Hangover Symptoms, Causes & Long-Term Effects

What is a Hangover?

A hangover is the experience of an unpleasant set of symptoms that occur because of excessive alcohol consumption, and the severity of a hangover is dependent on many factors. ¹ Common symptoms associated with hangovers include fatigue, weakness, thirst, nausea, vomiting, stomach pain, and more.

What Does a Hangover Feel Like?

Hangover symptoms vary in both duration and intensity.² Not everyone will experience all the symptoms of a hangover while some individuals may experience more intense symptoms than others. Hangover symptoms can affect an individual physically and mentally and each hangover can present differently.² The most common hangover symptoms include sleepiness, thirst, and concentration problems.³

Symptoms of a Hangover

Most people do not experience a hangover after having a drink or two. In fact, evidence suggests that individuals need to reach a blood alcohol concentration (BAC) of at least 0.11% to 0.12% to feel a hangover. As a rule, the more you drink, the more likely you are to experience a hangover. Of course, there are other factors that affect the intensity of the hangover. These may include gender, body weight, the type of alcohol consumed, the time frame with which the alcohol was consumed, the dilution of the beverage, and the time since the individual last ate a meal.⁴ Depending on what was consumed, during a hangover, an individual may feel:⁴

• Fatigue.
• Weakness.
• Thirst and dry mouth.
• Headache.
• Muscle aches.
• Nausea.
• Vomiting.
• Stomach pain.
• Sensitivity to light and sound.
• Anxiety.
• Irritability.
• Reduced alertness.
• Sweating.
• Shakiness.
• Decreased ability to concentrate.
• Rapid heartbeat.
• Increased blood pressure.

Factors That Affect a Hangover

There are various factors that contribute to a hangover, including:^1,2

• Additives in alcohol. Certain components in alcohol can contribute to hangovers. These include congeners, which are created during the fermentation process and add to the flavor and scent of the drink. Congeners are found in higher amounts in dark liquors and can make a hangover worse. Sulfites, which are preservatives added to wines, can cause headaches in people who are sensitive to them.
• Amount. Drinking larger amounts is more likely to cause a hangover.
• Breakdown of alcohol. As alcohol is broken down in the body, especially in the liver, it creates a toxic substance called acetaldehyde. This can lead to inflammation in various organs, including the brain, digestive tract, liver, and pancreas.
• Dehydration. Alcohol affects the hormones that regulate fluids in the body, which leads to mild dehydration and electrolyte imbalances. This can lead to fatigue, dizziness, headache, and thirst.
• Gastrointestinal irritation. Alcohol is an irritant and increases the production of acid in the stomach. This can lead to upset stomach, nausea, and vomiting.
• Increased inflammation. Alcohol is known to increase inflammation throughout the body, which can lead an individual to feel unwell.
• Low blood sugar. Alcohol changes how the liver and pancreas function and can lead to low blood sugar. This can cause symptoms such as fatigue, depression, and weakness.
• Sleep changes. Alcohol interferes with the sleep cycle and makes sleep less restful. While individuals may fall asleep quickly after drinking, the sleep tends to be fragmented and individuals often wake early, making them feel more tired and less able to think clearly or focus.
• Vasodilation. Alcohol dilates the blood vessels and has an impact on different hormones and chemicals in the brain that can lead to headaches.

The Hangover Timeline: When Does It Begin & End?

Hangovers typically begin when BAC significantly drops (roughly 6-8 hours after drinking), and can last for 24 hours, affecting cognitive functioning, work performance, productivity, concentration, and the ability to safely drive a car or operate machinery.⁴

Risk Factors for Hangovers

While anyone who drinks alcohol may experience a hangover, some people are more susceptible to getting them than others. Some potential factors that can contribute to this include:^2,5-7

• Age. Hangovers may be more likely and worse in younger individuals and older adults, especially at higher drinking levels. However, researchers point out that older adults may be more practiced at altering drinking habits to avoid or minimize a hangover, such as avoiding alcohol with more congeners in it.
• Gender. Females are more likely to experience more severe hangovers that last longer.
• Genetics. The enzyme needed to break down alcohol isn’t present in some people, which causes acetaldehyde, a toxic substance, to build up in the system, creating unpleasant reactions. This is known as acute alcohol intolerance and can lead to greater intensity of hangover symptoms. Individuals with a family history of AUD may be more prone to hangovers, as well.
• Health. Research indicates that diabetics’ sensitivity to alterations in blood glucose, which can lead to hypoglycemia, make them more susceptible to hangover symptoms such as fatigue, mood disturbances, and weakness. People with borderline personality disorder also experience hangovers more often.
• Personality. People with specific personality traits may be more sensitive to hangover symptoms. These people tend to be angry, defensive, or neurotic, while others may feel guilty about their drinking. People who have had negative life experiences tend to suffer from hangovers more often as well.
• Use of other substances. The use of nicotine or other drugs can cause hangover symptoms to be worse.

Take Our Alcohol Abuse Self-Assessment

Take our free, 5-minute alcohol abuse self-assessment below if you think you or someone you love might be struggling with alcohol abuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an alcohol use disorder. The test is free, confidential, and no personal information is needed to receive the result.

Hangovers vs. Alcohol Withdrawal

Hangovers can share similar symptoms to mild alcohol withdrawal. However, the difference between a hangover and alcohol withdrawal has to do with the history of alcohol consumption. Hangovers occur after heavy alcohol consumption regardless of if an individual has consumed alcohol for the first time, is dependent on alcohol, or has an alcohol use disorder (AUD), a medical condition defined by the inability to control alcohol consumption despite harmful consequences. Alcohol withdrawal occurs when an individual who is dependent on alcohol tries to cut down or quit drinking.

When is My Hangover an Emergency?

While a hangover may make you feel like you’re going to die, a hangover on its own won’t kill you, but you should call your health care provider for any symptoms that last longer than 24 hours.

For those with heart disease, hangover symptoms such as rapid heart rate or high blood pressure can be dangerous.⁵ Seek medical attention if an elevated heart rate persists for more than a day.

After drinking too much in a short amount of time, alcohol poisoning can occur.¹¹ This is a life-threatening condition that requires immediate medical attention and can cause permanent brain damage or death.¹¹ Signs of alcohol poisoning include:¹¹

• Breathing that is slow, irregular, or labored.
• Confusion.
• Reduced reflexes.
• Skin that is blue, clammy, cold, or pale.
• Slowed pulse.
• Trouble staying conscious.
• Very low body temperature.
• Vomiting, which can result in choking.
• Seizures.

Hangover Facts & Statistics

Here, a few of the facts and numbers behind hangovers.^5,10

• Around 23% of people who drink alcohol don’t experience hangovers, even when they drink heavily.
• In the United States, hangover-related absenteeism (from school and work) and poor job performance cost $148 million dollars each year.
• One study found that 25% of college students had experienced a hangover in the past week.

Alcoholism Treatment Options

If you or a loved one are experiencing alcohol withdrawal or suffering from the effects of an AUD, please know effective treatment for alcohol problems is widely available. Please contact an addiction specialist at a professional alcohol rehab center today to learn more about the individualized therapy options that can best serve you as you begin your path to lasting recovery.

Long-Term Impacts of Hangovers

The occurrence of regular hangovers can begin to negatively impact personal relationships, work performance, and overall quality of life. Prolonged and heavy drinking can also lead to alcohol withdrawal upon the sudden cessation of alcohol use, which could be life threatening.

Sources

1. National Institute on Alcohol Abuse and Alcoholism. Hangovers.
2. Swift, R., & Davidson, D. (1998). Alcohol hangover: Mechanisms and mediators. Alcohol health & research world, 22(1), 54-60.
3. Van Schrojenstein Lantman, M., Mackus, M., Van de Loo, A.J.A.E., & Verster, J.C. (2017). The impact of alcohol hangover symptoms on cognitive and physical functioning, and mood. Human psychopharmacology: Clinical and experimental, 32(5).
4. Alcohol Hangover Research Group. (2010). The alcohol hangover research group consensus statement on best practice in alcohol hangover research. Current Drug Abuse Reviews, 3(2), 116-126.
5. Razvodovsky, Y.E. (2021). Hangover syndrome: Pathogenesis and treatment. International archives of substance abuse and rehabilitation, 3(1).
6. Huntley, G., Treloar, H., Blanchard, A., Monti, P.M., Carey, K.B., … Miranda, Jr., R. (2015). An event-level investigation of hangovers’ relationship to age and drinking. Experimental and clinical psychopharmacology, 23(5), 314-323.
7. Genetic and Rare Disease Information Center. (n.d.). Acute alcohol sensitivity.
8. Centers for Disease Control and Prevention. (2020). Dietary Guidelines for Alcohol.
9. Wang, F., Li, Y., Zhang, Y-J., Zhou, Y., Li, S., & Li, H-B. (2016). Natural products for the prevention and treatment of hangover and alcohol use disorder. Molecules, 21(64).
10. Wiese, J.G., Shlipak, M.G., & Browner, W.S. (2000). The alcohol hangover. Annals of internal medicine, 132(11), 897-902.
11. National Institute on Alcohol Abuse and Alcoholism. (2021, May). Understanding the dangers of alcohol overdose.