Diabetes and Headaches: Is There A Link?

  • Diabetes and Headaches: Is There A Link?

Diabetes is not directly related to causing headaches and headaches are not always a symptom of diabetes but there are certain situations where the two medical conditions are connected. Diabetes can trigger severe head pain at specific times.

Changes in blood sugars, either low or high, is one reason people with diabetes suffer with headaches. “The more your blood sugars fluctuate, the more headaches will occur.” Having too low a sugar or too high a sugar throws your entire body off balance.

Let’s explore reasons for headaches in diabetes as well as triggers and treatments.

What are headaches?

Headaches are extremely common and most everyone experiences them at some point in their lives. “A headache is a pain in your head or face often described as a pressure that is throbbing, pounding, constant, sharp or dull.”

A headache can also feel like “a tight band around your head, neck or face as well as a squeezing sensation.” Headache pain results from signals interacting between your brain, blood vessels and nerves. There are over 150 kinds of headaches and no two people describe their symptoms exactly the same.

Primary and Secondary Headaches

Primary headaches are considered “independent of other medical issues” or having no underlying cause. They include tension headaches, migraines, migraines with aura and cluster headaches. Primary headaches are considered more bothersome than dangerous. Primary headaches often are caused by triggers including:

  • Drinking any alcohol beverage
  • Red wine (due to sulfites)
  • Foods with nitrates such as deli or processed meats
  • Nicotine from cigarettes
  • Lack of sleep, poor sleep, insomnia
  • Dehydration
  • Skipped meals
  • Eating no or too few carbohydrates
  • Symptom headaches: caused by sneezing, coughing, laughing, crying, blowing your nose or straining
  • Breathing 2nd hand smoke
  • Exercise
  • Poor posture
  • Use of MSG (a flavor enhancer for food)
  • Changes in weather
  • High altitude living
  • Loud, unexpected noises

Secondary headaches are caused by other medical issues including acute sinusitis, brain aneurysm, diabetes, fevers, hypertension, hormone changes, allergies, breathing foreign substances in from the environment, strokes and sensitivities to diabetes medications.

How are headaches diagnosed?

Besides a good history and physical performed by your health care professional, you may also need a CT scan, EEG or an MRI to rule out certain diseases contributing to the headaches. Bloodwork will also be done including a CBC, thyroid levels, glucose level, electrolytes, BUN and sed rate.

Hypoglycemia – Low blood sugar:

Hypoglycemia occurs when there is not enough glucose or sugar in the blood stream with a numerical value of 70 mg/dl or under. Each person reacts differently and some people with diabetes have symptoms of low blood sugar even with normal or high numbers.

A “hypoglycemic headache” generally presents with a dull yet throbbing headache at the temples of the head, prior to many other symptoms of low blood sugar. Other symptoms of low blood sugar may include:

  • Anxiety
  • Hunger
  • Rapid/ irregular heart rate
  • Shaking/tremors
  • Weakness/fatigue
  • Dizziness, confusion, nightmares

Hypoglycemia comes on quickly and in severe cases can result in seizures, coma or death, if not treated. Always check your blood sugars based on recommendations that you and your health care provider have decided on. Using a glucose monitor or wearing a continuous glucose monitor [CGM] allows you to find out your blood sugars quickly and treat appropriately.

Low blood sugar causes the hormones epinephrine, adrenalin, and norepinephrine to pour into the blood stream and constrict the blood vessels, possibly causing the headache. The profound release of adrenalin tries to maintain glucose to the brain and increase liver production of glucose.

It causes the heart rate to go up, the systolic blood pressure to go up and increase the hearts workload. The brain is in “fuel deprivation” or starving for sugar. Migraines, lack of coordination and concentration can be triggered by low blood sugar.

Possible reasons for Hypoglycemia:

  1. Too much diabetes medication, mainly insulin or sulfonylureas
  2. The longer you have been on insulin
  3. The longer you have had diabetes
  4. Not eating enough food
  5. Not eating enough carbohydrates
  6. Too much exercise
  7. Skipping meals
  8. Vomiting and diarrhea
  9. Too much alcohol

How to correct Hypoglycemia and prevent or resolve the headache

The fastest and easiest way to correct low blood sugar is to drink or eat simple sugar. The “15-15” rule is used. Test your blood sugar, chew 3-4 glucose tablets, or drink 4-6 ounces of fruit juice and retest in 15 minutes.

Your headache may linger after you have corrected your blood sugar, but it will eventually resolve. Follow it with a snack of protein and complex carbohydrate and calorie-free vitamin water or water with electrolytes. Make sure to figure out the reason for the low blood sugar so you can prevent it from occurring again.

Hyperglycemia – High blood sugar:

Your brain uses sugar for energy but too much sugar can be dangerous to the brain blood vessels that carry oxygen rich blood. Hyperglycemia or high blood sugar can often cause headaches by stressing the brain. Not only can hyperglycemia lead to headaches but it can also lead to mood shifts.

One side effect of hyperglycemia is severe dehydration which can increase the risk for severe headaches. Dehydration shrinks body tissues by reducing water content which creates excess pressure on the nerves and creates a headache. Drinking extra water also helps the kidneys flush out the excess sugar and helps regulate blood sugars.

Certain people with diabetes exhibit no hyperglycemia symptoms including headaches even with extremely high blood sugars. Usually, the longer you have uncontrolled diabetes the worse the symptoms are. Using a blood glucose monitor can prevent you from just guessing your blood sugar numbers.

Diabetes headaches from high blood sugars are called “Occipital neuralgia headaches – the scalp, upper neck, back of head and behind the ears have a stabbing, throbbing and shock like pain. This can feel like a migraine.

Symptoms of high blood sugar (this usually occurs at blood sugars of 180mg/dl or above):

  • Increased thirst
  • Increased hunger
  • Increased urination
  • Headaches- sometimes called “sugar headaches”
  • Blurred vision
  • Irritability
  • Extreme fatigue

Avoiding high blood sugars is the best way to prevent these headaches:

  1. Make sure you are monitoring your blood sugars
  2. Take your diabetes medication as directed
  3. See your MD for all appointments
  4. Eat appropriate portions of food throghout the day
  5. Eliminate empty calories and added sugars
  6. Do not drink any regular sweet beverages
  7. Exercise to achieve better blood sugar control
  8. Treat illness like colds, flu, COVID, fevers and infections to control blood sugars

Could stress be a factor causing your headaches?

High stress levels can increase blood sugars and alter hormone levels leading to a headache. Hormones such as epinephrine and norepinephrine can cause constriction of blood vessels in the brain. This can limit blood flow, increase pressure and cause head pain. With stress, cortisol pours into the blood stream which raises blood sugars and causes more headaches.

What about migraines?

There is a link between migraines and type 2 diabetes since “they both involve the vascular system and the transmission of nerve impulses.” People with migraines have higher insulin resistance, as do those with type 2 diabetes, more cardiovascular disease, more endocrine disorders and more psychological problems.

Migraines affect their overall quality of everyday life. A common trigger causing migraines is sugar and the brain is sensitive to the amount of sugar it receives. Migraines affect about 20% of the general population and women suffer 3 times more than men. It generally affects people from 25-50 years of age, and it is the 2nd most debilitating neurological disease.

Migraines have been associated with an increased risk of stroke and coronary artery disease similar to diabetes. Symptoms of a migraine are “super painful, throbbing or pulsating sensation usually on one side of your head.” An aura can be associated with migraines. An aura is considered a warning sign.

Auras may include blind visual areas, seeing bright flashing lights, visualizing sparkles or dots, having ringing in your ears or tinnitus, dizziness, vertigo or just a plain funny feeling. Up to 80% of people with migraines have a genetic component and have a close relative with migraines.

“Hypoglycemia or low blood sugar has a stronger association with migraines, since fluctuations in blood sugars may change pain receptors in the brain.” Fasting is one of the most well-known migraine triggers with a percentage of 39-66%. Another investigation found “insulin sensitivity is reduced in patients with migraines.” More research and studies must be done to tie these conditions together.

Tension headaches

Tension headaches are very common in those with or without diabetes. Tension headaches are still not well understood. They are usually mild to moderate with more head tenderness and a dull, aching pain. Tension headaches rarely cause visual disturbances or changes, nausea or vomiting.

A tension headache can be caused by eye strain due to poor lighting or improper glasses. TMJ temporomandibular joint disease can also cause tension headaches. They can be caused by lack of sleep or staring at a computer for too long. Any blue light source can cause a headache.

Tension headaches can be triggered by stress, or other emotions. One theory of a tension headache is “having a heightened sensitivity to pain.” There are 2 types: chronic and episodic tension headaches. These headaches can truly affect your quality of life if they become chronic.

What is a sugar rush, sugar crash and sugar withdrawal?

Both a sugar rush and sugar crash can induce a headache. A sugar rush (often considered a myth until it happens to you) can result after eating too much sugar causing a sugar crash or hangover. A sugar rush can cause physical symptoms including an upset stomach, shaking, fatigue, mood swings and severe headaches.

Again, the sugar constricts the blood vessels in the brain creating a headache. A sugar rush can occur after eating too many processed and hidden sugary foods such as donuts, pastries, cakes, cookies, candy, regular soda and juice. Then comes the sugar crash.

The sugar crash comes because “your body dumps out more insulin to carry the sugar into the bloodstream”, lowering the blood sugar, making you hungry, decreasing your energy level and creating a vicious cycle. If you regularly consume too much hidden and empty sugars, it can become addictive.

If you then suddenly limit the amount of added sugar, it can influence your neurotransmitters (dopamine) of your brain and create a migraine type of headache. This will occur less frequently when your body gets used to eating less processed sugars. Sugar withdrawal can last from a few days to multiple weeks making you irritable and craving more sugar.

How can you treat headaches at home?

  • For low sugars. Correct the blood sugar problem. Have 15 grams of glucose, Rule of 15, in either glucose tablets, regular life savers, 100% fruit juice or regular soda. Get blood sugars back into normal range and follow up with a protein/carbohydrate snack if you are not due for a meal in the next 15-30 minutes.
  • For high blood sugars. Correct the blood sugar problem. Drink water to dilute the blood sugar. Make sure you have taken your diabetes medicine correctly. Go for a walk. Eat carefully, concentrating on protein foods and eat less complex carbohydrates. Avoid any added sugars. Contact your health care provider if you can’t get back into normal range with these simple methods.
  • Take OTC remedies such as Advil, Aleve or Tylenol, all are known as NSAIDS. Migraine headaches are more severe and require more specific medication treatment. Make sure to contact your doctor if you have kidney disease with your diabetes. OTC medications may affect kidney function. Too many OTC pain relievers can also cause GI upset and gastric bleeding. Over time you can build up a tolerance to pain relievers requiring more and more with less of an effect.
  • Get fresh air. Stagnant air or air full of fragrances may be adding to your headache.
  • Hydration. Stick to plain water or water with electrolytes if blood sugars are elevated and small servings of sugary solutions if blood sugar is low.
  • Rest. Try resting or relaxing in a cool dark place.
  • Pain Management. Apply hot or cold compresses and alternate 10-20 minutes on with 10-20 minutes off.
  • Relax. Deep breathe or meditate. Practice progressive muscle relaxation.
  • Aromatherapy. Use aromatherapy by using 100% essential oils which may relieve your headache. These oils are “highly concentrated liquids made from leaves, stems, flowers, bark or roots of plants.” The best oils for headache relief are: eucalyptus, peppermint, rosemary, lavender and chamomile. Dilute 5 drops of essential oil in one ounce of carrier oil such as coconut or olive. Never ingest these oils and do not put them directly on your skin unless you have done a small patch test first.
  • Apply pressure to your temples in a circular motion. Massage your scalp gently.
  • Stretch. Do a few simple yoga poses and stretches for increased blood flow.
  • Do self-acupressure techniques.
  • Consider biofeedback. Cognitive behavioral therapy or acupuncture with a professional if headaches become frequent and unself-treatable.

What about diabetic retinopathy?

Diabetic retinopathy is a common complication of diabetes affecting your eyes also called optic neuropathy. It is caused by damage to the blood vessels of the light sensitive tissue at the back of the eye called the retina. Generally, it is due to long term out of control blood sugars.

Diabetic retinopathy can also be a cause of headaches. By monitoring and controlling your blood sugars, blood pressure and cholesterol, you will be able to prevent this condition. Go for regular eye exams for early diagnosis and treatment.

Can headaches be caused by diabetic neuropathy?

Diabetic neuropathy, another diabetes complication affecting your nerves, can also be the reason for headaches. Diabetic neuropathy is caused by poorly controlled diabetes. If the autonomic nerve is damaged, it can affect how your eyes adjust to light which can create a headache. The focal nerve can be damaged causing “aches behind the eyes and double vision.” Vision focusing problems can lead to headaches.

When should you seek medical help for your headache?

  • If you have a stiff neck which is sudden or severe
  • Frequent headaches for no apparent reasons
  • Throbbing pain on one side of the head or front of the head with any visual changes or disturbances
  • A severe headache with a fever
  • A headache that includes nausea, vomiting and light sensitivity
  • A change in mental status with your headache
  • A change in the pattern of your typical headache
  • A headache where you suddenly demonstrate inappropriate behavior, loss of balance, slurred speech, or a sudden fall
  • A headache with weakness on one side of your body
  • If you suffer from a head injury and a possible concussion
  • A headache with difficulty walking, speaking, or memory problems
  • A headache that includes total body weakness

How to prevent headaches:

Instead of treating a headache, let’s examine easy ways you can hopefully prevent one

  1. Check blood sugars as recommended. Even better, consider wearing a CGM (continuous glucose monitor) to know blood glucose trends before they happen cutting down on hypo and hyperglycemia episodes
  2. Limit alcohol, caffeine and added sugar. These are all triggers for headaches
  3. Make time for relaxation. By avoiding excess stress and anxiety you can prevent a headache
  4. Take your time. Give yourself plenty of time to get errands and chores done. Do not be in a rush
  5. Quit smoking. Nicotine constricts blood vessels which can promote headaches
  6. Watch out for your food triggers such as aged cheese, chocolate and nitrates. Many people are extremely sensitive to these foods. Food sensitivities can trigger neurotransmitters causing a headache
  7. Aspartame. A commonly used artificial sugar in foods and beverages may promote headaches in certain individuals
  8. Talk to your health care provider about supplementing with -vitamin B2, CoQ10 and magnesium. People with migraines tend to have lower levels of magnesium than people who do not get migraines. Low magnesium may constrict brain blood vessels playing a role in migraines. Foods high in magnesium are almonds, cashews, peanut butter, legumes and whole grains. These may reduce your headaches
  9. Treat sleep apnea or other sleep issues. Get yourself high quality sleep for 7-8 hours nightly
  10. Talk to your physician and treat hormone imbalances which may cause headaches
  11. Stay hydrated especially during the warmer months. Consider a sugar-free Gatorade or Vitamin Water for added electrolytes. Do not wait until you are thirsty
  12. Eat water rich foods. Lettuce, broccoli, bell peppers, summer squash (zucchini and yellow), cucumbers, celery, spinach, berries, watermelon, oranges, peaches, cantaloupe, honey dew, pineapples all in proper portion size. Fruit is high in natural sugar, for added hydration
  13. Reduce strong smells. Avoid exposure to food odors, perfumes, artificial fragrances, wall plug- ins, fragrant candles, car air fresheners and any smoke which could all trigger headaches
  14. Wear sunglasses to avoid bright sunlight and use low light with dimmers in your home instead of fluorescent light
  15. Avoid over-using OTC pain relievers which could cause rebound headaches
  16. Practice good posture which keeps blood flowing
  17. Exercise 5-6 days a week just by walking at least 30 minutes
  18. Eat a balanced diet to better control your diabetes. Greek yogurt, lentils, fatty fish, egg whites, lean turkey, avocados, nuts, whole grains and sugar free beverages
  19. Have your hearing checked. If you are hard of hearing, get treated since loud sudden noises and sounds can induce a headache

Having diabetes does not guarantee you will get headaches but there may be some connecting features. Know what you can do to prevent them if you do suffer with headaches. Feel your best!


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About the Author: Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia. She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past. She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups. More about Nurse Robbie

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