(Reuters Health) - - Many migraine sufferers avoid alcohol, saying it can trigger the severe headaches, a survey found.

Among more than 2,000 migraine patients in the Netherlands, more than a third said alcohol was a migraine trigger for them. Of the 650 patients who had stopped consuming alcohol, one in four said it was to avoid triggering migraines. And 78 percent of patients who did drink alcohol cited red wine as the specific drink that could trigger an attack. Vodka was a trigger for only 8 percent.

Whether alcohol is a reliable migraine trigger - and why - are both poorly understood, the study authors write in the European Journal of Neurology. Alcohol seems to affect about a third of those prone to migraines, and the amount of alcohol and time it takes to trigger a headache vary as well, they note.

“Migraine patients frequently link the consumption of alcoholic beverages with the triggering of their migraine attacks . . . however, patients report that alcoholic beverages do not consistently trigger attacks,” lead study author Gerrit Onderwater of Leiden University Medical Center in the Netherlands told Reuters Health.

These migraines are likely triggered by alcohol mixed with several other factors, he said.

“Identifying factors involved in the triggering of attacks may point to compounds which could be avoided,” he said in an email.

Onderwater and colleagues found that alcoholic drinks were reported as a trigger by about 36 percent of survey participants. For a third of these patients, the migraine started within three hours, and for almost 90 percent, the migraine began within 10 hours. Patients estimated that it took about two drinks to initiate an attack.

Still, among those who said red wine was a trigger for them, only 9 percent said it triggered a headache every time they drank it. Among those who said vodka was a trigger, only 11 percent said it brought on a headache every time.

“Migraineurs already have burdens and limitations regarding different trigger factors. I always heard from my patients that they were prohibited from consuming wine because they were migraine sufferers,” said Dr. Abouch Krymchantowski of the Headache Center in Rio de Janeiro, Brazil, who wasn’t involved in the study.

Migraines may be triggered by certain types of red wine, including those with more phenolic flavonoid components, he said. Combining wine with other triggers such as menstruation, stress, heat, certain foods, fasting or sleep deprivation may influence the migraine as well.

“I frequently have attacks when I combine wine with sleep deprivation, like a long-duration flight,” he told Reuters Health by email. “Combining with other triggers increases the chance of an attack over savoring your favorite wine when you are relaxed and well.”

“I believe that many chronic pain conditions, including migraines, can be significantly affected by lifestyle and behavior changes, and alcohol consumption is one of many behaviors that can be adjusted,” said Rachel Davis-Martin of the University of Massachusetts Medical School in Worcester, who wasn’t involved in the study.

Future studies could use smartphone apps and wearable biosensors for patients to record triggers and headaches on a daily basis to better understand how and when migraines begin, as well as the progression of migraines over time, she said.

“Migraines can be managed with medication and lifestyle choices, using treatment options from both physicians and health psychologists,” she said in an email. “Although chronic pain conditions can be debilitating, there are things people can do to help improve their overall quality of life.”

SOURCE: bit.ly/2FwSOJ5 European Journal of Neurology, online December 18, 2018.