Pharmacological analysis of red-wine-induced migrainous headaches

We describe a series of experiments designed to investigate the mechanisms by which headaches can be triggered by red wine in a small minority of migraine patients. Some red wines are particularly potent releasers of serotonin from platelet stores, but these are no more effective as triggers of headache in sensitive patients. Both the selective 5-HT(2A) antagonist ketanserin and the non-selective 5-HT(2ABC) antagonist pizotifen blocked the majority of headaches, and we then thought the antihistamine properties of these two drugs might be important. In a third experiment, however, the H(1) antagonist mepyramine did not convincingly antagonise the response to red wine. Plasma levels of the enzyme diamine oxidase, which metabolises histamine, were lower in all migraine patients, whether or not they were sensitive to red wine. The results reported here do not permit making firm conclusions; nevertheless it seems that different pharmacological receptors may be responsible in different patients.