The alcohol hangover

Purpose: To review the cause, pathophysiologic characteristics, cost, and t reatment of alcohol-induced hangover. Data Sources: A MEDLINE search of English-language reports (1966 to 1999) a nd a manual search of bibliographies of relevant papers. Study Selection: Related experimental, clinical, and basic research studies . Data Extraction: Data in relevant articles were reviewed, and relevant cl inical information was extracted. Data Synthesis: The alcohol hangover is characterized by headache, tremulou sness, nausea, diarrhea, and fatigue combined with decreased occupational, cognitive, or visual-spatial skill performance. In the United States, relat ed absenteeism and poor job performance cost $148 billion annually (average annual cost per working adult, $2000). Although hangover is associated wit h alcoholism, most of its cost is incurred by the light-to-moderate drinker . Patients with hangover may pose substantial risk to themselves and others despite having a normal blood alcohol level. Hangover may also be an indep endent risk factor for cardiac death. Symptoms of hangover seem to be caused by dehydration, hormonal alterations , dysregulated cytokine pathways, and toxic effects of alcohol. Physiologic characteristics include increased cardiac work with normal peripheral resi stance, diffuse slowing on electroencephalography, and increased levels of antidiuretic hormone. Effective interventions include rehydration, prostaglandin inhibitors, and Vitamin B-6. Screening for hangover severity and frequency may help early d etection of alcohol dependency and substantially improve quality of life. R ecommended interventions include discussion of potential therapies and remi nders of the possibility for cognitive and visual-spatial impairment. No ev idence suggests that alleviation of hangover symptoms leads to further alco hol consumption, and the discomfort caused by such symptoms may do so. Ther efore, treatment seems warranted. Conclusions: Hangover, a common disorder, has substantial morbidity and soc ietal cost. Appropriate management may relieve symptoms in many patients.