Time is the best cure for a hangover

Q: I always thought that you get a hangover from drinking too much. But when I have a single mixed drink, or sometimes even just one glass of wine, I wake up feeling nauseated and with a bad headache. What causes a hangover? Is there a cure?

A: The term "hangover" refers to the collection of deeply unpleasant (and sometimes debilitating) symptoms that can occur after drinking too much alcohol.

The specific symptoms, as well as their intensity and duration, vary from person to person. They include headache, stomach upset, fatigue, muscle aches, dizziness, sweating, nausea, vomiting, persistent thirst, rapid heartbeat and an increased sensitivity to light and sound. A hangover can also affect someone emotionally, leaving them feeling anxious, irritable or depressed. People sometimes find that their motor skills and cognition take a temporary hit as well.

While we typically associate a hangover with being overserved, the amount of alcohol needed to cause one varies from person to person. For some, it takes multiple drinks to excess and beyond to reach hangover territory. Others, like yourself, find that even a modest amount of alcohol causes the body to revolt. A wide range of factors have been found to contribute to the development of a hangover. These include the person's sex, age, body mass and general health; the amount and pace of their drinking; dehydration; gastrointestinal issues; inflammation; and even the state of their gut microbiome.

Also at play is how the body metabolizes alcohol. This is carried out primarily by the liver in a two-step process. First, the liver converts alcohol into acetaldehyde — a toxic byproduct that contributes to inflammation in the liver, pancreas, gastrointestinal tract and brain. In the second step of alcohol metabolism, the enzymes in the liver turn acetaldehyde into acetate, a nontoxic substance. But there's a catch. The liver can process only about one drink per hour. Drink any faster than that, and you're creating a buildup of toxic acetaldehyde. More recent research adds small proteins called cytokine to the hangover equation. Cytokines alert the immune system to potential threats. The theory is that drinking triggers the release of cytokines, which sends the immune system into defense mode.

As for whether science has come up with a hangover cure, the answer is not yet. You wouldn't know that from the astonishing -- and ever-expanding — array of hangover products that claim to help suffering drinkers. Unfortunately, the only real cure for a hangover is time, typically 24 hours or more. While waiting that out, you can take steps to manage the symptoms. This includes rest, antacids to calm the stomach, complex carbs to boost low blood sugar and plenty of water and other nonalcoholic fluids for hydration. Headache can be eased with nonsteroidal anti-inflammatories. However, never take Tylenol during or right after drinking, as when mixed with alcohol, liver damage is possible. And ignore advice that urges easing a hangover with an alcoholic drink. The boost it may give is temporary, and merely lengthens the time to a genuine recovery.

Ultrasound treatment can help with essential tremor

Q: I am considering an ultrasound treatment for essential tremor, which has affected my hands and also my voice. Can you please talk about tremor and about how this procedure works? Will it also help the tremor in my voice?

A: Tremor is marked by uncontrolled trembling or shaking in one or more parts of the body. It can occur at any age and often interferes with quality of life.

The condition falls into several categories, based on the triggers that cause the tremor to occur. For example, kinetic tremor, or action tremor, takes place during movement. Postural tremor arises when a limb is braced against the forces of gravity, as when reaching out an arm or lifting or holding an object. Resting tremor isn't associated with movement at all; it occurs when the muscles are relaxed and at rest and stops as soon as they are engaged.

Essential tremor is the most common form of this disorder. It is estimated to affect up to 10 million people in the U.S. The condition is distinguished by the onset of a kinetic tremor that is not associated with any neurological issues. Although essential tremor usually involves the hands, it is possible for the neck, head, trunk, legs and voice to be affected as well. The cause remains unclear. However, there is evidence of a link to mild degeneration of tissues in the cerebellum. That's the region of the brain that oversees movement. Genetics also plays a role. In up to 70% of cases, there is a familial link to the condition.

Treatment typically begins with medications known as beta blockers. These can dampen errant neurological activity. If medications are unsuccessful, or when side effects outweigh their benefit, the ultrasound treatment you are considering may be an option. Known as focused or guided ultrasound, it is a noninvasive form of neurosurgery. The treatment uses pulses of focused sound waves to heat and destroy a cluster of cells within the brain. The "guided" part of this surgery involves magnetic resonance imaging, or MRI. The MRI is used to map the precise location of the targeted cells, and to monitor the path of the sound waves. During the course of the treatment, which takes several hours, patients perform movements that are used to assess the progress of the treatment.

Success rates vary, depending on the location and severity of each person's tremor. Studies show that in many people, existing tremors improve by 50% or more, and that gains last more than five years. This can include tremors of the voice. As with all medical procedures, there is a risk of adverse effects. Head pain and dizziness are the most commonly reported side effects of the treatment.

An MRI scanner is essentially a powerful magnet. That means the treatment isn't appropriate for people with certain metal and metallic surgical implants. It is also not recommended for anyone with claustrophobia. Some health conditions, including chronic infection, heart problems or being on dialysis, can also limit participation. Your doctor can help you learn if your medical situation makes you a candidate for this type of treatment.

Q: Is the caffeine in a Tylenol caplet the same type of caffeine used in soft drinks? Also, does long-term consumption of highly caffeinated energy drinks cause permanent damage to the body in some way?

A: Tylenol doesn't contain caffeine, but some brands of drugstore pain relievers do. And yes, it is the same type of caffeine that you find in soft drinks. Caffeine, a stimulant that affects the central nervous system, has been found to be safe when used in moderation. Overdoing it can cause problems. Regular intake of 600 mg or more per day has been linked to sleep disturbance, anxiety and stomach acidity. It can also increase blood pressure and make existing high blood pressure worse.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.