Alcohol is widely consumed in the world for social enjoyment, relaxation and emotional coping. In many cultures, alcohol consumption is deeply ingrained in traditions, rituals, and social customs. However, it is also a leading contributor to substance abuse. In US and Europe, more than half of the population consumes alcohol now and then. However, about 15-20% of adults drink alcohol quite frequently. Further, about 6% of adults engage in heavy drinking.1

Drinking alcohol in moderate amounts and responsibly is safe. However, even those who do not consume alcohol regularly may consume it in excessive amounts now and then, for example, during parties, events, celebrations and more. Afterall, alcohol is associated with happy times.

Most of those who drink alcohol have experienced something called “hangover,” a condition characterized by signs like headaches, nausea, stomach ache, and many other symptoms. It lasts for quite a long, often a day or even more.

A hangover is challenging to manage since it remains a mystery to medical science. It is a condition that occurs when someone drinks alcohol in amounts more significant than usual for them. Thus, hangover occurs at different alcohol volumes in different people.

Another interesting thing about a hangover is that it begins when the alcohol amount has reached almost zero in the body. In fact, it even continues when the body has eliminated most metabolites of alcohol. That is why this phenomenon is so difficult to understand.

Additionally, there is insufficient research on the subject. Despite causing so much distress, doctors do not view it as a severe illness. Nonetheless, for those experiencing hangovers, it is a cause of much pain and misery. People experiencing it want to get rid of it as soon as possible.

Causes of hangover

It is only possible to treat the hangover by understanding it well. However, as already said that it still remains a poorly understood health condition. Nonetheless, there have been some efforts to understand what causes the issue.

In fact, there is an Alcohol Research Group that defines hangover as “the combination of mental and physical symptoms experienced the day after a single episode of heavy drinking, starting when blood alcohol concentration (BAC) approaches zero.”2

Similarly, there has been some study in identifying its causes. A hangover appears to occur for multiple reasons, which is why it is so challenging to manage. This also explains why a single remedy fails to relieve the condition and why managing the condition requires a complex approach.

Accumulation of by-products of alcohol metabolism

One of the explanations for hangovers is the accumulation of by-products of alcohol metabolism, more specifically acetaldehyde. Acetaldehyde is quite toxic to the body. Additionally, alcohol metabolism causes significant oxidative stress.

There are many ways in which alcohol is metabolized in the liver. It is mainly converted to acetaldehyde by an enzyme called alcohol dehydrogenase (ADH). Acetaldehyde is further converted to water and acetate with the help of aldehyde dehydrogenase (ALDH). Studies show that the speed and availability of these enzymes are highly dependent on NAD+ presence 3.

Then there are secondary pathways like microsomal ethanol oxidizing system (MEOS). This pathway is accelerated by the co-factor nicotinamide adenine dinucleotide phosphate (NADP+) 3.

The above two pathways seem to play a role in eliminating 90% of the alcohol. Rest 10% of the alcohol is eliminated through other minor pathways.

Therefore, researchers have paid much attention to these two primary pathways. It is quite likely that accelerating them may help prevent acetaldehyde formation, thus helping overcome hangovers. Thus, for example, vitamin B3 or niacinamide can boost the production of both NAD+ and NADP+.

Of course, this is just one of the reasons for the nasty symptoms of a hangover. Acetaldehyde may be toxic but does not reach the brain in large amounts. It means that there are some other mechanisms at work, too3.

Further, studies suggest that the metabolism of alcohol via MEOS pathways produces many free radicals. This results in significant oxidative stress in the body. If these free radicals are not neutralized, they can cause much harm. This may also cause inflammation, release of various inflammatory mediators, and much more. This highlights the importance of neutralizing free radicals with antioxidants like vitamins, glutathione, and more3.

Dehydration and hangover

Drinking lots of fluids to overcome a hangover is a common recommendation. Of course, it helps, but not sufficiently. This is because dehydration is there, but it is mild and just one of the factors causing hangovers. Hence, drinking excessive fluids or even IV fluids will provide relief, as they are some ways to manage dehydration.

Researchers have studied why alcohol causes dehydration. It appears that alcohol suppresses the release of a hormone called vasopressin. This hormone is essential for water retention in the body. Vasopressin’s lower levels mean the body continues to lose more water, causing dehydration4.

Those who consume alcohol chronically know that if they drink alcohol with lots of other beverages, their hangover tends to be milder. This is because high fluid intake promotes detoxification and helps prevent dehydration. But, of course, once a hangover has occurred, drinking fluids during the day provides limited relief.

Electrolyte disturbances

Fluid and electrolyte disturbances are among the contributing factors to hangovers. Generally, electrolyte imbalances caused by alcohol are not severe. Nonetheless, they are there. Many things are happening here, like acetic acid production, dehydration, and loss of salts.

Additionally, it is worth keeping in mind that issues like stomach disturbances are quite common in those affected by hangovers. In some people, gastrointestinal symptoms like liquid stool, vomiting, and severe nausea predominate. These issues are both due to local gastrointestinal irritation and neural toxicity5.

Therefore, are many ways to counter these issues. Taking more fluids may help. Similarly, taking electrolytes like zinc and magnesium may have a calming impact on the brain and gastrointestinal tract. This may also help reduce irritation of the so-called vomiting center in the brain.

Since this feeling of nausea has more to do with neural toxicity, drugs like ondansetron work better for controlling hangover symptoms6.

There are two ways to control nausea: improving gastrointestinal motility and reducing irritation of specific brain areas. In the case of a hangover, the focus must be on managing neuro-toxicity-related nausea.

Inflammatory response

For years, people have believed that dehydration was the main culprit. However, now researchers understand that things are more complex. What has amazed researchers is the fact that hangovers can be pretty awful, even in the absence of severe dehydration or changes in fluid and electrolyte balance. Moreover, hangover is not relieved quickly even by correcting these issues. On the other hand, anti-inflammatory medications do provide good relief.

All the above findings have strengthened the theories that inflammatory responses contribute significantly to hangovers. It appears that high alcohol intake and certain toxins produced during its high intake result in inflammatory responses. Studies show that hangover syndrome is quite similar to what a person with elevated cytokines will feel like7.

Additionally, some other hangover symptoms are difficult to explain based on dehydration. For example, during a hangover, one suffers from memory problems and reduced psychomotor functioning. Hence, despite the absence of fever, hangover shares many traits with a sickness behavior.

Some common signs and symptoms of a hangover

Everyone who has experienced it knows its symptoms. Here it is vital to understand that hangover still varies between individuals. In some, gastrointestinal symptoms may predominate, while others may experience severe headaches. Nevertheless, some of the common symptoms are7:

A hangover is quite complex, and even people who frequently experience it find it difficult to explain. Most people would experience all these symptoms, though some symptoms may be more severe.

Apart from individual differences, it seems that much depends on how long a person has been drinking alcohol. Thus, for example, hangover symptoms in those drinking heavily for several years would differ.

Hangover impact on health

A few episodes of hangover might not be a cause for worry. However, frequent hangovers indicate chronic alcohol abuse. Hence, hangovers may also have long-term consequences. Understanding these long-term effects is vital. Getting better at managing hangovers can contribute to improved overall health, addressing a hangover extends beyond alleviating immediate symptoms. It involves promoting long-term well-being as well.

Liver damage

Alcohol is primarily metabolized in the liver. It is also one of the leading causes of fatty liver disease. Those who consume alcohol are also at a higher risk of liver cancer. If hangover episodes repeat too often, it may lead to significant liver damage8.

Here it is also vital to understand that people who have been consuming alcohol for a long become prone to hangovers due to liver damage. In many such individuals, a hangover may occur even after consuming alcohol in small amounts. Such a hangover is a worrisome sign of falling liver health.

Fortunately, such liver damage can be reversed by limiting alcohol intake, using antioxidants, detoxification, vitamin therapy, and more. Remember that the liver has a significant regenerative ability.

Gastrointestinal issues

Alcohol causes multiple gastrointestinal problems. Almost anyone who experiences a hangover will also experience issues like nausea and vomiting. Alcohol causes severe damage to the gastrointestinal lining, causing local irritation and bleeding.

However, frequent hangovers will also cause chronic digestive health issues. For example, alcohol is the leading cause of pancreatitis, one of the life-threatening complications of alcoholism9. Of course, here we are not discussing chronic alcoholism. However, this does not mean that acute consumption of alcohol at higher dosages is not harming the pancreas. It is vital to know that a hangover also means some damage to endocrine and exocrine organs, resulting in changes in the digestive system.

Mental health issues

A hangover almost always means mood changes and irritation. It is due to significant neurotoxicity and probably due to certain changes in neurotransmitters. If the hangover keeps repeating, it may have more severe consequences and even lead to psychosis or personality changes.

During withdrawal or hangover, people experience anxiety, depression, and even psychosis10. Here it is vital to understand that though headaches or gastric issues may disappear in a day or two in most cases, but specific changes in the brain last much longer. Thus, one continues to experience mood changes for a week or two or even more. It is also the reason why many keep abusing alcohol.

This underlines the value of a therapeutic approach that focuses on brain health. This also explains why vitamins B1, B2, B5, and B6 could be of particular value. These vitamins have neuroprotective action, and they promote neural healing. Thus, these vitamins are good for managing both acute and long-term effects of hangovers.

Impaired cognition

One thing is more than clear that alcohol is not suitable for brain health. It definitely causes a decline in cognition. This can be said even without considering clinical studies, as it is a well-known observation. Those who have hangovers also have issues like a lack of mental clarity, memorizing things, and problems engaging in mental tasks. Hangovers increase dementia risk11.

Of course, having a drink or two does not cause such issues. Small amounts of alcohol are even protective and may reduce stress and dementia risk. However, when we are discussing hangovers, we are essentially discussing alcohol consumption in high amounts.

Those who have experienced a hangover once are likely to experience it multiple times -since it is a condition experienced by those who engage in heavy drinking, binge drinking, and so on.

If one is struggling with alcohol addiction, nutrition therapy can still help. Thus, IV therapy with antioxidants like glutathione, NAD+, B vitamins, and electrolytes may significantly help reduce the risk of cognitive decline.

Hangover remedies

Hangover remedies aim to alleviate the symptoms and promote recovery after a night of excessive alcohol consumption. While no single remedy can completely cure a hangover, certain strategies can help reduce the severity of symptoms and improve overall well-being. The benefits of various remedies may vary significantly among individuals.

Some of the non-pharmacological means to manage hangover are:

Consider more specific hangover treatments.

This requires separate discussion because most clinics would not offer such treatment. Doctors would generally advise rest, and they might offer medicines for nausea and headaches. Though such treatment is good for overcoming hangover pain, these treatments do not detoxify the body.

Therefore, consider more specific treatments if you frequently go to parties, drink at weekends, or experience hangovers. It is especially vital to consider these therapies if hangovers are getting worse, as this indicates declining health. Specific IV therapies that is formulated to reduce inflammation, nausea, and heartburn, detoxify, provide vital vitamins, and are rich in antioxidants, can help significantly overcome acute hangover symptoms. More importantly, such therapies help detoxify and thus also lower the risk of long-term complications.


In conclusion, hangovers are a common phenomenon experienced by individuals who consume alcohol in excessive amounts. Despite its prevalence, hangover remains a poorly understood condition, and there is limited research on the subject. Hangovers are characterized by symptoms such as headaches, nausea, stomach ache, fatigue, and cognitive impairment, lasting for a day or more.

Various factors contribute to the development of hangovers, including the accumulation of toxic by-products of alcohol metabolism, dehydration, electrolyte imbalances, and inflammatory responses. The exact mechanisms underlying hangovers are complex and multifaceted, making finding a single remedy that effectively alleviates all symptoms challenging. However, understanding these contributing factors can help manage and overcome hangovers’ impact.

Hydration, rest, and replenishing essential nutrients through a balanced diet are some non-pharmacological approaches that can help alleviate hangover symptoms.

Over-the-counter medications like painkillers may provide temporary relief for headaches and discomfort. Additionally, specific hangover treatments such as intravenous therapies with antioxidants, vitamins, and electrolytes can aid in detoxification and reduce inflammation, providing more targeted relief.

In summary, understanding the causes and remedies for hangovers can help individuals make informed choices about alcohol consumption and take proactive steps to minimize the impact on their health. It is advisable to consume alcohol responsibly, stay hydrated, maintain a healthy diet, and seek appropriate medical assistance if experiencing severe or recurrent hangovers. Prioritizing overall well-being and adopting a holistic approach to hangover management can contribute to improved health and a better quality of life.


  1. Data on Excessive Drinking | CDC. Published November 28, 2022. Accessed June 25, 2023.
  2. Verster JC, Scholey A, van de Loo AJAE, Benson S, Stock AK. Updating the Definition of the Alcohol Hangover. Journal of Clinical Medicine. 2020;9(3):823. doi:10.3390/jcm9030823
  3. Mackus M, van de Loo AJ, Garssen J, Kraneveld AD, Scholey A, Verster JC. The Role of Alcohol Metabolism in the Pathology of Alcohol Hangover. J Clin Med. 2020;9(11):3421. doi:10.3390/jcm9113421
  4. Hangovers | National Institute on Alcohol Abuse and Alcoholism (NIAAA). Accessed June 26, 2023.
  5. Swift R, Davidson D. Alcohol Hangover. Alcohol Health Res World. 1998;22(1):54-60.
  6. Griddine A, Bush JS. Ondansetron. In: StatPearls. StatPearls Publishing; 2023. Accessed June 26, 2023.
  7. Verster JC. The alcohol hangover–a puzzling phenomenon. Alcohol and Alcoholism. 2008;43(2):124-126. doi:10.1093/alcalc/agm163
  8. Patel R, Mueller M. Alcoholic Liver Disease. In: StatPearls. StatPearls Publishing; 2023. Accessed June 26, 2023.
  9. Nakamura Y, Higuchi S, Maruyama K. Pancreatic volume associated with endocrine and exocrine function of the pancreas among Japanese alcoholics. Pancreatology. 2005;5(4-5):422-431. doi:10.1159/000086543
  10. Alcoholism and Psychiatric Disorders. Accessed June 26, 2023.
  11. The Cognitive Consequences of Alcohol Use. Practical Neurology. Accessed June 26, 2023.