To explore whether alcohol intake is associated with onset of migraine attacks up to two days after consumption in individuals with episodic migraine (EM).

Although alcohol has been suspected as a common migraine trigger, resulting in avoidance of consumption and possible impact on quality of life, multiple studies have been inconclusive in proving this association.

This was a prospective longitudinal cohort study among adults with EM. Individuals used the N1-Headache™ digital health platform to enter daily headache symptoms and lifestyle factors. People who stated never drinking alcohol were excluded. Migraine days were defined according to ICHD criteria. A Bayesian mixed model was used to assess the effect of alcohol intake (Yes/No) in day-1 (day before) and day-2 (two days before) on migraine attack onset on day-0, including the presence of migraine on day-2 and its interaction with the effect of alcohol intake on day-2, and adjusting for gender, age and average weekly alcohol intake.

Data on 487 individuals contributing 5,913 migraine attacks and 40,165 diary days in total were included in the analysis. Participants were mostly women (86.0%) with  mean (SD) age 42.2 (12.2) years. People with lower migraine frequency consumed more alcohol, and consumption occurred more often during non-migraine days. The model, after excluding non-significant terms, showed that alcohol intake on day-2 was associated with a reduced probability of migraine attack on day-0 (OR[95%CI]=0.75[0.68-0.82]), while the effect of alcohol intake on day-1 (OR[95%CI]=1.01[0.91-1.11]) was not significant.

The relationship between alcohol consumption and migraine attack is complex and high variation between individuals exists. Among people with migraine who drink alcohol, it appears that consumption is not significantly associated with risk of migraine the following day.