A hangover is the experience of various unpleasant physiological and psychological effects usually following the consumption of alcohol. Hangovers can last for several hours or for more than 24 hours. Typical symptoms of a hangover may include headache, drowsiness, weakness, concentration problems, dry mouth, dizziness, fatigue, muscle ache, gastrointestinal distress (e.g., nausea, vomiting, diarrhea), loss of appetite, light sensitivity, depression, sweating, hyper-excitability, high blood pressure, irritability, and anxiety. While the causes of a hangover are still poorly understood, several factors are known to be involved including acetaldehyde accumulation, changes in the immune system and glucose metabolism, dehydration, metabolic acidosis, disturbed prostaglandin synthesis, increased cardiac output, vasodilation, sleep deprivation, and malnutrition. Beverage-specific effects of additives or by-products such as congeners in alcoholic beverages also play an important role. The symptoms usually occur after the intoxicating effect of the alcohol begins to wear off, generally the morning after a night of heavy drinking. Though many possible remedies and folk cures have been suggested, there is no compelling evidence to suggest that any are effective for preventing or treating hangovers. Avoiding alcohol or drinking in moderation are the most effective ways to avoid a hangover. The socioeconomic consequences of hangovers include workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement. A hangover may also impair performance during potentially dangerous daily activities such as driving a car or operating heavy machinery.
Signs and symptoms
An alcohol hangover is associated with a variety of symptoms that may include drowsiness, headache, concentration problems, dry mouth, dizziness, gastrointestinal complaints, fatigue, sweating, nausea, hyper-excitability, anxiety, and a feeling of general discomfort that may last more than 24 hours. Alcohol hangover symptoms develop when blood alcohol concentration falls considerably and peak when it returns to almost zero. Hangover symptoms validated in controlled studies include general malaise, thirst, headache, feeling dizzy or faint, tiredness, loss of appetite, nausea, stomach ache, and feeling as though one's heart is racing. Some symptoms, such as changes in sleep pattern and gastrointestinal distress, are attributed to direct effects of the alcohol intoxication, or withdrawal symptoms. Drowsiness and impaired cognitive function are the two dominant features of alcohol hangover. Some people experience anxiety, including a sense of worry, stress, and unease, during a hangover, colloquially called hangxiety. Hangxiety affects about 12% of people. The cause of hangxiety has not been identified. Hangxiety can manifest in various ways, such as racing thoughts, a sense of dread, increased heart rate, or feelings of guilt or regret about actions taken while under the influence of alcohol. It can be experienced by anyone who consumes alcohol, but individuals with underlying anxiety disorders or mental health conditions may be more susceptible to this phenomenon.
Causes Hangovers are usually caused by alcohol consumption, but other components of alcoholic beverages might contribute to hangover symptoms or make a hangover worse. For example, congeners are compounds, other than ethyl alcohol, that are produced during fermentation. These substances contribute to the taste and smell of alcoholic beverages. Darker spirits, such as bourbon, which tend to have higher levels of congeners than clear spirits, could worsen hangover symptoms for some people. Sulfites are compounds that are added to wine as preservatives. People who have a sensitivity to sulfites may experience a headache after drinking wine. Several pathophysiological changes may give rise to the alcohol hangover, including increased levels of acetaldehyde, hormonal alterations of the cytokine pathways, and a decrease in the availability of glucose. Additional associated phenomena are dehydration, metabolic acidosis, disturbed prostaglandin synthesis, increased cardiac output, vasodilation, sleep deprivation and insufficient eating.
Pathophysiology
After being ingested, the ethanol in alcoholic beverages is first converted to acetaldehyde by the enzyme alcohol dehydrogenase and then to acetic acid by oxidation and the egestion process. These reactions also convert nicotinamide adenine dinucleotide (NAD+) to its reduced form NADH in a redox reaction. By causing an imbalance of the NAD+/NADH redox system, alcoholic beverages make normal bodily functions more difficult. Consequences of the alcohol induced redox changes in the human body include increased triglyceride production, increased amino acid catabolism, inhibition of the citric acid cycle, lactic acidosis, ketoacidosis, hyperuricemia, disturbance in cortisol and androgen metabolism and increased fibrogenesis. The metabolism of glucose and insulin are also influenced. However, recent studies showed no significant correlation between hangover severity and the concentrations of various hormones, electrolytes, free fatty acids, triglycerides, lactate, ketone bodies, cortisol, and glucose in blood and urine samples. Alcohol also induces the CYP2E1 enzyme, which metabolizes ethanol and other substances into more reactive toxins. In particular, in binge drinking the enzyme is activated and plays a role in creating a harmful condition known as oxidative stress, which can lead to cell death.
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