I went to New Orleans last week, and after a few days on Bourbon street it became clear to me that the hangover is a scourge on society. I thought it would be good to try to cure the hangover.
Pathophysiology of the Hangover
Reading the literature, I learned that the pathophysiology of hangover is mostly unknown. Some believe that accumulation of acetaldehyde (the major metabolite of ethanol) could be the culprit, since artificially increasing acetaldehyde levels artificially leads to many of the bad symptoms of hangover, like flushing, nausea, and headache (disulfiram inhibits the enzyme that breaks down acetaldehyde and is actually a treatment for alcoholism – it makes drinking really terrible). Acetaldehyde levels are very low by the time that hangover symptoms start, though, so its probably not the cause.
Although important, dehydration has been mostly invalidated as the major cause of hangovers, since drinking a lot of water won’t abolish them, measures of dehydration are often normal in hung-over people, and dehydration by itself causes symptoms much different from hangovers.
A recent paper in PLoS-One (Maxwell et al 2010) lends credence to the idea that acetate, another breakdown product of ethanol, could cause hangover symptoms. They first gave rats chronic headache by injecting an inflammatory substance inside their skulls. Then, to induce headaches they hit the rats on the head with different forces and looked to see how uncomfortable it made them. Getting the rats drunk made the induced headache less painful, but then during the hangover, the headache was much worse. Increasing acetate levels (but not acetaldehyde levels) increased and lengthened hangover headache severity. Co-administering caffeine (a well-known hangover remedy, as well as an inhibitor of adenosine [a neurotransmitter which is increased by acetate]) blocked the negative effects of acetate.
Congeners, the random chemicals in alcoholic drinks other than ethanol, are another potential hangover cause; Drinks with a lot of congeners, like red wine and whiskey, have been shown to cause more painful hangovers than vodka. Also lending credence to this idea is the fact that drugs which bind congeners in the gut and prevent them from entering the blood stream (over-the-counter herbal mixtures like Chaser or RU-21) have demonstrated impressive effectiveness, at least anecdotally. Still, vodka can give you a giant hangover, so this doesn’t explain everything.
Ethanol consumption also disrupts normal sleep patterns, so sleep deprivation also probably causes some hangover symptoms. Not surprisingly, caffeine (as mentioned above) is one of the best tonics for a hangover.
There appears to be an immune or inflammatory component to the hangover, because the most effective treatment are non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (advil), or naproxen (midol), which inhibit synthesis of the immune mediating prostaglandins.
Finally, I can say that although this hasn’t been attempted in clinical trials, I can say from personal experience that last week I cured one of the worst hangovers of my life with a single 10 mg dose of Adderall, the ADHD medicine. It’s reasonable to me that depletion of modulatory neurotransmitters norepinephrine and/or dopamine, or dysregulation of the neuron groups that regulate their release, could occur as a result of ethanol’s central effects. This definitely warrants further investigation.
Hangover Neuroscience
The neurophysiology of the hangover is a wide-open field. No one has even put a person into an fMRI or EEG before and after getting drunk! To me, since there aren’t any metabolites that have been shown to convincingly correlate with hangovers, and given that the hangover is primarily a subjective phenomenon, it’s likely that there is a prominent central nervous system component to the disorder.
First step: Self-test of current therapeutic options
Before going to Taaka with a grant proposal, I’m going to test the current symptomatic treatments on myself and assay their effectiveness. Based on my reading of the literature, I designed what I think is an optimal treatment regimen:
- Take 2 Chaser tablets with the first drink – this will block congener absorption for 2-3 hours
- Take an extended-release acetaminophen (tylenol) right before bed. This is mainly used for arthritis, and because of its long half-life should be able to provide some analgesic effects even in the morning. If you were drinking often, this would be a bad drug to use because ethanol and acetaminophen together cause liver toxicity. But once every week or 2 will be fine – the liver can actually regenerate itself even if you resect most of it.
- Take Equate (generic excedrin), a combination of acetaminophen-aspirin-caffeine, in the morning. This gives you two different kinds of analgesic (aspirin, which is an NSAID, and acetaminophen which is similar but whose precise mechanism is unknown), plus caffeine, which helps by both normalizing sleep deprivation and blocking the effects of acetate.
- A strong latte.
- Adderall (if I can get some)
I’ll try these treatments in different combinations as well as all-together to see what works best, and to decide if curing the hangover is worth a 5-year investment.