How to Manage a Diabetic Headache

Diabetic Headache – What Is It?

When I look at a referral before seeing a new patient, I always look at the doctor’s notes. Often, I’ll see “repeat” patients – I saw them several months ago, and we made changes to their insulin regimen, their blood glucose log was emailed to me, but then the patient stopped following up.

They are then sent back to me because their hemoglobin A1C has increased – from 8.5% to 12.0%. And their chief complaint?

A headache.

Oh – and they are barely checking their blood sugar levels, which means they are rarely giving insulin.

The Diabetic Headache

The patient tells me that “all of a sudden” they started getting headaches or migraines, but their doctor won’t provide them with any migraine medication.

Obviously, I’m not a physician. I don’t know for sure that this patient isn’t getting migraines, but I can read between the lines – that their headaches are related to their blood sugar levels as opposed to migraines.

I explain this to the patient – gently.

Having diabetes does not automatically mean that someone will get headaches. In fact, many people with diabetes do not get headaches related to their condition. However, if they do get frequent headaches, it is most likely related to extremes in blood sugar levels – hyperglycemia and hypoglycemia.

  • Hyperglycemia is a blood sugar that is greater than 180 mg/dL.
  • Hypoglycemia is a blood sugar that is less than 70 mg/dL.

A headache can be a symptom of either of these blood sugar levels – and it can also be a sign of a greatly varying blood sugar.

For example, if someone’s headache was 80 mg/dL before a meal and they forgot to inject insulin according to the pizza they ingested – their blood sugar may go up dramatically. There are cases where some people may get a headache due to the rapid change in blood sugar level.

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

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Treatment of the “Diabetes Headache”

First of all, if hypoglycemia causes your headaches, it is imperative that you have a quick-acting source of carbohydrates with you at all times. Hypoglycemia can be life-threatening if not treated quickly and adequately. The “rule of 15” is a great rule of thumb:

The “rule of 15” is a great rule of thumb:

  1. Check your blood sugar if a meter is available.
  2. Treat your low blood sugar with carbohydrate – 15 grams of carbohydrate is generally adequate. Four glucose tablets, four ounces of juice, six ounces of regular soda, or eight ounces of milk are all great choices.
  3. Recheck blood sugar in 15 minutes.
  4. If blood sugar has not risen to > 70 mg/dL, repeat steps 2 & 3.

If your headache is due to hyperglycemia, blood glucose fluctuations, or your headache does not resolve after treating a low blood sugar; typically an over-the-counter medication is adequate in treating the pain like ibuprofen and acetaminophen.

For very resistant headaches, some doctors will treat the headaches like migraines and prescribe medications such as triptans, beta blockers, or antidepressants.

Natural remedies can be effective in treating headaches:

  • Essential oils such as thyme, peppermint, and rosemary can be applied topically to the head.
  • Magnesium 400mg daily has been shown to reduce the prevalence of headaches.
  • Butterbur extract has been shown to help with migraines, so this may be beneficial if your headaches are very resistant.

The best thing you can do, though? Get your blood sugars under control! Preventing the highs, lows, and fluctuations from occurring in the first place can prevent headaches.

If you take insulin there will always be the unexpected numbers due to miscalculated carbohydrates, illness, stress, and the unknown – but your best bet is working hard to get your A1C back into the target range.

Now, what about if your A1C is on target and you’re having a lot of low blood sugars – resulting in a lot of headaches? It could be that you are on too much insulin. Again, it is important to reach out to your care team to readjust your insulin dosages.

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