Migraine and diabetes: what’s the connection?

The human brain needs a consistent supply of energy to work properly. Its primary fuel is glucose. Since the central nervous system lacks its own energy stores, the brain relies on a steady supply of glucose from our diet. When our blood sugar levels are stable at a healthy level, the brain gets the fuel it needs to function well.

A proper supply of energy is particularly important for people with migraine. Medical research has shown that a shortage of glucose can trigger migraine attacks. Metabolic changes that affect blood sugar levels are especially significant for migraine sufferers.

Diabetes, sometimes known as “sugar disease”, affects how the body produces and uses insulin, a hormone that regulates blood sugar levels. Recent research is looking into the possible impact on migraine headache disorder.

Diabetes: insulin and blood sugar levels

There are two main types of diabetes. Type 1 diabetes is currently understood to be an autoimmune disease in which the body’s immune system attacks and destroys the insulin-producing cells in the pancreas during childhood or adolescence. As a result, affected individuals cannot produce insulin and need to take it like a medicine. This requires frequent blood sugar monitoring, often several times a day.

Type 2 diabetes, also known as “adult-onset diabetes”, typically develops later in life. It can be described as a gradual exhaustion of the body’s blood sugar regulation system. Over time, cells become less responsive to insulin, resulting in a condition called insulin resistance. This impairs the uptake of glucose into the muscles, liver, and fat issue, leaving more glucose in the bloodstream and causing blood sugar levels to rise.

Diabetes and migraine: are they linked?

Research exploring the role of brain energy supply in triggering migraines has often looked into potential connections between diabetes and migraine.

A French research team followed nearly 75,000 female subjects with and without migraine for 10 years. None of the participants had diabetes at the start of the study. By the end, almost 2,400 of them had developed type 2 diabetes. Two key findings stood out: 1. Women with a migraine diagnosis were about 30% less likely to develop type 2 diabetes over the 10-year period. 2. Migraine prevalence decreased in the period shortly before a diabetes diagnosis.

Does migraine protect against diabetes?

The authors of the study suggest these hypotheses for their observations: People with migraine are known to have mutations in the gene responsible for the synthesis of insulin receptors. This mutation makes insulin less effective, resulting in higher blood sugar levels. In response, the body’s regulation system compensates by producing more insulin. The scientists think this extra insulin production (“hyperinsulinism”) might have helped delay or even prevent type 2 diabetes in some of the subjects in this study. This might explain why the onset of type 2 diabetes seems to have effectively been prevented in almost one-third of the women studied over the 10-year follow-up period. However, as observation shows, this doesn’t necessarily mean everyone with the genetic mutation is protected from diabetes life-long.

Does diabetes protect against migraines?

A second effect is that the reduced hormone effect leads to a slight increase in blood sugar levels, at least temporarily. This makes people much less likely to experience episodes of low blood sugar and an associated shortage of glucose supply to the brain. These episodes of low blood sugar, known as “hypoglycemia”, are especially concerning for migraine patients because they are a major trigger of migraine attacks. Having an indirectly increased blood sugar level, or levels stabilized at the upper limit of normal, seems to provide some protection against migraine attacks by keeping hypoglycemia at bay, in that way eliminating one of the most powerful triggers of migraine attacks.

In those migraine sufferers who did eventually develop type 2 diabetes during the study despite their reduced risk, the researchers observed a linear decrease in migraine attack frequency shortly before the diabetes diagnosis was established. This is likely because, as type 2 diabetes develops, the body’s ability to compensate for declining insulin function weakens, causing blood sugar levels to rise. These rising blood sugar levels improve the glucose supply to the brain, in turn helping to protect against migraines: the high blood glucose levels effectively prevent migraine attacks.

The critical role of blood sugar

These effects have also been observed in other studies. A Norwegian study approaching the issue from a different angle monitored 93,000 type 2 diabetes patients and 8,000 type 1 diabetes patients for a decade. Both groups were found to have a significantly lower risk of experiencing active migraine attacks than a non-diabetic control group. The study authors suggest that the presence of diabetes might offer some protection against migraines. They also note that people with diabetes are required to closely monitor and maintain stable blood sugar levels, which most of them do very diligently. This ensures a constant supply of energy to the brain, helping to avoid a major migraine attack trigger. These Norwegian findings have been supported by a number of other studies with similar results.

Stabilizing blood sugar to prevent migraines

The interplay between diabetes and migraine underscores the importance of maintaining stable glucose levels for preventing migraines, whether or not someone has diabetes. For migraine sufferers, maintaining a steady energy supply to the brain throughout the day is crucial. This involves eating regular meals that stabilize blood sugar at a high level. Complex carbohydrates, which release glucose slowly, are particularly beneficial. Avoiding long gaps between meals is important too. This means never skipping breakfast, and always having your first meal of the day shortly after waking up. Some people find that eating a small snack containing complex carbohydrates before bedtime can help prevent early-morning migraines. This is entirely logical, as the brain continues to work during sleep – so it needs a steady energy supply throughout the night and a quick top-up when morning comes.