Will I Have a Hangover Headache Tomorrow? A Prospective Cohort Study of the Predictors of Delayed Alcohol-Induced Headache.

INTRODUCTION: Alcohol-induced headaches are one of the most prevalent types of headaches. The International Classification of Headache Disorders defined them as throbbing and bilateral, and their phenotype combines characteristics of migraines and headaches secondary to low cerebrospinal fluid pressure. We aimed to evaluate the factors associated with the presence of a headache as a hangover symptom. METHODS: This was a prospective cohort study, including 32 healthy individuals who voluntarily consumed alcohol and completed self-administered questionnaires during three separate alcohol consumption and hangover episodes. RESULTS: A headache was a hangover symptom in 55/96 (57.3%) episodes. The phenotype was predominantly holocranial (94.5%), frontal (98.2%), and pressing (67.2%), with a median intensity of 6 (IQR 4-8). Headaches worsened with physical activity (100%) and had orthostatic changes (89.1%). A prior history of headaches was associated with headache occurrence (odds ratio: 3.480; 95% confidence interval (CI): 1.084 to 11.177), and headache precipitation by standing up was associated with a shorter duration (hazard ratio: 0.257; 95% CI: 0.073 to 0.901). CONCLUSIONS: Delayed alcohol-induced headaches had a migraine-like phenotype. An orthostatic pattern suggestive of a low cerebrospinal fluid pressure was associated with a shorter duration of the headache.