How can we treat hangovers?

This article was published in Medical Observer.

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Clinical scenario

Simon, a uni student presented looking decidedly seedy; diagnosis: alcohol hangover.  “What can I do about this doc?”  What indeed?  Christmas and New Year is just around the corner; it’s the festive season and Australians triple their alcohol consumption over this period.¹  To declare a self interest, I like an occasional drink myself!  So, are there any effective treatments for hangovers?

Clinical question

What is the evidence for preventing or treating alcohol hangovers?

What does the research evidence say?

A search for “alcohol hangover” in the Cochrane Library finds a systematic review of randomised controlled trials (RCTs) published in the BMJ in 2005.  Searching PubMed does not reveal any new RCTs.  I will look at Pittler, et al. (2005) ² in detail.

Critical appraisal

Critical appraisal of a systematic review is different from analysing a therapeutic trial.  I will use the appraisal sheet for systematic reviews available from the Centre for Evidence Based Medicine. ³

What PICO question does the systematic review ask?

In alcohol drinkers (Participants) what is the effectiveness of any medical intervention (Intervention) compared to placebo or alternative treatment (Comparator), for the prevention or treatment of alcohol hangover symptoms (Outcome).

Is it clearly stated?

Yes.

Is it unlikely that important studies were missed?

Yes.  The authors searched more than four large electronic databases, hand searched alternative and complementary conference proceedings and journals, hand searched the bibliographies of all retrieved articles, and contacted manufacturers of commercial preparations and five experts on the subject to contribute to further studies.

Were the criteria used to select articles for inclusion appropriate?

Yes.  The authors included any trial testing a medical intervention for the prevention or treatment of alcohol hangover, where the allocation was randomised.  Randomised controlled trials and crossover trials are generally best for testing therapeutic interventions for reversible conditions.

Were the included studies sufficiently valid for the question asked?

Unclear.  Two authors assessed the quality of the included studies independently using Jadad scores. ⁴  The methodological quality of the included studies were mixed.  All studies were small.

Were the results similar between studies?

No.  Each included study tested different interventions, and used different outcome measures.  No pooled estimates are possible.

What were the results?

Positive results were demonstrated for γ-linolenic acid from B. officinalis, a yeast based preparation, and tolfenamic acid.  Each intervention had results from only a single small study.  No significant results were found for propranolol, tropisetron, fructose or glucose, artichoke supplement, and prickly pear supplement.

Conclusion

There is no convincing evidence of the effectiveness of any of the interventions included in the systematic review.  Moreover, there is little quality evidence for the prevention or treatment of alcohol hangover that is in the published literature.

What can we do (for ourselves!) and what should we advise our patients?  Research suggests that Australians have been gradually drinking more alcohol over time ⁵ and I suspect that doctors are no different.  Apart from those lucky people who appear to be resistant to hangover, ⁶ the only known effective way to avoid alcohol hangover is to drink sensibly; and as a reminder, the current NHMRC guidelines for well adults recommend no more than two standard drinks daily, or four on a single occasion of drinking. ⁷  So rather than relying on suspect hangover tonics, perhaps prevention really is the best option in this setting.

Happy holidays and cheers! (but not too much!)

Stat Facts

Systematic reviews

Systematic reviews are literature reviews of primary research that aims to identify, select, synthesise, and appraise all the available empirical evidence that fits pre-specified eligibility criteria, for a particular question. They use explicit, systematic methods with a view of minimising bias. ⁸

References

1. Australians booze to ease the blues [media release]. FebFast 27 December 2010. http://febfast.org.au/pdf/FebFast%20MR%20-%20Festive%20Season%20ALL.pdf Retrieved: 14 November 2011
2. Pittler MH, Verster JC, Ernst E. Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials. BMJ 2005; 331: 1515
3. Systematic Review: Are the results of the review valid? Centre for Evidence Based Medicine, University of Oxford. http://www.cebm.net/index.aspx?o=1157 Retrieved: 14 November 2011
4. Jadad AR, Moore RA, Carroll D, et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials 1996; 17: 1-12
5. Chikritzhs TN, Allsop SJ, Moodie AR, Hall WD. Per capita alcohol consumption in Australia: will the real trend step forward? MJA 210; 193(10): 594-597
6. Howland J, Rohsenow DJ, Allensworth-Davies D, et al. The incidence and severity of hangover the morning after moderate alcohol intoxication. Addiction 2008; 103(5): 758-65
7. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Commonwealth of Australia 2009.
8. Higgins JPT, Green S (editors). “What is a systematic review?” (Section 1.2.2) in Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0.  The Cochrane Collaboration 2011. http://www.cochrane-handbook.org/ Retrieved: 14 November 2011