Headaches are a common complaint among people with diabetes. But can diabetes directly cause headaches? Or are there other factors at play? Below we’ll explore the link between diabetes and headaches.
The short answer
Diabetes is not generally considered a direct cause of headaches. However, the fluctuations in blood sugar levels that occur with diabetes can trigger or exacerbate headaches.
How diabetes affects headaches
While diabetes does not directly cause headaches, having diabetes may make you more prone to headaches for several reasons:
- Blood sugar swings – The fluctuations in blood glucose levels that occur with diabetes can trigger headaches. Both high and low blood sugar levels may cause headaches.
- Medication side effects – Certain diabetes medications like metformin may cause headaches as a side effect in some people.
- Dehydration – People with high blood sugar often urinate more frequently, which can lead to dehydration and electrolyte imbalances that can cause headaches.
- Diabetes complications – Nerve damage (neuropathy) and blood vessel damage from diabetes can cause headaches.
- Stress – Having a chronic disease like diabetes can be stressful, and stress is a common headache trigger.
Blood sugar and headaches
One of the main ways diabetes is linked to headaches is through fluctuations in blood glucose levels. Both high and low blood sugar levels may trigger headaches or migraines in some people with diabetes.
High blood sugar and headaches
Hyperglycemia, or high blood sugar, can sometimes cause headaches due to:
- Dehydration – High blood glucose causes more frequent urination and fluid loss, which can lead to dehydration. Dehydration causes electrolyte imbalances and can trigger headaches.
- Ketoacidosis – In severe hyperglycemia, metabolic acids called ketones build up in the blood. This condition (diabetic ketoacidosis) often causes headaches.
Low blood sugar and headaches
Hypoglycemia, or low blood glucose, can also trigger severe headaches and migraines in some people with diabetes. This may occur due to:
- Brain cell starvation – Glucose is the main source of fuel for brain cells. When glucose levels drop too low, brain cells become stressed and trigger pain signals that may register as headaches.
- Dilated blood vessels – As a protective measure, blood vessels in the brain dilate (widen) when blood sugar drops too low. This rapid dilation can cause headaches.
Diabetes medications and headaches
Certain medications used to treat diabetes can also sometimes cause headaches as a side effect. These include:
- Metformin – The most common first-line diabetes drug. Headaches are an uncommon side effect, affecting around 1-5% of metformin users.
- GLP-1 agonists – Injectable medications like liraglutide (Victoza) and semaglutide (Ozempic) may cause headaches in up to 10-20% of people, especially when first starting these medications.
- Sulfonylureas – Oral meds like glipizide and glyburide. Headaches occur in less than 5% of people taking sulfonylureas.
- Insulin – Headaches are an occasional side effect of insulin therapy. This may be due to changes in blood sugar levels or hypoglycemia.
Headaches caused by diabetes drugs tend to improve over time as the body adjusts to the medication. But let your doctor know if you have persistent headaches after starting any new diabetes medication.
Diabetes complications and headaches
Some of the long-term complications that can occur with diabetes may also cause or contribute to headaches. These include:
Diabetic neuropathy
Over time, high blood sugar levels can damage nerves throughout the body. This nerve damage (diabetic neuropathy) most often affects the feet and legs, but can also damage nerves in the head and neck.
Cranial neuropathies and other types of diabetic nerve damage in the head and neck area can sometimes manifest as chronic headaches or facial pain.
Retinopathy
Diabetic retinopathy refers to damage to the small blood vessels and nerves in the retina at the back of the eye. Retinopathy can cause visual changes, eye pain, and headaches.
Blood vessel damage
Poorly controlled diabetes accelerates atherosclerosis, or hardening and narrowing of blood vessels throughout the body. This reduces blood flow to the brain and scalp, which may worsen headaches.
Stress and headaches
Having to manage a chronic condition like diabetes on a daily basis can be stressful. Stress and anxiety are very common headache triggers.
Feelings of being overwhelmed, burnout from daily diabetes management, blood sugar frustrations, fears about complications – all of these stresses that often accompany diabetes can provoke headache pain.
When to see a doctor
Occasional headaches are common. But see your doctor if you experience:
- Frequent headaches (more than 2 per week)
- Severe headache or migraine pain
- Headaches along with other concerning symptoms like vision changes, weakness, dizziness, confusion, etc.
New onset of frequent headaches warrants medical evaluation to look for underlying causes like high blood pressure, diabetes complications, or other health issues that may require treatment.
Treatment options for diabetes-related headaches
Working with your healthcare providers, there are ways to prevent and treat diabetes-related headaches:
Regulating blood sugar
Keeping blood glucose levels in a healthy target range can help stabilize blood sugar swings that may trigger headaches. This may include adjusting medications, meal planning, physical activity, and blood sugar monitoring.
Staying hydrated
Drinking plenty of water and avoiding dehydration can help minimize headaches. Electrolyte replacement drinks can sometimes help replenish electrolytes lost through excess urination.
Medications
For persistent headaches, prescription medications may be recommended. These can include pain relievers, anti-inflammatories, anti-migraine drugs, blood pressure medications, etc. Botox injections may help chronic migraines.
Alternative treatments
Relaxation techniques, biofeedback, acupuncture, cognitive behavioral therapy (CBT), hypnosis, and supplements like magnesium or CoQ10 may help relieve headaches for some people.
Lifestyle measures
Getting enough sleep, managing stress, limiting alcohol, staying active, and identifying and avoiding headache triggers can also help prevent headaches.
The bottom line
While diabetes does not directly cause headaches, having frequent blood sugar fluctuations, diabetes medication side effects, disease complications, and increased stress can make headaches more likely for many people with diabetes.
Working closely with your healthcare team to optimize blood sugar control and treat any underlying factors contributing to your headaches will provide the best chance of relief.
