Possible Causes of Pain After Drinking Alcohol

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If you've experienced pain with drinking alcohol, what could it mean? Pain with drinking alcohol has been associated with Hodgkin lymphoma, but in general, pain associated with alcohol consumption is much more commonly due to other conditions.

Specifically, drinking too much alcohol can produce the familiar hangover, the general feeling of being unwell, along with, at times, irritation or pain in the area over the stomach, esophagus, pancreas, gallbladder, and liver.

Indeed, excessive alcohol consumption is associated with quite a long list of ailments, disorders, and chronic diseases.

What to Know About Alcohol Intolerance
Verywell / Elise Degarmo


When someone has an unexpected response to alcohol there are a number of possibilities. The list of ailments or conditions includes Hodgkin lymphoma, but also something called carcinoid syndrome, as well as plain old genetics: mutations of the gene encoding alcohol dehydrogenase (most commonly found in Asian populations).

Alcohol Intolerance and Allergy

Alcohol intolerance and allergy account for most unexpected responses to drinking alcoholic beverages.

True alcohol allergy is believed to be rare and it usually runs in families, and like other food allergies may carry the risk of severe allergic reactions (anaphylaxis). Sometimes the allergy is actually to an ingredient in an alcoholic beverage, such as grains or preservatives, and not the alcohol itself.

Alcohol intolerance, which may be associated with the symptoms of intoxication, can have many underlying causes. The hereditary lack of an enzyme to break down alcohol (alcohol dehydrogenase) can lead to rapid (and persistent) intoxication.

Celiac disease (gluten sensitivity), histamine intolerance, wheat allergy, and sulfite allergy, may all result in alcohol intolerance.

Carcinoid Syndrome

Carcinoid syndrome is something that occurs rarely and is associated with a certain type of slow-growing tumor, or carcinoid tumors, that release serotonin.

Serotonin is a chemical messenger that can, in turn, produce symptoms known as "carcinoid syndrome," including abdominal pain, red flushing of the neck, face, and chest, diarrhea, palpitations, and wheezing. These symptoms may be precipitated by alcohol in some cases.


Alcohol intolerance is also associated with the use of certain medications including Antabuse (disulfiram) and Flagyl (metronidazole).

Alcohol Pain in Hodgkin Lymphoma

Pain in the lymph nodes after drinking alcohol does occur in some people with Hodgkin lymphoma, but it is not one of the key symptoms in the diagnosis of lymphoma. In fact, it is quite rare.

The association of alcohol pain with Hodgkin's disease goes back a number of years. In a 1966 review describing 747 patients with alcohol-induced pain associated with cancerous conditions, Hodgkin lymphoma accounted for 40% of cases. Two other reviews in 1994 and 2013 discuss the association but there are otherwise few studies available.

Lymph Node Pain With Alcohol

About half of people with lymphoma will have enlarged lymph nodes. These nodes are not usually painful to the touch, although they can ache. In some people, the affected lymph nodes can become painful after drinking alcohol, and this seems to be more common in people with Hodgkin lymphoma.

Mechanism of Alcohol-Related Pain

What is responsible for alcohol-related pain in Hodgkin's disease? Scientists don't know the precise biologic mechanism or cause, but there are several theories. Some believe pain is related to the expanding of the vessels within the lymph node capsule following exposure to alcohol in the bloodstream.

In one case report, the alcohol-induced pain was relieved with Advil (ibuprofen), and since Advil acts on a chemical messenger called prostaglandin, the authors speculated that a prostaglandin-mediated process might have been involved.

If you do have Hodgkin's disease and if you experience this sort of reaction to alcohol, it is not known whether the alcohol intolerance reveals or predicts anything in terms of the severity or prognosis of the disease.

Example Case

In 2013, Dr. Andrew Bryant and Dr. John Newman of Vanderbilt University Medical Center reported the case of a 31-year-old man who came to their clinic with severe chest pain that began minutes after ingesting two-to-three sips of alcohol. This reaction had been occurring for the previous three months.

The patient felt no pain when swallowing other liquids or solids, and his pain was relieved with low doses of ibuprofen. In this particular patient’s case, lymph nodes near the right lung, heart, and diaphragm (mediastinal lymph nodes) had become involved with Hodgkin disease.

In addition to the pain in his chest with sips of alcohol, he had periodic fevers, night sweats, and general malaise (malaise is a term which means simply not feeling well). Imaging and biopsy of one of the abnormal lymph nodes led to the diagnosis of Hodgkin lymphoma.

Symptoms of Hodgkin Lymphoma

Alcohol pain is not a common, typical or prominent presenting symptom of Hodgkin's lymphoma, however painful lymph nodes after alcohol consumption is a symptom that has been documented many times in people with Hodgkin's disease.

People with Hodgkin lymphoma may develop different symptoms, but the most common scenario at diagnosis is enlarged lymph node(s) and nothing else. Lymph nodes may be enlarged in the neck, armpits, or groin, causing a painless lump, or within the chest, found on imaging studies.

Less commonly, those with Hodgkin lymphoma may have weight loss, fever, itching, or drenching sweats at night, collectively called B symptoms of lymphoma.

A Word From Verywell

If you experience pain after drinking alcohol or are concerned about unusual symptoms or reactions after drinking alcohol, make an appointment to talk to your healthcare provider.

As with conditions such as gluten sensitivity, it may take some time to get to the bottom of your symptoms. You may want to begin a food journal while you are waiting for your appointment and tune into your body to note any other symptoms you may be experiencing.

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