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Diabetes and Headaches: What’s the Link?

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Diabetes and Headaches: What’s the Link?

For many people, headaches are a daily occurrence that range from being mildly annoying to completely debilitating. It’s probably safe to say that all of us have had a headache at one time or another, and in many cases, we can pinpoint the trigger. Headaches are the most common form of pain, and it’s also a main reason people miss days at work or school or visit the doctor. People who continually experience headaches can face anxiety and depression.

Perhaps not surprisingly, people who have diabetes can get headaches, and apart from the “usual” culprits, these headaches can stem from fluctuations in blood sugar. There are ways to treat and manage them, however. Read on to learn more.

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What is a headache?

Simply put, a headache is a pain that occurs in any part of the head — on the side, in the front, or in the back. The type of headache pain can vary widely, from sharp, to dull, to throbbing. And the frequency of pain may be different — the pain may come on all of a sudden or more gradually, and it can last for an hour or last for days.

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Types of headaches

Not all headaches are the same. There are two main categories of headaches: primary and secondary. A primary headache is due to a problem with or overactivity of pain structures in the head, such as blood vessels, nerves, or muscles.

Examples of primary headaches include:

  • Migraines
  • Cluster headaches
  • Tension headache
  • New daily persistent headaches

Causes of primary headaches generally involve overactivity of or problems with chemical activity in the brain, nerves, or blood vessels in the head, or muscles of the head and neck. Some people are genetically susceptible to develop primary headaches, too.

Secondary headaches occur as a symptom of a disease or condition, such as:

  • Blood clot
  • Brain aneurysm
  • Brain freeze (also known as “ice cream headache”)
  • Brain tumor
  • Carbon monoxide poisoning
  • COVID-19
  • Dehydration
  • Dental problems
  • Ear infection
  • Flu
  • Hangover
  • High blood pressure
  • Sinus infection or congestion
  • Stroke
  • Concussion
  • Panic attacks
  • Changes in hormones
  • Trigeminal neuralgia

Secondary headaches are triggered by certain factors, such as:

  • Stress
  • Lack of sleep
  • Alcohol
  • Infections
  • Head injury
  • Not eating enough
  • Certain foods and beverages (e.g., aged cheese, nuts and seeds, caffeinated beverages, processed meats, non-nutritive sweeteners, foods containing MSG)

Why might diabetes cause headaches?

Having diabetes doesn’t necessarily mean that you’ll automatically have headaches. However, diabetes headaches tend to occur due to changes in blood sugar levels. In fact, a headache is a sign that your blood sugar may be outside of its target range. The more “up and down” your blood sugars are, the more likely you could get a headache. Once your blood sugars are back in range, your headache will subside.

It’s likely that fluctuations in blood sugar trigger headaches due to the response of blood vessels in the brain to hormones such as epinephrine and norepinephrine. In other words, those blood sugar ups and downs trigger headaches stemming from hormone changes

High blood sugar (hyperglycemia)

High blood sugar is generally defined as a blood sugar of 180 mg/dl or higher. You can’t always “feel” when your blood sugar is too high (which is why it’s important to check your blood sugars regularly). Common symptoms of high blood sugar are:

  • Thirst
  • Frequent urination
  • Feeling tired or weak
  • Blurry vision
  • Trouble concentrating

Headaches are also fairly common when blood sugars go too high; they may come on gradually and worsen over time if blood sugars remain high.

If your blood sugar is high, doing some form of physical activity can help to lower it. Cutting back on your carbohydrate intake can help, as well. However, if you find that changes to food and activity aren’t helping to lower your glucose levels, it’s time to talk with your healthcare provider about possibly making changes to your diabetes medicines.

Low blood sugar (hypoglycemia)

Low blood sugar is a blood sugar below 70 mg/dl and occurs if you take too much insulin or diabetes medicine, if you take a different dose of your diabetes medicine or take it at different times, if you wait too long to eat, if you don’t eat enough carb at your meals, or if you do unplanned physical activity. Symptoms of lows tend to be much more noticeable than symptoms of highs. These include:

  • Shakiness
  • Dizziness
  • Sweating
  • Feeling hungry
  • Feeling anxious or confused
  • Headaches

Headaches from low blood sugar tend to feel like a dull, throbbing pain in the temples, and may occur with other symptoms of low blood sugar. Some people notice that low blood sugar triggers a migraine headache, as well.

Low blood sugar can also stem from changes in your diet. For example, if you are fasting, skipping or delaying meals, or eating much less carbohydrate than usual, you are at risk of low blood sugar, and likewise are more prone to developing a headache, especially a migraine.

If your blood sugar is below 70 (or your own blood sugar target), you need to treat it promptly with 15 grams of carbohydrate (e.g., 4 ounces of juice or soda, 4 glucose tablets, or 8 ounces of skim milk). Check your blood sugar again after 15 minutes to make sure it’s back to a safe level.

If you’ve noticed that headaches come hand-in-hand with high and/or low blood sugars, make sure you check your blood sugars often enough that you can quickly treat the situation and prevent the headache. Continuous glucose monitoring (CGM) is particularly helpful in that it can alert you if your glucose levels are starting to go too low or too high, too fast. This gives you time to take corrective action.

Other factors

Living with diabetes can be extremely stressful. Stress is a major trigger for headaches, likely due to the release of cortisol (aka “the stress hormone”). Other hormonal issues that are common in people with diabetes are hypothyroidism (low thyroid), menstruation, pregnancy, and menopause. All of these conditions can lead to headaches.

Treating headaches

There are a number of ways to treat headaches, and treatment depends, in part, on the type of headache that you have.

Medication

Some headaches respond well to over-the-counter remedies, including aspirin, acetaminophen, and ibuprofen. More potent, prescription medications include triptans (a type of medication that blocks pain pathways in the brain), ergot alkaloids, narcotics, beta blockers, and antidepressants. Some of these medications are also used to prevent headaches, such as migraines, from occurring.

Talk with your provider about the best use of medication in order to avoid “rebound” headaches from overuse.

Natural remedies

Rubbing natural oils, such as thyme, rosemary, or peppermint oil on your temples and forehead may be helpful. Taking 400 milligrams of magnesium daily has been shown to help prevent headache (watch out for side effects, though, which include diarrhea). Butterbur extract can provide migraine relief, too, although there are safety concerns about this product. And try sipping on a cup of ginger or chamomile tea for relief. Note: Always check with your healthcare provider before taking or using supplements or natural remedies.

Stress reduction

Meditation, yoga, acupuncture, biofeedback, massage, and heat therapy can all be helpful for headache relief. Even taking time to practice deep breathing or relaxation by listening to music or taking a bath can help. Cognitive-behavioral therapy (CBT) can help you develop skills to cope with the pain of a headache and it’s resulting distress. A trained therapist can also teach you relaxation skills. Research shows that CBT led to a significant reduction in headache activity ranging from 30% to 60%.

Dietary changes

Certain foods and beverages can be headache triggers. Common culprits include:

  • Red wine
  • Chocolate
  • Aged cheeses (parmesan, romano, aged cheddar, Swiss, brie)
  • Citrus fruits
  • Onion
  • Avocado
  • Aspartame (a non-nutritive sweetener, such as NutraSweet or Equal)
  • Caffeine

It may be apparent which foods or drinks set off that headache, but in other instances, you may not know. The best way to pinpoint the trigger food(s) is to keep a food diary, noting what and when you ate, as well as the onset and severity of your headache.

Staying hydrated

If you are dehydrated, say, from high blood sugars, being ill, being out in the hot weather, exercising, or simply not drinking enough, you’re at risk of a dehydration headache (dehydration can also trigger migraines). Make a point to drink plenty of water during the day and limiting time outside during hot weather.

Diabetes management

If blood sugar changes trigger headaches for you, work on getting and keeping your blood sugars in your target range. That will likely mean working with your healthcare team to manage your eating plan, physical activity, and/or diabetes medications. If you do experience headaches on a frequent basis, don’t suffer! Talk with your provider to find out the type of headache that you have, as well as the best form of treatment for you.

Want to learn more about diabetes and headaches? Read “Five Ways Diabetes Causes Headaches” and “Diabetes and Headache: Soothing That Aching Head.”

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter, DiabeticConnect.com, and CDiabetes.com

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