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FOOD AND TRIGGERS

Can alcohol trigger migraines? Red wine and the evidence

Red wine gets the blame most, but few people react every time. What diary studies show about alcohol and next-day migraines, and how to check your diary.

Published by Migraine Tracker Updated 9 min read

The short answer

Alcohol can trigger attacks in some people with migraine, but diary studies find a smaller effect than surveys suggest. In surveys, about a third say alcohol can bring on their attacks, red wine most often. Yet in a Dutch survey, only 8.8% of those who named red wine said it set off an attack every time.

In a 2020 US diary study of 98 adults, 1 or 2 servings were not linked to more headaches the next day, while after 5 or more, a headache followed 33% of the time, against 20% after days without alcohol. A headache the morning after can also be a hangover headache, which the International Classification of Headache Disorders (ICHD-3) lists separately. Averages cannot show how you react; your diary can.

What the studies found

Studies that ask people about their triggers find that alcohol is often blamed, while studies that follow people day by day find a smaller effect. A 2016 review found that about a third of people with migraine named alcohol in studies that asked them to look back, but that studies following people forward in time gave it limited importance.

Four studies of alcohol and migraine
Study and participantsWhat it found
Onderwater et al., 2019: 2,197 people with migraine in a Dutch study, asked about their past experience in an online questionnaire36% named alcohol as a trigger. Of the current drinkers who did, 78% named red wine. Of those who named red wine, only 8.8% said it set off an attack every time; for vodka, the figure was 10.7%. About a third said their attacks usually began within 3 hours of drinking, and almost 90% within 10 hours.
Mostofsky et al., 2020: 98 adults with episodic migraine in the US, with online diaries every morning and evening for at least 6 weeks: 4,467 days and 825 headaches1 or 2 servings were not linked to more headaches of any type the next day in this group. After 5 or more, the chance of a headache the next day was 33%, against 20% after days without alcohol. The diaries did not record the type of drink or when it was drunk.
Vives-Mestres et al., 2022: 487 people with migraine who drink, the first 90 days of each in a headache diary app: 40,165 diary days analysed and 5,913 attacksDrinking was not linked to an attack starting the next day (odds ratio 1.01, where 1 means no difference), and attacks were slightly less likely two days later (0.75). Most participants were light drinkers. The app’s maker part-funded the study and supplied the data, and two of the five authors had consulting fees and stock options from it.
Littlewood et al., 1988: 19 people with migraine who blamed red wine but not other alcohol, given red wine or vodka mixed to the same strength, served cold from dark bottles9 of the 11 people given red wine had a typical attack, and none of the 8 given vodka. The study is small and old, and only its summary is freely available.

Some people avoid alcohol altogether because of migraine. In the 2019 Dutch survey, a quarter of the people who did not drink said they avoided alcohol because they thought it could trigger attacks. A 2024 Dutch study of 5,176 people with migraine found that they were less likely to drink at all than 8,370 people from the general population (odds ratio 0.66). Diary studies can only measure alcohol in people who still drink, so they cannot show what it would do to those who stopped.

Next-day headache: migraine or hangover?

A headache the morning after drinking may be a migraine attack, or a delayed alcohol-induced headache, which ICHD-3 lists separately. ICHD-3 describes two headaches caused by alcohol itself, and the timing is what separates them.

When a headache starts after drinking, and what the sources say
When it startsWhat the sources say
Within 3 hours of drinkingICHD-3 calls this immediate alcohol-induced headache, once known as cocktail headache. It is much rarer than the delayed type. In people with migraine, a very small amount can sometimes bring it on.
5 to 12 hours after drinkingICHD-3 calls this delayed alcohol-induced headache, once known as hangover headache, and says it is one of the commonest headaches with an outside cause. It goes within 72 hours of starting.
The next day (diary studies)In the 2020 diary study, a headache the next day was more likely only after 5 or more servings. In the 2022 app study of mostly light drinkers, drinking was not linked to an attack the next day.

Migraine attacks after drinking do not fit neatly into these windows. In the Dutch survey, about a third of people said their attacks usually began within 3 hours of drinking, and almost 90% within 10 hours. Both types of alcohol-induced headache need at least one of these features: pain on both sides, throbbing pain, or pain made worse by physical activity. Those overlap with migraine, so telling them apart is for a clinician. What your diary can add is timing: when you last drank, when you went to sleep and when the pain began. Feeling drained the day after a migraine attack, rather than after drinking, is something else again: see the post on the migraine hangover.

Is red wine worse?

Red wine is blamed more than any other drink, but the evidence that it is worse is thin. In the 1988 study, red wine set off attacks and vodka did not, in people who already blamed red wine. Its authors concluded that something in red wine other than alcohol and tyramine was responsible, and what that might be has not been settled.

  • Red wine was not more consistent. In the Dutch survey, 8.8% of the people who named red wine said it set off an attack every time, and 10.7% of those who named vodka said the same of vodka.
  • Alcohol was rarely a regular trigger. A 2011 study had answers from 126 people with migraine with aura who had named something that often or always set off their attacks. Alcohol came up 22 times, and 20 of those were red wine. But no one said alcohol set off half or more of all their attacks.
  • The evidence is weak overall. A 2025 review in the journal Nutrients rated the quality of evidence on alcohol as a migraine trigger as low. It said the blame placed on red wine is not always confirmed by the few prospective studies.

The Migraine Trust, a UK charity, says that about 1 in 10 people with migraine get attacks from alcohol regularly, and that stress or sleep may sometimes be the real trigger. A late night out changes several things at once. Christmas can bring many of them together, as our post on Christmas and migraine shows.

Check your own diary

Your diary can show whether attacks follow drinking more often than other evenings, and whether the amount, the drink or a short night explains it better. Here is a fictional diary kept for 8 weeks, or 56 evenings, with 9 attacks.

Fictional diary: attacks within 24 hours of each kind of evening, over 8 weeks
EveningsAttack within 24 hoursShare
3 or more drinks5360%
1 or 2 drinks9111%
No drink42512%
All evenings56916%

In this fictional diary, an attack followed 4 of the 14 evenings with a drink (29%) and 5 of the 42 evenings without one (12%). In this diary, though, the evenings with 1 or 2 drinks looked much like the evenings without a drink. Red wine was drunk on 6 evenings and other drinks on 8: an attack followed 2 of each, and both red wine attacks came after evenings with 3 or more drinks. Three of the 4 attacks after drinking followed a night with less than 6 hours of sleep, and began the next morning, 7 to 11 hours after the last drink. That is inside the window ICHD-3 gives for a delayed alcohol-induced headache, so the diary should also say what the pain was like.

A trigger summary for this diary would show Alcohol for 4 of the 9 attacks (44%) and Red Wine for 2 (22%), which makes red wine look important. The evenings suggest that the amount and the short nights matter more. With 9 attacks, this proves nothing, but it gives you a specific question for an appointment.

  1. Write down the drink, the amount and when you finished. Note the time you went to sleep, too.
  2. Count the evenings with a drink and no attack. A trigger list only covers attacks, so keep a tally of the other evenings, for example on a calendar.
  3. Use one window every time. For example, count an attack if it began within 24 hours of your last drink.
  4. Compare shares, not counts. Divide the attacks by the evenings, as in the table. The chocolate post and the weekend migraines post use the same check.
  5. Give it time. With a handful of attacks, a difference can easily be chance. The guide to reading patterns explains why a pattern is a starting point, not proof of a cause.

What Migraine Tracker records

Migraine Tracker for iPhone and Apple Watch records suspected triggers, notes and sleep with each attack, so you can see later what came before it.

  • Alcohol and Red Wine. Both are among the app’s built-in food and drink triggers. You can select them during an attack, when you edit one or add a past one, and on Apple Watch with Premium. A trigger records what you suspected, not what caused the attack.
  • Notes. When you edit an attack or add a past one, you can write a note, for example what you drank, how much and when you finished.
  • Sleep. If you allow access to Apple Health, an attack started in the app, on Apple Watch or with Siri keeps the previous night’s sleep when Health has it, shown in the attack’s details. Our Apple Health guide explains the access settings.
  • Top Triggers. With Premium, Reports shows your 5 most common triggers in a period and the share of attacks with each. It does not count evenings without an attack, which is why the diary check above counts evenings. Premium also lets you add your own trigger, such as Beer.

The guide to what to record covers the other details worth keeping with each attack.

When to talk to someone

  • The NHS says to see a GP if “your migraine attacks are severe or getting worse, or lasting longer than usual”, if “you have migraine attacks more than once a week” or if “you’re finding it difficult to control your migraine”.
  • If you are worried about how much you drink, the NHS alcohol support page explains where to get help. It warns: “If you have become physically dependent and need to stop drinking completely, stopping overnight could be harmful. You should get advice about this and about any medicine you may need to do this safely.”
  • The Migraine Trust suggests checking the leaflet of any medicine you take, or asking your doctor, about mixing it with alcohol.
  • The NHS says to call 999 if you “have a headache that came on suddenly and is extremely painful”, “have problems speaking or remembering things”, “lose your vision, or have blurred or double vision”, “cannot move or have weakness in the arms or legs on 1 side of your body, or 1 side of your face”, “have a seizure or fit” or “have recently had a head injury”. In the US, call 911. Elsewhere, call your local emergency number.

Information from the NHS website, as at 061126: Migraine and Alcohol support.

Sources

Sources checked on 19 October 2026. The diary example uses fictional data.

App details checked against Migraine Tracker 1.1.0 on 19 October 2026. The diary example uses fictional data. This post explains research and record keeping, not medical advice or advice about drinking. The sources explain general principles and do not endorse Migraine Tracker.