WINE AND HEADACHE

Headache can be induced by histamine in wine in patients suffering fro m histamine intolerance, a disease characterized by impaired histamine degradation based on reduced diamine oxidase activity or a lack of th e enzyme. Diamine oxidase is localized in the jejunal mucosa and is th e most important enzyme metabolising histamine. It is competitively in hibited by alcohol and numerous drugs. In preliminary investigations, assessment of diamine oxidase levels gave decreased activity (0.03 nKa t/l) in patients with histamine intolerance compared to healthy contro ls (0.07 nKat/l). In pregnancy, diamine oxidase levels are known to be about 500-fold elevated. giving mean levels of 25.0 nKat/l. Other bio genic amines such as phenylethylamine or serotonin may be causative fo r wine/food-induced headache. In experimental models, headache has bee n induced by histamine infusion as well as red wine provocation. Hista mine-induced headache is a vascular headache likely to be caused by ni tric oxide which probably represents a key molecule in vascular headac hes. A histamine-free diet is the treatment of choice for patients wit h histamine intolerance and chronic headache. To start treatment, an a ntihistamine (Hi blocker) for 14 days as well as a histamine-free diet for at least 4 weeks are recommended. Clinical improvement to the die t as well as in vitro tests for plasma histamine and diamine oxidase i n the serum as well as vitamin B-6 levels have to confirm the diagnosi s. As supportive treatment, a vitamin B-6 (pyridoxal phosphate) substi tution appears useful in histamine-intolerant patients as pyridoxal ph osphate seems to be crucial for diamine oxidase activity. Histamine in tolerance, based on reduced diamine oxidase activity or a lack in the enzyme is causative for wine/food-induced chronic headache. According to the localization of diamine oxidase in the jejunal mucosa, histamin e intolerance is primarily a disease of intestinal origin. A histamine -free diet is the treatment of choice in histamine-intolerant patients suffering from chronic headache. In addition, it is also important to avoid diamine-oxidase-blocking drugs and alcohol which act as inhibit ors of diamine oxidase. As avoidance of histamine-rich food is a simpl e, inexpensive and harmless treatment, histamine-containing food such as cheese and alcoholic beverages should be labeled.