No Convincing Evidence That Hangover Cures Work

By Linda Carroll

January 05, 2022

(Reuters Health) - Only very low-quality evidence supports the efficacy of the various hangover cures that have been studied in randomized clinical trials, researchers conclude in a new review.

A systematic review of 21 randomized clinical trials that examined hangover cures revealed there is no high-quality evidence supporting any of the remedies touted to prevent or abort alcohol-related symptoms, such as headache, nausea, stomachache and tiredness, according to the results published in Addiction.

"Only very low-quality evidence is currently available to recommend any remedy for the treatment or prevention of alcohol-induced hangover in humans," said the study's first author, Emmert Roberts, a researcher in addiction medicine at King's College London.

"Of the limited remedies studied scientifically, clove extract, tolfenamic acid, and pyritinol show the most promise to be further examined in larger well-designed studies," Roberts said in an email. "The surest way of avoiding hangover symptoms is to drink in moderation or abstain from alcohol."

The "cures" investigated in the new study do have a theoretical basis, Roberts said.

"All the treatments studied have some plausible mechanism of action to potentially relieve hangover symptoms," Roberts said. "Some work on the same brain receptor system as alcohol, others alter the rate of alcohol metabolism or have pain killing properties."

To take a closer look at the evidence supporting hangover cures, Roberts and his colleagues searched for randomized placebo-controlled clinical trials cures touted to relieve alcohol-related symptoms such as clove extract, red ginseng and Korean pear juice.

The research team eventually settled on 21 studies with a total of 386 participants to include in their analysis. They excluded studies for "common reasons for exclusion including reporting a non-protocol study design or lack of placebo control."

The review found statistically significant reduction in the mean percentage of overall hangover symptoms versus placebo for clove extract (42.5% vs 19.0%, p less than 0.001), tolfenamic acid (84.0% vs 50.0%, p less than 0.001), and pyritinol (34.1% vs 16.2%, p less than 0.01), Hovenia dulcis fruit extract (p=0.029), L-cysteine (p=0.043), red ginseng (21.1% vs 14.0%, p less than 0.05) and Korean pear juice (41.5% vs 33.3%, p less than 0.05).

The researchers note that meta-analysis wasn't possible because each study examined a different hangover cure. They faulted the included studies for "significant methodological limitations alongside significant degrees of imprecision in the outcome measures of the treatment effects."

Tolerability outcomes were also of low or very low quality, and no study reported dropouts because of adverse events.

Roberts says he would like to see more research.

"There is generally a dearth of evidence in this area," he said. "Given the large number of people experiencing distressing symptoms from hangover each year, alongside its economic impact, increased and targeted funding would enable more research in this are to be conducted and improve our knowledge around the mechanisms for and treatments which can prevent hangover symptoms."

The findings are not surprising, said Dr. Michael Fingerhood, an associate professor of medicine and public health at Johns Hopkins University in Baltimore, Maryland. "There is no cure for hangover (veisalga)," Dr. Fingerhood said. "Attempts have been made for centuries."

"A major difficulty in reviewing the literature is finding the overwhelming obstacle of designing and conducting a meaningful study," Dr. Fingerhood said in an email. "Indeed, the authors found most of the literature reporting low quality studies. It is unclear why some individuals who drink to intoxication wake up with a hangover, while others never do. As the authors point out, there appears to be increased likelihood of hangover in prone individuals related to dehydration and sleep deprivation, as well as increased propensity with certain types of pigmented alcohol beverages," Dr. Fingerhood noted.

"In places, like Las Vegas, there are 'hangover cure centers' that administer intravenous fluids with vitamins," Dr. Fingerhood said. "They are expensive and take advantage of individuals desperate to quickly feel better after binge drinking. The punchline is do not binge drink and you will not have a hangover."

SOURCE: Addiction, online December 31, 2021.