Does Sulfite Cause Red Wine Headaches?

Every now and then someone tells me they don’t like red wine and prefer white wine because the sulfites in red wine gives them a headache – commonly known as the Red Wine Headache (RWH). The label “WARNING: Contains Sulfites” seems to justify their claim. The question is do the sulfites in red wine really cause headaches?

Sulfites are used as a natural preservative in wine. The reason it is called a “natural” preservative is because sulfites are a natural byproduct of the fermentation process. More sulfite is often added by the winery as potassium metabisulfite. This added preservative allows the wine to age over many years; otherwise it would quickly turn to vinegar. Organic wines have this aging problem.

All red wine contains sulfites, even the ones labeled “no sulfite added”. So do all white wines – white wines have much more sulfite on average. All wines contain 40-80 mg/liter of sulfites on average. Organic wines contain less, but they still have sulfite in them. You cannot make wine without making sulfites. It does not matter which country the wine originates from. The US and Australia list sulfite warnings on their labels, but the Europeans are not required to do so. European wines still contain the same amount of sulfites.

Sulfites are also used in dried fruit; no one claims that they got a headache from a bag of dried apricots. Pancake syrup typically contains more sulfite than red wine. The human body also produces sulfites through normal biochemical processes, about 1000 mg per day.

Some studies have shown that some people can have strong reactions to sulfites. Slightly less than 1% of the population lacks an enzyme to break down the sulfites. In comparison, peanut allergies affect about 4% of the population.

For these people the inability to break down sulfites can be a life threatening problem – much more serious than a headache. Symptoms typically include restricted breathing to varying degrees, especially in asthmatics prescribed steroids. Skin rashes, itching or nausea are rarer symptoms, but headaches are not typically a symptom of sulfite reactions. Despite the seriousness of some reactions, the FDA has reported only 19 sulfite related deaths since 1990. None of these deaths were related to red wine.

Researchers in Australia studied a group of people who were very sensitive to sulfites. The researchers gave these people a drink that contained 300 mg/liter of sulfites, much higher than the amount typically in red wine. Only 4 test subjects out of 24 showed an asthmatic response. None of the subjects responded adversely to drinks with 100 mg/liter. This study published in Thorax (2001 Oct; 56 (10):763-9), showed that “only a small number of wine sensitive asthmatic patients responded to a single dose challenge with sulfited wine under laboratory conditions. This may suggest that the role of sulphites [sic] and / or wine in triggering asthmatic responses has been overestimated.”

This still does not answer the question about RWH. The fact is no current peer reviewed medical research links sulfites to headaches. This does not mean that red wine does not cause headaches for some people. There is research that shows that red wine does cause headaches for some, the culprit however is not the sulfites.

Most recent medical studies believe that prostaglandins, hormone-like substances, may be responsible for the production of some types of pain and inflammation and could be the culprit in RWH. Herbert Kaufman, M.D. and Dwight Starr, M.D. from Mt. Zion Hospital and Medical Center showed a significant decrease in headaches in subjects prone to RWH and given prostaglandin inhibitors.

If you are still in doubt, try eating a bag of dried orange apricots. These are heavily sulfited. If you don’t experience the very rare headache, or the much more common respiratory problems, you are not sensitive to sulfites. The best advice is to keep a journal of red wines that you try. Note which wines give you a headache, and which wines that have no effect. In the future, drink the red wines that do not give you a headache.

One last note, the headache you get from several wines the night before is called a hangover. Those can be avoided by not drinking as much!