Chronic migraine headaches are known as the 7th most common cause of disability. 1 in 7 people worldwide suffer from migraines . While researchers are still unclear of the exact cause, there are a variety of triggers for chronic headaches and migraines including food, hormonal fluctuations, musculoskeletal strain, neurological stressors, among others. What can we do in our control to minimize our susceptibility to these headache episodes? One controllable factor that influences multiple triggers (food, neurological, hormonal, and stress) is blood sugar. This article will look at how a major biomarker like blood sugar, aka blood glucose, could be at the root of your migraines or headaches.
Migraines and Associated Health Risks
A 2018 study following people who suffer regular migraines for the past 18 years found that migraine sufferers had higher risk of experiencing these life-threatening conditions:
- Heart attack
- Atrial fibrillation 
What We Know About Migraines
Why migraines affect some people more than others is still a mystery to researchers. Researchers believe that fluctuations in hormones like estrogen contribute, which is why 18% of US women (and up to 37% of women in reproductive years) suffer migraines compared to just 6% of men .
The mechanism of migraines, although still not fully understood, may be tied to either constriction (narrowing) or dilation (expansion) of blood vessels in the brain . It’s this neurological dysfunction which separates migraines from an everyday headache.
Also, you may have heard that “stress” can cause the onset of migraines as well. And because some of us may not realize or recognize stress as easily as our subconscious nervous system can detect it, it’s extremely important that we accurately measure stress with the proper testing methods. Four general categories of stress include glycemic regulation, perceived stress, inflammation, and circadian disruption. This article will focus on the first category: glycemic regulation .
Migraines and Blood Sugar
Research has shown that both high and low blood sugar can cause the onset of migraines . Migraines can become more frequent if you have a high BMI, or body mass index . And because this study shows that “Increased BMI was associated with increased prevalence of diabetes mellitus, hypertension and dyslipidemia,” it’s very important that you track and control your blood sugar levels to avoid blood sugar levels that swing wildly out of control .
Taking over-the-counter medications or prescription drugs prophylactically may help to stop the progression of a headache, but not always. If we are looking to avoid additional headaches in the future, we need to act proactively, not reactively. And because we now know that they can be exacerbated by blood sugar dysregulation.
What do I mean by blood sugar dysregulation? Well, hang with me here and see for yourself. Do an internet search for “avoiding migraine” and here’s a list you’re likely to see:
- Avoid skipping meals
- Eat meals regularly
- Establish a regular sleep schedule
- Make sure you get enough sleep
- Take steps to avoid too much stress
- Limit your caffeine intake
- Make sure that you get enough exercise
- Lose weight if you’re overweight or obese 
Most people who suffer from migraines will tell you these recommendations are minimally to moderately helpful, but with 39 million Americans still suffering from migraines, these aren’t addressing the root cause of the condition.
But if you read between the lines, there is a hidden message encoded in a list like this. What do all these recommendations have in common?
Answer: They all are inextricably linked to metabolic flexibility.
What the heck does that mean? Let’s break it down to details you’re not likely to hear your healthcare provider talk about.
In a nutshell, metabolic flexibility refers to the ability of your ability to switch between using glucose (i.e. sugars and carbohydrates) and fats . If you have the flexibility, your body can easily derive energy from carbs or fats. The analogy for healthy metabolic flexibility would be a hybrid car that switches between gasoline/petrol and an electric battery. When this system starts to have problems, the car analogy is more like a large oil tanker hauling thousands of gallons worth of fuel. Even though there are thousands of gallons in cargo, the engine can’t access that fuel source. There’s lots of fuel aboard without any practical way to access it.
Migraines and Blood Sugar…AND seizures?!
The research has confirmed that migraines are not just ordinary headaches, they are a neurological condition. Seizures have signs and symptoms that are so similar to migraines, they are often misdiagnosed as ictal headaches. There are even accounts of seizures that immediately follow a migraine. Doctors are now calling this “migralepsy.” In fact, migraines and seizures are thought to share similar causes by neurologists treating both with the same medications  .
What Does All This Have To Do With Managing Migraines?
The connection lies within the metabolism of neurons…remember the whole metabolic flexibility thing? In children with drug-resistant seizures, one of the most promising interventions we have is improving metabolic flexibility via the ketogenic diet. The ketogenic diet is also the treatment of choice for seizures in the class of “glucose transporter type 1 deficiency syndrome” or GLUT1DS. No anticonvulsant medication comes close .
What should we be learning from all this? Before using pharmaceutical interventions with unintended consequences including sedation, cognitive impairment, tremors, and gastrointestinal side effects, we first need to address the basics of cellular metabolism  . A low-cost, effective way to do this is purchasing a blood glucose monitor to periodically take note of your blood sugar levels around the time of your headache or migraine episodes. It’s not fool-proof, but it is a helpful marker to help determine if and how your blood sugar is related to your health. For determining what levels to aim for, see this article on the Basics of Blood Sugar Testing.
If you notice your blood sugar levels are out of range on a regular basis, you may have more serious blood sugar dysfunction going on. Addressing this through nutrient dense, whole foods, physical activity, sleep, and stress management are the broad categories that are most helpful when starting off. For many people this may be enough to correct the problem, while others may need a more individualized, functional medicine approach.