Changes in Plasma Glucose Levels During Migraine Attacks

Plasma glucose levels are increased in patients with migraine with and without aura during spontaneous migraine attacks compared with the interictal state, according to study results published in Headache.

Previously, it was suggested that blood glucose fluctuations may contribute to migraine attacks. While there is evidence that during the interictal phase patients with migraine have impaired insulin sensitivity and higher fasting plasma insulin levels, limited data are available on changes in blood glucose levels during migraine attacks.

The goals of the study were to explore the changes in blood glucose levels during migraine attacks, the correlation between these changes and pain characteristics, and to assess for differences between patients with and without aura.

This sub-study included 31 of 38 patients from a larger study conducted at Rigshospitalet Glostrup, Greater Copenhagen, Denmark. The study cohort included adult patients aged 18 to 65 years with a diagnosis of episodic migraine with and without aura.

Blood samples were drawn during and outside of spontaneous migraine attacks. Plasma glucose values were corrected for diurnal variation of plasma glucose by subtracting the difference between the moving average (intervals of 2 hours) and overall mean from the plasma glucose values. Headache intensity was rated on a verbal rating scale (VRS) from 0 to 10 (0: no pain, 10: worst imaginable pain).

Of the 31 patients (24 women, mean age 39 years), 13 were diagnosed with migraine with and 18 without aura. The mean time from attack onset to blood sample drawing was 7.6±4.3 hours. The mean pain intensity during attacks was 6.0±2.2.

Average blood glucose levels were significantly higher in the ictal phase compared with the interictal phase (89.30±13.71 mg/dL vs 99.52±11.07 mg/dL, respectively; difference of 10.20 mg/dL; 95% CI, 4.50-15.94, P =.001). Following correction for diurnal variation, the average plasma glucose levels were still significantly higher in the ictal phase (88.63±11.70 mg/dL vs 98.83±13.16 mg/dL, respectively; difference of 10.20 mg/dL; 95% CI, 4.30-16.10, P =.0014).

The ictal increase was highest in patients investigated early during attacks and decreased linearly with time from onset of migraine (−1.57 mg/dL/hour from onset of attack with correction for diurnal variation).

There were no differences between patients with migraine with and without aura in average plasma glucose levels with or without correction for diurnal variation. I n a similar fashion, the attack-related increase in blood glucose was not affected by pain intensity.

The researchers noted several study limitations, including missing data on the patients’ diets prior to blood sampling and on potential confounders that may have an effect on plasma glucose levels such as cortisol, epinephrine, or glucagon levels.

“We found increased levels of plasma glucose in migraine patients with and without aura during spontaneous migraine attacks compared to the interictal state. While increased plasma glucose may be a consequence of a systemic stress response to pain and discomfort, a migraine-specific mechanism is, of course, also possible,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Zhang DG, Amin FM, Guo S, Vestergaard MB, Hougaard A, Ashina M. Plasma glucose levels increase during spontaneous attacks of migraine with and without aura [published online ahead of print, 2020 Feb 7]. Headache. doi:10.1111/head.13760