Viewpoint: What Is Veisalgia and Can It Be Cured?

Charles P. Vega, MD, FAAFP


February 27, 2006

Interventions for Preventing or Treating Alcohol Hangover: Systematic Review of Randomised Controlled Trials

Pittler MH, Verster JC, Ernst E
BMJ. 2005;331:1515-1518

Most adults become familiar with the symptoms of veisalgia (the medical term for the alcohol hangover) at some point, but many do not realize the larger consequences of this familiar illness. In a study of 48 healthy adults who were randomized to receive ethanol 1.4 g/kg or placebo over an evening session, the group that received alcohol demonstrated worse outcomes for delayed recall of events from the previous evening.[1] However, measures of immediate recall and overall vigilance were similar on the morning after drinking, indicating that the deficit in delayed recall associated with alcohol use was not solely due to sedation.

Binge drinking has important societal and mortality consequences. The study authors note that the cost of lost wages due to alcohol use in Britain totals approximately 2 billion pounds per year. Furthermore, in a study of alcohol sales and mortality in Finland between 1983 and 1999, the study authors found that fatal alcohol poisonings were clustered around major holidays, and a 1% increase in the sale of spirits was associated with a 0.4% increase in the number of fatal alcohol poisonings.[2]

Given the consequences of heavy drinking, the general public has a keen interest in a cure for the common hangover. This review highlights that although many treatments are proffered for hangover, very few have been tested in randomized trials. Of particular note was research focused on tolfenamic acid, in which a test of 30 healthy volunteers treated with tolfenamic acid 200 mg or placebo before and after drinking demonstrated a benefit for active treatment in reducing headache, nausea, vomiting, irritation, tremor, thirst, and dryness of mouth compared with placebo.[3] Tolfenamic acid was also associated with reduced levels of serum prostaglandins when compared with placebo. In another trial of dried yeast vs placebo involving 61 volunteers, treatment with 750 mg of dried yeast was superior to placebo in terms of discomfort, restlessness, and impatience on the morning after drinking.[4] Finally, the study authors found one trial of gamma-linoleic acid derived from Borago officinalis that improved the overall hangover symptom score compared with placebo among 40 individuals.[5] In this last trial, only 18 subjects completed the study.

Another investigation into a possible cure for alcohol hangover was published last year. In this study, the investigators compared Opuntia ficus-indica (OFI) with placebo for the prevention of hangover.[6] Although OFI reduced the overall hangover symptom score by 18% when compared with placebo, this result missed statistical significance. At the same time, subjects receiving OFI had a significant improvement in nausea, anorexia, and dry mouth compared with placebo. OFI was also effective in reducing C-reactive protein levels on the morning after drinking.

Despite these data of some efficacy for various hangover treatments, the study authors concluded that there is no strong evidence for a cure to the common hangover. Several factors helped them reach this conclusion, the biggest of which is the lack of research to follow up these small studies that demonstrated a symptomatic benefit. The studies cited above enrolled 30, 61, 40, and 64 volunteers, respectively. Many of these trials could serve as pilot studies for larger trials in which the power to detect small differences between treatments could be better elucidated. However, these more powerful studies have yet to be done, and it is difficult to make practice recommendations that are based on such limited data. Another limitation of research involving treatment of hangover is a lack of standardization of outcomes, making it difficult to compare various studies.

Possibly the biggest limitation to research into the treatment of hangover is a lack of clear understanding of the underlying physiology of veisalgia. The study authors note that hangover may be due to a number of factors, including the production of acetaldehyde and congeners, such as methanol, dehydration, sleep disturbance, and perturbations of the immune and endocrine systems. Elucidating the physiology of hangover should help researchers target an effective cure, and well-performed, reproducible trials may allow physicians to better help patients with hangover.



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