woman with bad hangover
When hangover symptoms last several days or get worse as time goes on, it could indicate alcohol withdrawal. (Photo source: iStock)

Have you ever over-indulged, drinking four or even more alcoholic beverages in a short period of time. And then got up the next morning with a headache, nausea, and generally feeling run down the next morning? These symptoms are all quite common after a night of over-consumption. But how can you know if it is just a bad hangover or something more serious? Read on. 

What’s behind a hangover?

In addition to its pleasant, intoxicating properties, alcohol has several potentially adverse physical effects. Alcohol can do the following:

  • dehydrate your body (hence the frequent trips to the bathroom)
  • alter blood vessel dilation
  • increase blood pressure
  • irritate the stomach lining and,
  • together with its metabolite acetaldehyde, it serves as a source of direct toxicity to several tissues and organ systems.

Physiological effects like these can help to explain the headache and nausea commonly associated with a mean hangover. In many cases, these symptoms resolve relatively quickly with some carefully selected food (I’m looking at you, breakfast burrito). Also, drink several glasses of water to replenish nutrients and rehydrate.

Warning: You could be experiencing a potentially dangerous alcohol withdrawal  episode if any of these apply to you:

  • Frequent, bad hangovers have become the norm.
  • You don’t bounce back as quickly as you used to with the usual remedies.
  • Your “hangover” effects persist or even get worse over several days.

Acute alcohol withdrawal is a sure sign of physical dependence on alcohol. And, it could potentially be part of a larger alcohol use disorder.

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Here are other physical signs that could be additional red flags.

Five Important Warning Signs

These five warning signs will tell you that it’s more than just a hangover:

1. The symptoms are severe.

Rapid heartbeat, uncontrollable tremors, and excessive sweating are all signs of acute alcohol withdrawal, along with high blood pressure, irritability, and anxiety or agitation.

In more severe cases, complications such as seizures or delirium tremens—a rapidly progressive combination of altered mental status and autonomic nervous system hyperactivity—can be life-threatening developments that require immediate medical attention.

2. The symptoms last longer than a day.

Everyone has a different withdrawal experience. But if what you think is a hangover lasts for a second or third day, it’s a sign that it might be more than just your typical hangover.

Withdrawal can progress over a period of several days as your body adjusts to the absence of alcohol. When a suspected hangover turns into a days-long ordeal, there’s a good chance it’s more than the result of just a little overindulgence.

3. The symptoms get progressively worse.

With a typical hangover, you should start to feel better within a few hours after eating something and drinking water. But, if you’re 12 hours out from your last drink and symptoms continue to get worse, it could mean you’re in withdrawal.

In fact, some of the most severe symptoms of withdrawal can continue to develop as many as two or three days after the last drink. If you or someone you know is getting worse instead of better, it’s time to seek medical help immediately as the risk of seizures increases without treatment.

4. You consistently feel hungover every time you drink.

If you start to experience significantly troublesome hangover symptoms that interfere with your daily routine after every drinking session, that could be a warning sign of escalating physiological dependence and a developing alcohol use disorder.

And, you don’t necessarily have to drink every day in order for it to be a problem. For example, long recovery time after binge drinking every weekend could be an indication of maladaptive patterns of use and growing alcohol dependence.

Such developments may be especially problematic if you’re experiencing other negative impacts in your life as a result of drinking. For example:

      • strained relationships
      • inability to make it to work or other activities
      • choosing not to go to functions or events where you can’t drink.

If your frequent hangovers interfere with your life, it may be time to seek help.

5. Drinking more makes you feel better.

Hair of the dog has been touted as a hangover cure for centuries. But drinking more may not be doing your body any favors. It could be merely postponing the onset of acute alcohol withdrawal.

If your body is accustomed to functioning with alcohol and it’s struggling to do so without it (hence the symptoms), of course giving it what it’s accustomed to is going to make you feel temporarily better.

But it’s certainly not helping the underlying problem. If drinking again immediately makes you feel better, this is definitely a red flag (and, furthermore, meets one of the criteria for the diagnosis of an alcohol use disorder).

Related Content:  Alcohol, Not Opioids, is America’s Most Abused Substance

Over-indulging occasionally is common

Overindulging on a rare occasion is common. Alcohol lowers your inhibitions and impairs judgment, after all. It doesn’t necessarily mean you have a problem.

However, when frequent, severe hangovers become part of your everyday life, you could be headed down a path toward alcohol use disorder. Problematic alcohol use is typically progressive. It’s not impossible to turn it around on your own, but it’s more likely to get worse without intervention.

If you’re concerned about your hangovers or potentially problematic or compulsive drinking behaviors, start by speaking with a physician, therapist, or other addiction treatment professional.

They can help determine your level of addiction risk and potential avenues of treatment, if necessary. You might also start by taking a self-assessment to see where you stand in terms of a diagnosable condition.

Summary

If you’re concerned that you’re already at risk of experiencing acute alcohol withdrawal whenever you attempt to slow or stop drinking, talk to your doctor. There’s no harm in acting early in addressing potential problem drinking. If knowing the risks of developing physical dependence and the dangers of withdrawal can deter excessive drinking, one might avoid the hangover altogether.

Related Content:  Why Seek Professional Help for Alcohol Addiction?

Importantly, though, knowing how to get help if you need it can keep you safe. It can also ease the path for long-term alcohol recovery so you can enjoy many more holidays with family and friends in the years to come.

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Published: 12/19/19. Reviewed and updated 11/16/20.

Scot Thomas, MD

During his medical studies at the University of California, San Diego School of Medicine, Dr. Scot Thomas, M.D., saw firsthand the multitude of lives impacted by substance use and addiction, motivating him to complete a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, he later applied the tenets he learned to guide his therapeutic approach to substance use treatment.

In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas provides accurate, authoritative informational services to those seeking help for substance abuse and behavioral health issues and has been creating digital content in the healthcare space for nearly 15 years.

Dr. Thomas has written articles discussing drug addiction treatment programs and alcohol detox, the warning signs of drug addiction, the dangers of mixing drugs and alcohol, withdrawal symptoms, duration, and dangers, among many more.

Dr. Thomas is also a member of the American Medical Writers Association (AMWA), the leading professional organization for communicators of medical information. You can connect with Dr. Thomas on LinkedIn.

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