Deeper into Migraine, Glucose and Insulin…

by James on 2 October 2009

There’s a lot of talk about migraine and sugar levels.  At one time or another, it seems everyone suspects there’s a strong relationship.  So it really is surprising how little we talk about it, and how little research has come out to explain it.

One little study coming out of Austria published this month in the journal Cephalalgia is getting the conversation going again.  The study set out to investigate things like glucose, insulin, and something known as "nitric oxide stress" in migraineurs.

Now there’s a lot to explain here, so stay with me and I’ll try to give you a simple overview.

All three of these things – glucose, insulin, and nitric oxide, are interrelated.  It’s common for people with diabetes, for example, to have impaired nitric oxide (NO) pathways.  Too much or too little NO in your body can cause problems.

Now NO has an amazing influence on all kinds of things in your body.  It has to do with regulating blood flow in your blood vessels (through smooth muscle function).  It plays a role in inflammation.  Proper levels in your body may help prevent heart disease, influence how you feel pain, and even impact your memory.  You can already see how a migraineur may be interested in research related to nitric oxide.

Coffee Donut Glucose

But when there are problems with NO production or elimination, this can lead to too much insulin in the body (hyperinsulinemia).  Hyperinsulinemia may actually have no symptoms on its own, but it could lead to things like low blood sugar, and may lead to the development of insulin resistance and type 2 diabetes.  And this brings us back to questions of carbohydrates and glucose and the glycaemic index and all those things that have to do with blood sugar levels, diabetes and hypoglycemia.

Back to our study.  Using various parameters and tests on 48 migraineurs and 72 non-migraineurs, the researchers found that migraineurs were significantly more likely to have hyperinsulinaemia (hyperinsulinemia), and so showed signs of increased nitric oxide stress.

I hope you’ve followed me so far, and see the value of the study.  What we’re looking for is evidence that can be tested that migraine patients do have insulin related problems.  This gives us a glimpse into a web of related functions in the body – nitric oxide pathways, insulin production, glucose, and so on, and how these things may not be functioning properly in the person with migraine disease.

Not only is it a step into a new world of treatment, it’s also another confirmation of what we already knew – there is a relation between migraine and blood sugar levels.

Because of this, two things.  First, the way we eat and the way we exercise can make a difference in our symptoms, and this gives us a clue of how to think about it.  Second, just eating differently and exercising may not be enough for many of us.  The research needs to continue to see why the body is not functioning the way it should be.

Summary of the study:  Hyperinsulinaemia in migraineurs is associated with nitric oxide stress.
Another study currently in process related to nitric oxide stress and insulin

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{ 17 comments… read them below or add one }

Paula Kirsch October 4, 2009 at 9:10 am

One thing I have noticed over the years (I have had migraines since age 9) is that I can eat things early in the day with no problem, but IF I eat the same things late in the day they will trigger a migraine. Wonder if this relates to the above?

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Shalom September 8, 2010 at 4:41 am

I’m the opposite. If I have a long fasting period (more than 10 hours) or if I’ve had a smallish dinner and I take something sweet in the morning I’m a goner in approximately 4-6 hours and the migraine will last for the next 48 to 72 hours.

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Megan October 4, 2009 at 5:31 pm

This is something that I have also noticed but my migraines do not occur until the next day when I wake up. Could there be a connection?

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James October 5, 2009 at 5:02 pm

That’s interesting – I’m not sure how different times of the day would relate, but I’m sure it would. There could be other reasons as well why eating something later could have an impact – for example, a build-up of other triggers.

Certainly many people have reported a significant “delayed reaction” when it comes to food triggers.

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Aurora October 7, 2009 at 5:53 am

The “smertesykepleier” literally pain nurse in English explained to me of the idea of strengthening my migraine threshold by not eating the triggers and attacking the attack early on; I understand now that it also works the same with my food allergies—some days I can tolerate eating prawns without taking antihistamine. Then one day, wham! I get thick lips and swollen ears. The bathtub is full, James. But one thing’s sure for me, the day after I have eaten hotdogs, I get an attack. I saw the pattern in my diary.

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Linda October 21, 2009 at 6:49 am

Hot dogs and all packaged lunch meat are a definite no-no for me. I’ve also noticed the sugar connection. I love my sweets. I can usually tollerate them early in the day, but I try hard not to eat anything after dinner. I do so much better if I go to bed on an empty stomach. When I’ve had food, especially something sweet before bed, I can feel the pressure behind my eyes when I wake up. Usually a cup of coffee shakes it out, but sometimes not, and I’m uncomfortable for the most of the morning.

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Laurie October 23, 2009 at 7:16 am

I notice that when I have a migraine, I usually crave high carb foods. If I eat pasta and have a soda the pain usually eases up.

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Susan October 26, 2009 at 12:08 pm

I used to love pepperoni pizza, but would always get a killer migraine two days later. It took me awhile to notice the connection since it was that delayed, but once I did, I realized that it happened every time. Now I rarely eat pizza, and if I do, I definitely leave off the pepperoni. Certainly not worth the day (or more) in pain!

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Leslee October 26, 2009 at 1:37 pm

My migraines with visual aura have been ocurring mostly midmorning when I am hungry. I have long suspected a drop in blood sugar as being the trigger.

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James January 26, 2010 at 8:38 pm

Thanks for your examples. Yes, processed meats are generally a trigger – and probably not all that good for you anyway! :)

One other challenge is that cravings are sometimes mistaken for triggers when they’re not. Of course, eating a food you crave may be a trigger, but sometimes the migraine attack causes you to crave something before the attack is in full swing.

For many people, this may be the case with chocolate – not a trigger for you, but you tend to crave it early in the attack.

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Tammy February 3, 2010 at 4:54 pm

I have suffered from migraines for ten years and currently take high doses of topamax to manage them and imitrex several times a week to manage the attack. I have always suffered with my headaches when I wake up at 4 – 5 in the morning. By then it’s too late for preventive medicine and usually have to take a shot. Recently, I was trying to lose a few lbs (from preganancy) and do some healthy detox and started fasting alternate days. I immediately noticed on the days that I didn’t eat dinner, I didn’t have a migraine. I was totally surprised because I had done always thought the opposite. So I tried to eat some small portions and healthy foods on the alternate days….didn’t work, I still got a headache…..not a migraine. Definitely different! Can’t remember the last time I just had a headache. Anyway, Over the past few weeks, I have stopped eating dinner and it has been amazing….I can’t tell you the difference. I don’t have diabetes but wonder if I do have some type of insulin problem. I do have hashimoto thyroiditis and take supplement for that. I’m 5’8″ and now weigh 125 lbs. Never been over weight just a heavy migraine sufferer trying to figure out how to find a cure! Thought someone else should try this because after ten years this is working for me. I’m going to try to start taking myself off of the topamax if this continues to work for me. I have also started taking a natural progesterone too.

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Sara October 7, 2010 at 10:34 am

Hi Tammy,

My 19 year old daughter has had a low grade daily chronic migraine every day since February, 2010. She started on Topamax in July and gradually increased up to 125 mg over 2.5 months. Over the last month her headaches increased in intensity with earlier onset, and the headaches spike 45 minutes to one hour after eating, no matter what she eats and no matter how little she eats. I have read that Topamax increases sensitivity to insulin. Her neurologist does not believe she is having blood sugar issues, but it sure looks like it. I was wondering how you are doing off of the Topamax?

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Shalom September 8, 2010 at 4:49 am

Many years ago I read a book written by a medical professional with lots of great research and charts in it which really helped my migraine but I lent it to a friend and forgot the title. It talked about the relationship between gluten intolerance, glycemic index, insulin, blood sugar and migraine. The summary of it is don’t spike the blood sugar level too high and then go too low. This triggers migraines hours later.

For instance, don’t drink on an empty stomach or drink too much alcohol if you’re going to go for hours later without eating, which is most likely the case if you got drunk.

If you sleep a lot and the time between your first real meal and your last is more than 12 hours don’t take something sweet or high in glycemic index when you wake. Many cereals and processed foods (crackers, biscuits, white rice) contain a lot of sugar, including milk and juices. General rule : don’t take sweet things when you’re feeling VERY hungry. Try drinking a glass of warm water before.

Don’t go without food for more than 6 hours unless you have moved to all low glycemic index food for some time and done detox to restore liver and pancreas function. When you do eat stay away from highly processed, deep-fried, sweetened food even though you’re most likely tempted to eat those types of food.

Eat small regular meals. Make sure you have something healthy to standby for breakfast.

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Cheryl April 30, 2012 at 5:20 am

I also get migraines due to the heat, so I can’t do garden work or have to be very cautious not to get overheated and after some research found out that blood sugar drops when you are overheated. I notice that after I eat, if I get very sleepy, the next day I will have a migraine, even if it was just a salad and not a high carb meal. Very frustrating trying to figure it out.
If I load up on magnesium at the start, I can reduce a 3 day migraine into 1. I have also noticed that my bowel movements have an offensive odor during the migraine, which leads me to think there is problem digesting something so it just sits there fermenting in my gut and hence causes me constipation. My first clue I’m going to get a migraine are muscle spasms or I’m constipated. I”ve just started keeping a food diary.

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Garry May 12, 2012 at 7:30 am

I usually get migraines every 1-2 weeks. I’ve tried vitamin D3 and Magnesium. They have taken the edge off much of my anxiety and depression associated with the migraines (my auras). I once tried a low carb diet for 3 weeks. No migraines. I now use Topamax. Migraines have gone for good. It must work because of how it affects the GABA levels. I am currently back on that low carb diet thanks to the topamax because all of my sugar cravings have gone too. Miracle drug.

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Lynn September 3, 2013 at 1:39 pm

Yeah, there’s nothing like vigorous exercise that can give me a raging migraine and I have serious insulin resistance. They tell me to exercise. It’ll help improve the insulin resistance. Sure. Let me tell you something. It doesn’t. Fun fun fun…but I’m on Qsymia now and wow, I’m just eating the same low carb diet I’ve been eating for the past ten years and just wow. It’s only been 3 week and 6 lbs have fallen off. I’m even thinking about doing some vigorous exercise in the hopes I won’t get a migraine. :)

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Nigel Ricketts March 31, 2014 at 10:52 pm

Just saw this thread. I started getting migraines after knee surgery about 10 years ago. Had a massive one the day after and were frequent ever since. 18 months ago I was diagnosed as a late onset Type 1 diabetic and put on insulin. Ever since, no migraines. It appears that for me injecting myself with insulin a few times a day has eliminated by migraines. I wonder if anyone has looked to treat migraine symptoms with an insulin injection?

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