LAUSR

Abstract Purpose To determine whether alcohol intake is associated with occurrence of headaches on the following day. Methods In this prospective cohort study, adults with episodic migraine completed electronic diaries every morning and evening for at least six weeks in March 2016–October 2017. Every day, participants reported alcohol intake, lifestyle factors, and details about each headache. We constructed within-person fixed-effect models adjusted for time-varying factors to calculate odds ratios for the association between 1,2,3,4, or 5+ servings of alcohol and headache the following day. We also calculated the adjusted risk of headache the following day for each level of intake. Results Among 98 participants who reported 825 headaches over 4,467 days, there was a statistically significant linear association (p-trend = 0.03) between alcohol and headache the following day. Compared to no alcohol, 1–2 servings were not associated with headaches, but 5+ servings were associated with a 2.08-fold (95% confidence interval [CI] 1.16–3.73) odds of headache. The adjusted absolute risk of headaches was 20% (95%CI 19%–22%) on days following no alcohol compared with 33% (95%CI 22%–44%) on days following 5+ servings. Conclusion 1–2 servings of alcoholic beverages were not associated with higher risk of headaches the following day, but 5+ servings were associated with higher risk. KEY MESSAGES 1–2 servings of alcoholic beverages were not associated with a higher risk of headaches on the following day, but higher levels of intake may be associated with higher risk. Five or more servings were associated with 2.08 times (95% confidence interval 1.16–3.73 the odds of headache on the following day. The adjusted absolute risk of headaches was 20% (95%CI 19%–22%) on days following no alcohol consumption compared with 33% (95% CI 22%–44%) on days following 5+ servings.