What is a hangover? Thirst, headache, lethargy or worse? Perhaps leaving one feeling a ‘bit off’ or maybe a more substantial ‘woe is me’ situation. Both are common, and much depends on the quantity of alcohol consumed and one's own individual response.
There are various definitions for hangover, the one that we will focus on is:
“The alcohol hangover refers to the combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration approaches zero”.
Veisalgia, the medical term for hangover. From the Norwegian kveis - uneasiness following debauchery - and the ancient Greek algia - pain.
Symptoms and Severity
Once the alcohol has left the body, the consequences have to be dealt with.
Dependent on the amount of alcohol consumed and, in part due to individual variability. In layperson's terms, symptoms range from: light fatigue, concentration problems and headache to increased blood pressure, anxiety and severe vomiting.
Hangover can be measured by using one of three different scales, one being the Alcohol Hangover Severity Scale. Here we see 12 measurable items, including “fatigue”, “clumsiness”, “dizziness”, “apathy”, “sweating”, “shivering”, “confusion”, “stomach pain”, “nausea”, “concentration problems”, “heart pounding” and “thirst”. Regret is not included here, but - no kidding - is another quantifiable factor.
Even at the lesser end of a hangover's severity, the effects have consequences when trying to function: to play sports or drive a vehicle.
A hangover does not have to be the-day-after. It is perfectly possible to have a hangover on the day of the drinking session itself.
Why a Hangover?
Alcohol (ethanol) and, once broken down by the liver, its metabolites acetaldehyde (more harmful) and acetate (less harmful) contribute to hangovers by affecting a number of processes in the body. These contribute to inflammation, oxidative stress, hormonal and metabolic changes.
Dehydration is involved but perhaps not as much as we once thought.
Disturbed sleep, due to the alcohol, has a major role to play.
Darker coloured beverages seems to create worse hangovers than lighter due to their higher content of chemical congoners, say brandy and red wine compared to vodka and beer.
Individual Variability
Some people appear to suffer worse or better than others, so called ‘hangover-sensitive’ and ‘hangover-resistant’ drinker. Why? For some, their sleep quality is affected more than others. For others, likely due to the ability of their liver to process alcohol. This can be affected by genetics, especially for Asians who get worse hangovers than others due to variations in the ALDH2 gene.
We also know that hangover severity can change for the same individual, based on their health at the time, if they are sick or even feeling down.
The hangover definition we have used also highlights “a single episode of alcohol consumption” to differentiate between a true hangover and, say, withdrawal effects as might be experienced by alcoholics.
Function
When it comes to function, physical and mental performance, the research shows that a hangover has pronounced effects on short and long-term memory as well as psychomotor speed. The effects are not quite as bad for sustained attention. If you choose to wait out the hangover by watching a movie, you can suffer through it although you might not be able to remember it quite so well.
Everyday task performance is affected – be it sports performance or, more seriously, the ability to drive a vehicle. Just to be clear, we are not referring to intoxication, we are referring to the hangover affecting your physical control - when blood alcohol is near or at zero.
For those that have to play sports or exercise, they will play at lower activity levels and likely avoid vigorous activity.
Recovery
There is no magic fix when you have a hangover. Focus on the following:
Prioritise hydration. Water or very diluted juices or cordial, with a tiny pinch of salt. Do not chug back orange or fruit juice. Electrolytes help with rehydration but don't 'cure' a hangover.
Eat some nutritious food, easy to digest carbs can help. Having correct B-vitamin and zinc levels appear to have a positive effect on reducing hangovers, however, popping a multivitamin and mineral pill isn't really going to help when you are suffering.
Coffee, or caffeine, can increase you sense of alertness but beware taking too much as it might interfere with all important sleep.
There have been some small scale - mainly unreplicated - studies on herbs and plant extracts to reduce the severity of hangovers. However, the evidence is still very limited as to whether plant extracts and herbal formulas provide an appreciable benefit, even the popular Milk Thistle has little evidence behind it when it comes to curing a hangover. To quote one study (Smith, Hotopf, Drummond) "Although there was evidence of statistically significant improvements across a range of alcohol-induced hangover symptoms when comparing placebo to clove extract, tolfenamic acid, pyritinol, H. dulcis fruit extract, L-cysteine, red ginseng and Korean pear juice, all evidence was of very low quality." Other popular remedies fared less well when tested.
The time honoured 'hair of the dog that bit you' can temporarily minimise some symptoms but only prolongs the pain.
Light exercise might make some people feel better but for others it might just make them feel worse. Perhaps better to go for a walk than a run, try to enjoy some light movement and focus on hydration, nutrition and rest.
Good luck, you’ll mostly be back to normal within 24 hours.
How do hangovers affect you, are you a sensitive, resistant or somewhere in between? When it comes to over the counter remedies, the evidence is weak, so save your money. To rehydrate, a pinch of salt in some watered down juice or cordial will work just fine.
Of course, prevention is better than cure but we all know that anyway, right?!
If you want to have a chat about healthier living, cutting back on the booze, beating stress or following the doctor's advice, we can help. Just drop us a line to see how our consults and programmes can help.
Stay Healthy,
Alastair
Are parties and hangovers getting the better of you? Consider a dry month.
Alternatively, just say no to that extra drink. It can be hard, we share some tips here.
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Related Studies
Mackus M, van de Loo AJAE, van Neer RHP, Vermeulen SA, Terpstra C, Brookhuis KA, Garssen J, Scholey A, Verster JC. Differences in Next-Day Adverse Effects and Impact on Mood of an Evening of Heavy Alcohol Consumption between Hangover-Sensitive Drinkers and Hangover-Resistant Drinkers. J Clin Med. 2023 Mar 7;12(6):2090. doi: 10.3390/jcm12062090. PMID: 36983093; PMCID: PMC10055860.
Roberts, E, Smith, R, Hotopf, M, Drummond, C. The efficacy and tolerability of pharmacologically active interventions for alcohol-induced hangover symptomatology: a systematic review of the evidence from randomised placebo-controlled trials. Addiction. 2022; 117: 2157–2167. https://doi.org/10.1111/add.15786
Verster JC, Arnoldy L, Benson S, Scholey A, Stock AK. The Alcohol Hangover Research Group: Ten Years of Progress in Research on the Causes, Consequences, and Treatment of the Alcohol Hangover. J Clin Med. 2020 Nov 16;9(11):3670. doi: 10.3390/jcm9113670. PMID: 33207574; PMCID: PMC7696633.
Verster JC, Scholey A, van de Loo AJAE, Benson S, Stock AK. Updating the Definition of the Alcohol Hangover. J Clin Med. 2020 Mar 18;9(3):823. doi: 10.3390/jcm9030823. PMID: 32197381; PMCID: PMC7141232.
Gunn C, Mackus M, Griffin C, Munafò MR, Adams S. A systematic review of the next-day effects of heavy alcohol consumption on cognitive performance. Addiction. 2018 Dec;113(12):2182-2193. doi: 10.1111/add.14404. Epub 2018 Aug 30. PMID: 30144191; PMCID: PMC6282576.
Pittler MH, Verster JC, Ernst E. Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials. BMJ. 2005 Dec 24;331(7531):1515-8. doi: 10.1136/bmj.331.7531.1515. PMID: 16373736; PMCID: PMC1322250.