FAQ Episode 67: Sweet cravings, hypoglycemia and migraine

Frequently Asked Questions about Natural Migraine Relief for Women

Not everyone likes to journal the details of their medical problems. Especially when in the throes of managing the suffering. But one clue to recall about the onset of a headache is a craving for sweets. It’s also a kind of chicken and egg situation. Did a low blood sugar tip the scale to bring on a migraine? Or did the prodrome (early) phase of the migraine also drop blood sugar and bring out the craving for something sweet? Or both? Then…either way, what to do next time? Or maybe even, minimize all those next times.

There is no shortage of theories of why migraines happen. Most likely all of them are to some degree true for most who suffer headaches. But which fraction of your migraine event can be attributed to any one contributing factor? And which explanations apply specifically to your story? And once again, what to do? Let’s explore the sugar connection.

What makes your brain run?

Low blood sugar as a potential ‘trigger’ for migraine was proposed as far back as 1935. I would put hypoglycemia into the “neuro-energetic” category of migraine provocation. Ordinarily, your brain runs second by second on just two energy components: oxygen and glucose, although it can also use ketones for energy. While it takes about 12-15 seconds to lose conciousness without oxygen, when blood glucose levels drop, you can have suboptimal brain cell function for some time before you demonstrate obvious neurological deficits. This is the zone where reduced energy reserves can lower the threshold where a migraine can be initiated. Studies show that energy levels (as measured by the molecule ATP) in the brains of migraine sufferers is already 16% lower¹ than in controls and even worse during the migraine itself. We don’t need to have anything else piling on board to aggravate this energy shortfall.

Situations that can set up a low blood sugar event

You don’t need to have a diabetic condition to suffer blood sugar highs or lows. You can get on the “blood sugar rollercoaster” by:

• not having enough carbs by skipping or delaying meals, including planned fasts or intermittent fasting.

• the flip side of this is having a recent high carb meal which resulted in a release of extra insulin. This can lead to a blood sugar drop out several hours later.

• drinking alcohol which is, in its own way, a concentrated liquid carb.

• exercising too intensely, especially if carb intake was low before the exercise session.

• being diabetic and having a mismatch between your medication and the intended glucose lowering benefit.

• those with gastric bypass surgery or on GLP-1 type meds (Ozempic, etc.) where food volume or bowel transit time is modified.

Keep in mind that “hypoglycemia” is a relative term, meaning the drop in blood sugar is to a lower level than what you’re used to. Typically, those with “normal” blood sugars would have to drop their blood glucose from 90 mg/dl to 55-60 mg/dl levels before its “too low.” For adults with low grade or undiagnosed diabetes, the same drop could be from 115 mg/dl to 75-80 mg/dl. The 75 sounds “fine,” but it’s the relative change that counts.

Symptoms of low blood sugar can include:

• feeling hungry

• feeling dizzy or light-headed

• feeling anxious, irritable, or moody

• headache

• sweating

• shaking, tremor in hands, tingling in lips

• fast heart rate or heart palpitations

• feeling tired, weak, or “suddenly exhausted.”

• changes or blurring in your vision

• feeling confused, or having problems concentrating or finding the right words

If you are having one or more of these symptoms, especially if they occur before, or right at the onset of a migraine, it’s very possible that hypoglycemia is a promoting factor for your migraines. Keep in mind that it is rare for any one promoting factor to be the only root cause factor for your headaches. But the more of your underlying migraine root causes you identify and manage, the better your current meds can work, and perhaps the less interventions of any kind you’ll need to be as headache free as possible.

Action Considerations:

1. It may be worth the effort to buy or borrow a blood glucose monitor. You can get a simple yet reliable version like One Touch or similar brands in the $30s range. Check your blood sugar to verify if a level of 30+ points lower than “your average” correlates with prodromal symptoms, an aura, or the headache itself. You may need to take a few AM fasting levels to find your normal baseline for a comparison.

2. Consider having blood work for a “glycosylated hemoglobin” level, also called an “A1c” which is a running average for blood glucose over 90 days. You’ve seen the dancing diabetics on the Jardiance drug ads, right? That’s the A1c they’re talking about. It can give you an idea if you are one of the millions of Americans who run near the edge of insulin resistance, where hypoglycemia doesn’t have to drop to 55 mg/dl to be an issue. A check of your fasting insulin level can also inform on this. When our cells use glucose less efficiently as an energy source, we end up making more baseline insulin to compensate. Although it varies among labs, “normal fasting insulin levels” range between five and 15 μU/mL, and preferably should run <10 μU/mL, optimally even less than five. If either the A1c or fasting insulin are sub-optimal, you should discuss the details with your personal physician. There’s multiple factors involved, but one that I’ve found most beneficial over time is to improve the tone and fitness of your total body muscle mass, so that it is a more stable “calorie burning platform” for 1) hour to hour energy 2) calorie burning and weight loss and 3) blood sugar stability.

   One could debate the relative merits of cardio, strength training and flexibility work, but whichever you choose, focus on 1) consistency…like, show up! and 2) gradual progression…you’ll get there, just stay in the game! Sorry about the implied yelling there, it just felt to me like readers might be feeling a bit snoozy at this point in the post (or did I just have too many carbs for lunch?)

3. If you find that hypoglycemia is provoking an impending migraine, you may benefit from ~15 grams of carbs (~100 calories) as ‘a quick glucose fix,’ like fruit juice (1/2 cup), half a banana, four to five saltine crackers, a small piece of fruit, or a tablespoon of honey. You can also take two to four glucose tablets directly when you have the “pre-headache blood sugar dive symptoms”; every pharmacy has them as a non-prescription rescue remedy for hypoglycemia. If you try this, it might be best to use a glucose monitor to gauge your best dose.

4. Consider the value of ketones in pre-migraine brain energy support. Ketogenic diets have shown value in reducing the overall incidence of migraines. You may also benefit from a trial of oral ketone supplementation used at the times that you’re most vulnerable to low blood sugar provocation of migraine. A simple way to take a test drive on this would be to get a liquid ketone supplement (known chemically as BHB, or beta-hydroxy-butyrate) like Ketone-IQ or KetoneAid with around 10 grams of ketone per dose, and take it proactively in your vulnerable migraine-prone zones, such as post exercise or if having extended hours between meals. A low cost version of this is to buy magnesium-BHB powder online (e.g. bulksupplements.com) and mix up your own version with 2 tsp in 3-4 ounces of water or juice. I’d try one of the liquid pre-mixed versions first to find out if this works for you.

   If you are looking for a nutritional support combined with ketone therapy, take a look at Migraket, an excellentnon-prescription product which combines the nutrients needed for optimal brain energy production, along with ketone support

   One caveat on regular ketone use is that ketone supplementation has been reported to interact with the drug Topimax (topirimate), which is commonly used for migraine management. Avoid combining them unless cleared by your personal physician.

Just like managing every other potential root cause factor in migraines, 90% of the hardest part is knowing for sure if it’s true for you. The other 90% is the “what to do” part. To learn more about how you can make that 180% work for you, take a look at what you can learn about the broad range of migraine “root cause” factors by surveying my online course “Natural Migraine Relief.” For details, check out FAQ Episode 42: What can I learn from the Natural Migraine Relief course?

As always, the content of Natural Migraine Relief is not intended to be a substitute for individualized professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

1. The metabolic face of migraine — from pathophysiology to treatment Elena C. Gross, et.al. Nature Reviews Neurology Volume 15, pages 627–643 (2019)https://www.nature.com/articles/s41582-019-0255-4