there are some legal definitions for organic wines, the regulations are different in each country.
But, just because a wine is organic or is sparkling doesn’t mean that it has high levels of histamine and tyramine for certain. Similarly, not all wines that are put through the malolactic fermentation cause headaches.
It just means those wines are more likely than others to have detrimental amounts of biogenic amines in them.
Indeed, there is a high likelihood that the trend for natural, non-intervention and organic wines is correlated to the higher incidence of wine-induced headaches.
Therefore, it’s really important for the wine industry to tackle this. Otherwise, people will unfortunately associate their headaches with organic and natural wines. Whereas, we should only associate natural, organic and non-interventionist wines with better viticultural practices, less chemical sprays and overall health of the land.
How do we do this?
The most direct method is for organic, natural and low-interventionist wines to add sulphur. But that’s not the only way. You’ll have to come back for my second post on this topic which will detail ways winemakers can intervene.
The simplist way (yet not really that simple at all) for consumers to eliminate the chances of getting a headache from wine
The simplist recipe (when truly this is not a simple approach at all) for headache prevention is to ask wine producers directly if they are adding sulphur to their wine.
USDA Organic-Certified wines are not legally allowed to add any sulphur – unless it’s added as field additions. Generally speaking if you get headaches, you will want to ask the organic producer if they add sulphur as field additions (they will need to add at least 60 ppm or 60mg/l so they will have 20 ppm or 20 mg/l free SO2).
I’ll detail the specific amounts recommended by the panel in the next post on Winemaker’s Report: How to Make You Wine Headache-Free.
For now, it is safer for consumers that get wine-induced headaches to purchase wines that are a) high in acidity (and therefore have low pH, b) have not gone through the malolactic fermentation which means avoid red wines in particular c) avoid sparkling wines especially traditionally made sparkling wines and the organic ones and d) avoid wines such as organic and low intervention wines with no sulphur added.
Most consumers think that wines with sulphites are giving them headaches. Yet, conclusively research shows that it is actually histamine and tyramine that are the culprits. Histamine and tyramine are biogenic amines. When they are consumed, they cause headaches.
As histamine is known to be toxic, levels of it are regulated in food. But it is more difficult to do this with wine as the toxic levels are miniscule compared to the toxic levels of histamine in food. It is therefore clear that alcohol causes people to have higher sensitivity to histamine because it prevents the body from breaking it down.
Furthermore, toxicity levels are from the accumulated amounts of histamine from all sources – so consumers must be aware of histamine levels from their food as well as in their wine – in order to adjust the amounts to their tolerance levels.
Consumers can't predict which wines will cause them headaches
Research says that wines that have little or no added sulphur to them are more likely to have toxic levels of histamine and tyramine and cause headaches!
When SO2 isn’t added, its anti-microbial properties aren’t present in the wine. This creates the perfect conditions for biogenic amine buildup. Wines that have high pH (3.6 and above) are more likely to have toxic levels of histamine and tyramine too. Finally, sparkling wines and red wines are more likely to cause headaches.
The wine industry must tackle this challenge so that consumers don't turn away from wine
So come back and visit us for the second installment of this topic where I’ll cover the ways for winemakers to prevent biogenic amine buildup in their wines.
Do you get headaches from drinking wine? Tell us your story below!
‘Biogenic Amines: A Claim for Wines‘ by y Maria Martuscelli and Dino Mastrocola (from the Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy) but published in creative commons intechopen on, November 5th 2018, DOI: 10.5772/intechopen.80362. Accessed on October 6th, 2021.
‘Biogenic Amines – the impact on wine sanitary status and quality‘ hosted by by Sam Herrop MW, the Master of Wine (IMW) Webinar Series on July 22, 2021 with Sophie Parker-Thomson MW, Dr. Patrick Lucas, director of the Oenology Research Unit at ISVV of the University of Bordeaux, Dr Sibylle Krieger-Weber, R&D Manager at Lallemand Oenology, and Ann Dumont, Communications Manager at Lallemand Oenology
‘Level of Biogenic Amines in Red and White Wines, Dietary Exposure, and Histamine-Mediated Symptoms upon Wine Ingestion‘ Esposito et al. 2019 in US National Library of Medicine, National Institutes of Healths, Vol. 24 (19), assessed October 26th, 2021.
‘Occurrence of biogenic amine-forming lactic acid bacteria in wine and cider‘ in Food Microbiology Volume 27, Issue 8, M. Cotton et al. December 2010, Pages 1078-1085, assessed Sept 27, 2021.
‘SO2 and Wine: A Review’ Dr. Creina Stockley et al. OIV Collective Expertise Document, OIV Publications, 1st Ed published March 2021, assessed Nov 28, 2021.
‘Understanding Wine Technology; The Science of Wine Explained’. 3rd ed published 2010. by David Bird. entries on acetaldehyde, fermentation and others
* See also links within the text above