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We all get the odd headache. In fact, 15 per cent of Australians will have popped a painkiller to treat one by the time you finish reading this story. People living with diabetes, however, are more likely to be hit with headaches than the rest of the population, and having diabetes may even increase your migraine risk.
‘Headaches are one of the most common complaints doctors are presented with,’ says Dr Tony Bartone, president of the Australian Medical Association (AMA) Victoria. ‘That, combined with the fact they can be caused by a variety of things, means it’s understandable that some people may not make the link between their diabetes and their headaches.’
Find the link and you are halfway to solving the problem. Here’s what to look for…
High or low blood glucose levels
A headache can be a symptom of hypo- or hyper glycaemia – when blood glucose levels go too low or too high. Low blood glucose levels trigger the release of hormones that cause vasoconstriction – a narrowing of the blood vessels – which may bring on a headache. High BGLs can cause you to run to the loo more often, which sometimes leads to dehydration and, in turn, a headache.
THE FIX: As soon as you feel a headache coming on, test your blood glucose levels. This is especially important if you frequently wake up with a pounding head, which could be a sign of nocturnal hypoglycaemia (going too low overnight) if you take insulin or certain other medications. See your doctor if you suspect this is the cause of your headaches. If your levels are low, treat them with 15g of fast-acting carbohydrate and monitor your symptoms as your blood glucose levels return to normal. Once they stabilise, the headache may ease.
On the other hand, if your levels are high, exercise may help, but first check your urine for ketones (a product of fat breakdown) if your fasting blood glucose level is above 14mmol/L. If ketones are present, skip the exercise, because that can push your levels even higher, and see your doctor. These options aside, though, if you suspect there’s a link between your blood glucose levels and your headaches, working on a long-term preventive approach, by taking steps to better manage your levels, is smart.
‘Headaches caused by fluctuating blood glucose levels can be more common for people newly diagnosed with diabetes, because they’re still trying to understand how to keep their blood sugars stable,’ says Dr Bartone. ‘Talk to your GP or a credentialled diabetes educator.’
Stress
Studies have found a link between stress and headaches. This is because stress instructs the nervous system to flick the ‘fight or flight’ switch, leading to shallow breathing, increased blood pressure and muscle tension. On a hormonal level, your body becomes flooded with adrenaline while your levels of relaxation chemicals, such as endorphins, plummet. Unless stress eases, the body stays on alert and headache can be just one side effect.
THE FIX: It’s easier said than done, but trying to moderate your stress levels is key to avoiding those stress-related headaches. A range of factors contributes to stress, but living with diabetes can be a cause of stress all on its own. It can be a real vicious circle, with stress then affecting your blood glucose levels.
Day to day, establishing routines, practising relaxation techniques such as meditation, noticing how you talk to yourself and spending time with people you care about all help. ‘A number of strategies can be effective, but the first step is often acknowledging the situation and asking for help,’ says Dr Bartone. ‘If you experience physical symptoms of stress, including frequent headaches, talk to your GP about how to better manage that stress.’
Sleep Apnoea
If you have type 2 diabetes and you get unexplained morning headaches, it might be worth asking your GP about sleep apnoea. ‘Someone who has sleep apnoea will repeatedly stop breathing or take very shallow breaths throughout their sleep and may snort, choke, gasp or snore loudly whenever normal breathing recommences,’ says endocrinologist Dr Sultan Linjawi. ‘This stop-start breathing can result in reduced blood-oxygen levels throughout the night. Unsurprisingly, these sleep disruptions can mean that you wake up with a headache.’
THE FIX: The first place to start is with an accurate diagnosis. Your doctor may refer you for a sleep study where your breathing, oxygen saturations and sleep quality will be assessed. If the results show you have sleep apnoea, it is likely you will benefit from a CPAP machine.
‘CPAP stands for continuous positive airway pressure and, as the name suggests, it supplies a constant stream of air to keep the airways open throughout the night,’ says Dr Linjawi. The machine consists of a nasal or oral/nasal mask connected via tubing to a small machine, similar to a nebuliser, that sits on your bedside table. ‘There are several models and most people choose one based on the mask they find most comfortable,’ he says.
High blood pressure
Most people with high blood pressure, or hypertension, don’t have any symptoms, but it can cause a headache if your reading is high enough for long enough. ‘If you think of your brain as encased in a box – your skull – it makes sense that an increase in circulatory pressure could cause a headache,’ says Dr Bartone. High blood pressure is common in people with diabetes, so if your blood pressure is normal, have it checked every six months, but if it’s elevated, get it tested every three months.
THE FIX: There are many ways to treat high blood pressure, so if you have been diagnosed and your doctor has prescribed medication, make sure you take it as directed to help bring down your readings. Making lifestyle changes can also help moderate blood pressure.
Exercising regularly, cutting back on salt, limiting alcohol and quitting smoking will all help lower your levels. And if you need to trim down, studies have shown that shedding just five to 10 per cent of your body weight is likely to produce an improvement in blood pressure as well as in your overall health.
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