Hangover symptoms: How does it feel and how long does it last?

Hangover Definition

Hangover is defined as the presence of at least two of the following symptoms: a headache, nausea, anorexia, diarrhea, fatigue or shakiness several hours after stopping drinking, that is after complete metabolism of alcohol–when the blood alcohol concentration drops to zero ⁶.

There is no definite hangover cure known, but this may help: water, bread or crackers, throwing up, aspirin, sleep and – time.

Content:

Prevention

Abstinence: Do not drink alcohol.
Moderation: Adults usually experience a hangover after their blood alcohol concentration (BAC) has exceeded at least 0.11% ^56,57, which results from at least 3-5 drinks in an hour.
Light-colored alcoholic beverages (vodka) are associated with fewer headaches than dark colored (whiskey, rum).

Symptoms and Signs

Picture 1. An alcohol hangover with typical symptoms:
a headache, nausea, fatigue and sensitivity to light

Hangover symptoms usually appear several hours after stopping drinking, may last from few to 72 hours (usually less than 24 hours) and may include:

A headache: throbbing (pulsating), bilateral, in front of the head, aggravated by exercise
Nausea, vomiting, poor appetite (anorexia), bad taste in mouth, stomach upset, diarrhea
Fatigue
Tremor (shaky hands)
Dry mouth and other symptoms of activated sympathetic nervous system: anxiety, cool, pale, sweaty skin, increased sensitivity to light (photophobia) and sound, increased heart rate, pounding heart (palpitations)
Drowsiness or sleeplessness (insomnia), dizziness, lightheadedness, vertigo
Red, bloodshot eyes, blurred vision
Mood changes: irritability, depression, anxiety, panic attack
Possible consequences: decreased work performance ¹², ability to drive ¹² and operating the plane ⁴², impaired perception, reasoning, sustained attention and memory ^51,59,61.
References: ^{6,7,12,13,16,42}

Fever and Liver Pain Are Not Typical Symptoms of Hangover

Fever can be a symptom of alcohol withdrawal or acute pancreatitis, but not a hangover.

Liver pain–below the right rib cage–, often experienced after drinking may speak for fatty liver, hepatitis or liver cancer.

How long does a hangover last?

Time can cure even the worst hangover in 72 hours, usually in few to 24 hours ^15,16.

Chart 1. Alcohol Hangover vs Intoxication vs Withdrawal
	Hangover	Intoxication	Withdrawal
Who?	Anyone	Anyone	Chronic alcoholics
When?	Several hours after stopping drinking	During drinking	Few-72 hours after stopping drinking
Symptoms	Headache, nausea, vomiting, fatigue	Unsteady gait, slurred speech	Alcohol craving, seizures, hallucinations

Chart 1 references: ^24,26

Other Disorders That Mimic a Hangover (Differential Diagnosis)

Lack of sleep, or sleeping too long
Moderate to severe dehydration: >3% loss of body weight, dark urine
Heat exhaustion
Caffeine withdrawal in a regular caffeine consumer who stops drinking coffee ⁶⁹
Depression
Motion sickness, jet lag
Morning sickness in pregnant women
Migraine attack ^17,55
Food poisoning ²¹
Head trauma ⁶⁵
Medications: antihistamines (diphenhydramine) ⁴³, sleeping pills, anxiolytics (diazepam), opiates (morphine, oxycodone) ⁴¹, nitroglycerin ²⁵
Illegal drug overdose: ecstasy (MDMA), amphetamines, mephedrone, cocaine, crack, opiates (heroin) marijuana, ketamine, inhalation of solvents, glue ²⁹
Carbon monoxide poisoning

Causes of Hangover: Ethanol and Congeners

According to some studies, the most likely causes of hangover are ethanol and congeners — byproducts of alcohol fermentation, which include methanol (and its metabolites formaldehyde and formic acid), glycols, acetone, fusel oils, furfural, or naturally occurring substances in red wine, such as histamine, amino acids (tyramine), tannins and polyphenols, or additives, artificial dyes and flavors.

The high amount of congeners can be found in dark alcoholic beverages, such as bourbon or Scotch whiskey, tequila, brandy, cognac, rum, red wine, port, dark-colored beers and beer with high alcohol content. Beverages low in congeners include white wine, champagne, white rum, vodka, gin and light colored beers. References: ^{6,11,13,35,38}

Moonshine ³⁹ and absinthecan also cause a hangover.

Carbonationand sugar ⁹do not likely cause or aggravate a hangover.

Who is at increased risk of a hangover?

Inexperienced drinkers ⁶
Women ⁵⁶
Individuals who suffer from migraines ^15,16
Asians with ALDH2 deficiency (Asian flush reaction) ^60,62
Other risk factors for a hangover may include feeling guilt, anger or depression while drinking ³⁰, exercise during drinking ⁶, lack of sleep, smoking (nicotine use) and poor health ⁴.

Hangover Resistance and Tolerance

About 20% of people never experience hangover no matter what amount or which type of alcoholic beverage they drink ⁵⁷. The risk of hangovers may decrease with age ^47,54,56.

Mechanism (Pathophysiology)

Mechanism of a hangover is not known but may involve:

Immune response to alcohol can trigger the release of inflammatory substances (prostaglandins ⁴, cytokines ⁵and C-reactive protein) ⁴⁵.
A side effect of the ethanol’s breakdown product acetaldehyde ⁴
- According to one experiment in rats, the hangover-causing substance could be acetate, which is a breakdown product of acetaldehyde ²³. Similarly, acetate-sensitive individuals can experience headaches during hemodialysis that involves acetate ^20,27.
Inflammation of the lining of the stomach and increased gastric acid secretion can cause nausea ¹².
Metabolic acidosis after binge drinking without eating (due to a buildup of lactate, ketones and fatty acids) can cause nausea, vomiting and anorexia ^28,52.
Less likely mechanisms: hypoglycemia, electrolyte and hormone disturbances ^4,6, histamine and serotonin release (after drinking red wine) ¹².

Hangover Cure

There is no scientific evidence about any instant cure for hangover ^5,6but the following may help: vomiting, water, a small amount of bland food, painkillers, sleep and time.

1. Vomiting to Relieve Nausea

If you feel you could vomit, do it; this way you excrete excessive gastric juice that causes nausea. After vomiting, rinse your mouth with water to remove the gastric acid from the teeth. DO NOT brush teeth soon after vomiting, because you can aggravate the effect of gastric acid on teeth.

TRY TO AVOID VOMITING if it takes a great effort to expel the stomach content because the muscles in the lower part of your esophagus can tear (Mallory-Weiss syndrome).

DO NOT USE HARD OBJECTS, such as spoons or sticks, to induce vomiting.

DO NOT induce vomiting in a drowsy or unconscious person, because of the danger of the vomit aspiration.

2. Water to Flush Your Stomach and Relieve Dehydration

Drink some water during and after alcohol drinking and before bed.

Contrary to popular belief, alcohol by itself does not cause significant dehydration ^36,37,52. The main causes of alcohol-related dehydration are insufficient water drinking and vomiting. The main symptoms of dehydration are dark urine and sudden weight loss.

In any case–being dehydrated or not–a cup or two of water may help ease nausea since it rinses the mouth and dilutes the stomach secretions. If you are not dehydrated, drinking large amounts of water before bed will only make you get up and urinate frequently ⁶.

What else to drink to overcome a hangover?

Often proposed drinks and drink recipes but not proven to be more effective than plain water in relieveing a hangover: coconut water, vitamin water, carbonated drinks (soda, cola), herbal tea, pickle, prickly pear, tomato or orange juice, tea, sauerkraut sauce, banana smoothie, chicken soup, bouillon broth, milk, milkshake, ginger ale and ginger beer ⁶⁵.

Coffee, Tea

In regular caffeine consumers, coffee in the morning can prevent caffeine withdrawal headache. In nonregular coffee drinkers, coffee or other caffeinated beverages have not been proven to prevent or cure a hangover headache; coffee or tea can also prevent a nonregular user from sleeping.

3. Eat some bread or crackers.

Try to eat something before bed — it may calm you down and help you sleep. Plain carbohydrate foods, such as bread or crackers seems to be the best ¹².

Foods NOT proven to help:

Eggs and other foods high in cysteine
- Cysteine helps break down acetaldehyde, which is a suspected trigger of a hangover, but cysteine is not a proven cure for a hangover ³¹.
Bananas and other foods high in potassium
- Potassium deficiency (hypokalemia) and other electrolyte disturbances are not proven causes of a hangover ^4,6.
Honey and other foods high in fructose may speed up the breakdown of alcohol, but it does not seem to improve hangover symptoms ^9,31.
Pickles (cucumbers)

Foods to avoid:

Fried and other fatty foods (bacon, cakes, chocolate) can worsen nausea ¹⁵. Fatty foods before drinking slow alcohol absorption and thus help to prevent severe alcohol intoxication, but fatty foods after drinking do not prevent a hangover ¹⁵.

4. Aspirin to Relieve a Headache

It is probably best to avoid any medication during or after drinking alcohol, because of common alcohol-drug reactions. During a hangover, any medication may further irritate the stomach.

A tablet of aspirin before bed, after and not during alcohol drinking, can ease a hangover headache ^5,14,53. Other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, ketorolac and ketoprofen can also help ^12,53. Side effects can include stomach irritation and bleeding.

Other medications that can help relieve a hangover:

Bismuth subsalicylate and calcium carbonate are antacids, which may help relieve upset stomach and heartburn ⁴⁴.
Tolfenamic acid (a drug for a migraine, not approved in the U.S.) can help relieve a headache ^8,31.
Chlormethiazole (a sedative) may help in a severe hangover ⁵¹.

AVOID acetaminophen (paracetamol), which may, in combination with alcohol and fasting, cause severe liver damage ^66,67,83.

5. Sleep

Sleep can help overcome a hangover. If possible, avoid noise, lights, watching TV, working with computer and reading.

Home remedies:

Brush your teeth with toothpaste to remove bad taste before bed.
Tea bags (moist and chilled green or black tea bags), one over each eye, for 10 minutes may help reduce puffy eyes.
Sunglasses on a sunny day can help you deal with sensitivity to light (photophobia).

6. Vitamin B6 and Other Supplements

The following substances may have a mild headache preventative effect:

Vitamin B6, 3 x 400 mg: before, during and after drinking ⁶
Gama-linolenic acid from pale butterfly bush flower (Buddleja officinalis) ³¹
A yeast-based preparation containing vitamins B1, B2 and B6 ³¹

The following might ease nausea:

Prickly pear cactus extract (Opuntia ficus indica) ⁴⁵
A mixture of Kitsuraku (Citrus tangerine Hort. et Tanaka), the rhizome of ginger (Zingiber officinale), and brown sugar (KSS formula) ⁴⁹
An Ayurvedic preparation Liv.52 ⁴⁸

Unproven Nursing Tips and Myths

Exercise

You cannot “sweat out” a hangover ¹⁵.

Shower, Hot Bath, Sauna

A shower or hot bath is not a proven cure for hangover ³¹.

Sauna after drinking alcohol may trigger a dangerous drop in blood pressure upon rising (orthostatic hypotension) possibly resulting in fainting or irregular heart rhythm (arrhythmia) ⁶⁴.

Cold Compresses or Ice Pack on the Head

Cold compresses do not likely relieve hangover ³¹.

Drugs and Supplements

Not proven effective in relieving hangover:

Tropisetron or propranolol ³¹
Banana bag or rally pack
- This intravenous infusion of physiologic solution (0.9% NaCl), magnesium sulfate, vitamin B1 (thiamin), folic acid and other vitamins, is intended to treat Wernicke-Korsakoff syndrome in chronic alcoholics but not a hangover ⁴⁰.
Anti-hangover pills, “stoppers,” “helpers” or “relievers,” which usually contain activated charcoal and various vitamins and herbal extracts, do not likely help in a hangover ³¹.
A hangover patch: Commercially sold hangover patches often include vitamin B1 (thiamin), but hangover by itself is not associated with vitamin B1 deficiency ³¹.
Other things, such as Epsom salt, vitamin B12 or C, succinic acid, taurine (in energy drinks), choline and N-acetyl cysteine also probably do not help.

Natural Remedies and Herbs

Consuming sugars, such as fructose or glucose, or herb extracts, such as artichoke extract (LI120), barley grass, borage, globe artichoke, evening primrose oil, ginseng, kudzu root (a Chinese herb), milk thistle, nutmeg or white willow bark, have no proven effects in the treatment of a hangover ^5,9,31,46.

“Hair of the Dog”

Drinking another alcoholic beverage, including “Bloody Mary” (a cocktail of tomato juice, vodka, Tabasco, black pepper and other spices) to get over a hangover does not work. It only postpones the drop of blood alcohol concentration to zero and hence a hangover, but it does not prevent a hangover ¹⁵.

References

Hangover Headache and Nausea: Causes, Prevention, Cure