Migraine and diabetes: is there a connection?

To work properly, our brain needs a steady supply of energy. Its main fuel is glucose (a type of sugar). Since the central nervous system doesn’t store energy, we need to get regular supplies of glucose from the food we eat. When there’s enough glucose in our blood, our blood sugar level is just right, and the brain gets the energy it needs to do its job properly.

Keeping the brain well supplied with energy is particularly important for people with migraine. Medical research has shown that a shortage of glucose can trigger migraine attacks. In addition to that, other metabolic changes affecting blood sugar levels have a big impact in migraine sufferers.

Diabetes, sometimes known as “sugar disease”, affects how the body produces and uses insulin, a hormone that regulates blood sugar levels. Scientists are now studying how diabetes might impact migraine and how the two conditions might be linked.

What causes diabetes: more about insulin and blood sugar levels

There are two main types of diabetes. Type 1 diabetes is believed to be an autoimmune disorder. In autoimmune disorders, the body’s immune system mistakenly attacks the body’s own cells and tissue. In type 1 diabetes, the immune system mistakenly attacks the insulin-producing cells in the pancreas. This process usually starts early in life, destroying insulin-producing cells during childhood or adolescence and leaving the body unable to make its own insulin. People with type 1 diabetes need to take insulin daily and monitor their blood sugar levels closely, in fact several times a day.

Type 2 diabetes is different. Often called “adult-onset diabetes,” it usually occurs later in life. Type 2 diabetes happens because of a problem in the way the body regulates its blood sugar levels. The sugar regulation system basically gets tired and starts responding poorly to the insulin produced in the body. “Insulin resistance” develops. The response to insulin becomes weaker and eventually stops altogether. As a result, less glucose is taken up into the muscles, liver and fatty tissue than normal. More glucose stays in the blood, and the blood sugar level rises.

An interesting link between diabetes and migraine

Some of the research into the role of the brain’s energy supply in triggering migraine attacks explored possible connections between diabetes and migraine.

A study by French researchers followed nearly 75,000 women with and without migraine for 10 years. None of the women had diabetes at the start, but about 2,400 developed type 2 diabetes during the study. Two key findings emerged. 1. Women with a migraine diagnosis were about 30% less likely to develop type 2 diabetes over the 10-year period. 2. Migraines became less frequent in the period just before diabetes was diagnosed.

Does migraine prevent diabetes?

The authors of the study suggest these explanations for their observations: Changes (mutations) in a specific gene are known to be involved in causing migraine headache disorder. This gene is responsible for producing insulin receptors, i.e., the docking sites for insulin on the body's cells. The mutation makes insulin less effective. As a result, less glucose is absorbed by the cells. This leads to an increase in blood sugar levels. In response, the body produces more insulin to make up for the reduced effect. This higher insulin production might help delay or prevent the development of type 2 diabetes in some people, the authors of this study suggest. This might explain why the onset of type 2 diabetes was effectively prevented in almost one-third of the women studied over the 10-year follow-up period. However, this doesn’t mean that everyone with this genetic mutation will be free from diabetes for their entire life.

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. As a result, episodes of low blood sugar (hypoglycemia) – where the brain does not get enough glucose – become much less common. These periods of low blood sugar are especially concerning for people with migraine, as low blood sugar is a major trigger for migraine attacks. An indirectly increased blood sugar level, or at least one at the upper end of the normal range, seems to offer some protection by preventing low blood sugar and avoiding the hypoglycemia that is such a major trigger for migraines.

For migraine sufferers who developed type 2 diabetes during the study in spite of their lower risk, researchers observed a noticeable decrease in migraine attacks shortly before their diabetes diagnosis. This is likely because, as type 2 diabetes progresses, the body can no longer compensate for the reduced insulin effect. This leads to higher blood sugar levels. With the better glucose availability for the brain due to the higher blood sugar levels, glucose shortages and the related migraine attacks are effectively prevented.

The critical role of blood sugar

Similar findings have been reported in other studies. A Norwegian research group approached the issue from a different angle. Over a ten-year period, they studied a group of 93,000 people with type 2 diabetes and 8,000 people with type 1 diabetes. They found that both groups had a significantly lower risk of experiencing migraine attacks than a non-diabetic control group. The researchers suggest that having diabetes might offer some protection against migraines. Another possible explanation is that people with diabetes need to carefully manage their blood sugar levels to keep them within a normal range. They usually do this very diligently, which helps maintain a steady energy supply to the brain and avoids one of the main migraine triggers. The findings from Norway have been supported by many other studies with similar results.

A consistent energy supply helps prevent migraines

Research into the link between diabetes and migraines highlights how important a steady supply of glucose is for preventing migraine attacks. This applies to people with and without diabetes. For migraine sufferers, maintaining a steady energy supply to the brain throughout the day is crucial. Regular meals that keep blood sugar levels stable for a long time are key. A diet that includes complex carbohydrates (found in foods like whole grains) can be especially helpful. It’s also important not to go too long between meals. Always eat breakfast and try to have it soon after waking up. Some people find that eating a small meal with complex carbohydrates in the evening can help prevent an early-morning migraine attack. Since the brain works even during sleep, it’s important for it to get enough energy and to replenish energy stores quickly in the morning.