Timeless - hyperinsulinaemia in migraineurs 2009

Hi Timeless,

Apologies for such a late response to your message a while back. Here’s the paper you enquired about.

The story is basically this: that there is increasing evidence that problems with glucose and insulin metabolism may be involved in the development of migraine. A chemical that allows for blood vessels to relax (vasodilate) called nitic oxide (NO) plays a big role in vascular function and it can be measured. They have found in this study that migraineurs show greater NO stress. Furthermore they showed that this stress was correlated with hyperinsulinemia – in other words, excessive insulin levels in the blood.

So how does one keep insulin levels in the normal range and also prevent hyperglycemia (gluocse spikes in the blood) which causes insulin spikes? Don’t eat refined carbohydrate and exercise daily as Bernstein outlines: 30 minutes/day at a moderate pace where you can feel your heart working. Strength training is also important; the more muscle mass you have the better you store glucose and the less you need insulin. Strenght training doesn’t mean going to the gym and becoming Arnold Schwarzenegger but it means using your muscles in a way that you can feel them being worked. Strength training is one of the goals in the Sydney Diabetes Prevention Program I’m involved with. We encourgae participants to buy dumb bells and strap on weights that go around your ankles. They then do a routine about 4 days a week on their arms and legs. Walk up stairs instead of using the elevator etc. There’s lots that can be done to make a difference and increase strength.

In terms of diet, everyone here should be lookig at a low glycemic index version – choosing low GI carbs instead of high. Marci has found that she does well on a low carb diet (not to be confused with low GI). We don’t recommend low carb diets because they can cause problems and are very hard to stay on long-term but if you think you can stick it out, and it reduces migraines then it’s obviously worth it. But see if you can achive the same results with low GI first. Most of us are eating well anyway I’d say because a migraine diet is pretty much low GI anyway.

You can check all the latest GI values of foods here if you want to look into this more:

http://www.glycemicindex.com (click on the GI Database link)

Let me know if this all makes sense.

Best … Scott 8)

Thanks, Scott. This is very good information. While maybe not directly on point, since my MAV crash, my reactive hypoglycemia has been absolutely horrible. I am currently trying dietary modifications as you suggest. I hope that Paxil is continuing to be good to you! Ben

Ben -just wondering if you’re still on the lexapro. I know you recently said that it wasn’t helping. let us know. wishing you well!!

Thank you for the information Scott it makes sense to me and I am going to study it some more in depth and may have additional questions after that has been accomplished as my diet is so sparse I do not think I am getting all the nutrients I need right now.

Thank you for this, Scott. This may be another piece of the puzzle for me. Nitrates are one of my major triggers. This study showed significant increased nitrate levels in migraineurs. I wonder if by eating low-carb and therefore controlling my glucose and insulin levels, I am reducing my nitrate levels? What do you think?


BTW - I’ve once again proven low-carb is a necessity for me. I was feeling mighty good and slipped up on the halloween candy around the office, which sent me on a two-day carb binge. I am paying for it big-time today. You are correct about low-carb being difficult to stick to. The key is not taking the first bite so as not to start the glucose/insulin rollercoaster of cravings. You would think feeling well would be enough motivation. The thing is, you forget just how lousy you felt before and think you can get away with just a little (because sometimes you can). “Hello, my name is Marci, and I am a carbaholic.”

Hi Lisa, I am still pushing through with Lexapro. This is going on week 3 at the full 10 mg. Still not doing anything positive and I still have increased dizziness but I am determined to give it a full 4-6 week…thanks for asking and I hope that you are doing ok. Ben

Ben - sounds like a good idea to give it a full trial before stopping. please keep us posted. still doing horribly, which is expected until I can take meds.

Ben – actually it’s becoming clear that Paxil is not doing me much good. I had been edging up the dose over the last 2 weeks and with that, anxiety and agitation have been moving up with it. Mid-week I was so anxious and jacked up over something it was ridiculous. So I cut the dose and the feeling like someone has been standing on my chest is finally dissipating. Something about this med makes me feel not quite myself either and I can’t put my finger on it. It doesn’t increase headaches and it has kept me from sliding down into any dark holes on the smallest dose but it has also left me feeling “off”. My normal confidence level doesn’t feel right. The effects from these SSRIs can be so subtle that you wonder if it’s the drug or if it’s just you … but then I’ll increase the dose and you get a really big hit and see the bigger picture. I may try Remeron (Avanza here) next.

Check this out from Crazy meds on Remeron – a tetracyclic antidepressant:

Cons: You will literally eat sugar straight out of the bag to satisfy your cravings for sweets and carbohydrates. Most of the anticholinergic effects common with psychiatric medications (e.g. constipation, confusion, loss of coordination, memory loss) are infrequent with Remeron. Instead you get intense hunger for the wrong foods, and with that comes weight gain, dry mouth and constipation caused by what you eat and not Remeron itself. Then you want to sleep a lot. It’s like you may as well be smoking pot when you take Remeron. :lol:

Sorry to hear about the hypoglycemia. I wonder if that is tied into migraine somehow as yet another neurological disturbance – though not sure how neurology would be behind glucose metabolism problems.

Marci – I don’t think we can pigeon hole all nitrates as being migraine triggers as there are so many. Check this out:

— Begin quote from ____

Many nitrates can be harmful to a person’s health, while others can have a more or less neutral effect. Some are actually used to prolong life in emergency medical conditions. If nitrate levels in the blood rise too high, this may in some cases lead to a lack of oxygen absorption by the body. The nitrate ion contains oxygen, and when this part of it bonds with hemoglobin in blood cells, it keeps elemental oxygen from doing so, reducing the ability of the blood as whole to carry oxygen. This condition sometimes presents in newborns and infants younger than six months. Environmental sources of these types of nitrates can include agricultural runoff containing fertilizer and industrial waste water.

A few types of nitrates, such as sodium nitrate, are used in food products as preservatives. Their most common use is in meat products to preserve color and to inhibit the growth of the bacteria which can lead to botulism. It is not known for sure if these chemicals pose any hazard in the levels at which they are normally ingested, and they are generally considered to be safe (not if you happen to be a migraineur!).

— End quote

I reckon that your insulin levels are probably rock bottom and, for whatever reason, seems to wipe out a trigger somewhere. How do you feel after drinking milk? Dairy products tend to cause a big insulin response not related to glucose in the blood.

Cheers … Scott

— Begin quote from "scott"

How do you feel after drinking milk? Dairy products tend to cause a big insulin response not related to glucose in the blood.

— End quote

Actually, I feel quite good after drinking milk. I don’t drink it in large quantities because I try to keep my overall carb intake low, but a glass of milk makes me feel pretty good.

Hi Ben,

I believe the reactive hypoglycemia (you and me both) can trigger some of the migraines. Another problem is that some of the preventatives have an effect on blood sugar (my old moan at why dont the specialists consider this when prescribing the next one to us). I had a major bs attack the other morning, down to 2.9 and could hardly stand with dizziness, could feel the familiar head coming on, ate and it actually went away. I swing with the bs attacks all day, mostly mornings, even though I eat regularly protein, fat and tiny bit carb. I have a friend who suffers from reactive hypo and takes low dose cortisol which keeps the bs up, her migraines have really gone down and she very rarely gets dizzy or has a vertigo attack now.

Scott, I am so sorry to hear about the paxil. I have been off the Lyrica for 4 days now and talk about low mood. Oddly enough, hardly any headache for 4 days. Oh and of course, no sleep, 3 hrs each night!


Hi Christine,

My mood is rock bottom as well. All day I was out with friends but had this low level depressed “my life is miserable” feeling going on. I’m at home now watching a video and the screen motion just makes me feel even more flat. I can’t bear this but I have a feeling getting off of Paxil after 2 months is going to be hard work. It is supposedly the worst SSRI to drop.

Scott :frowning:

Scott, I tried going out too, I was told I looked like a zombie! Thats about right, really tired from no sleep and depressed :cry:

Have you been on a very high dose of the paxil? If it has been a low dose, that might make it easier coming off, having said that, I was only on 12.5 mg Lyrica for 7 days and it has affected me.

Just have to remind ourselves that we werent feeling this bad before the pills so it should lift. Just makes you so wary of trying yet another one. I am still looking at the Cymbalta and Effexor and Topamax sitting on the table, dont fancy any of them at the moment :?


Hi Scott,
What happened? I thought you were doing well. Have you ever thought of increasing the dose of Paxil instead?


Hi Lisa,

I have been increasing it and all last week it really started making me feel very agitated, a jacked up out-of-control feeling I know all too well from other SSRIs – and it’s mucking up sleep. It’s not from normal stress. The penny dropped on Thursday after an entire day with my heart in my throat for no reason. I’ve been on this stuff at a low dose for 2 months … and then with incremental and slow increases this has kicked in.


Scott, I am sorry to hear that Paxil is causing even more trouble! I too am a bit worried about coming off Lexapro, if that is where I am heading - I am not there yet, but so far nothing good has come of it. We will see. I will say that I didn’t have much issue coming down from Effexor (I made it to 75 for a few days after being on 37.5 for 5 weeks). I weaned slowly over about two weeks. You will make it through and I wish you the best!

Christine, I definitely think my reactive hypoglycemia is somehow related to my issues, although I think my MAV conidition actually is causing the reactive hypoglycemia. I continue to try dietary changes. Very frustrating!

Hi Ben,

I too found coming off of Effexor to be really easy. There was no backlash. When I came off Cipramil (similar to Lex) I felt a lot more anxious, sometimes flat, dizzier, and would get really nasty flu-like symptoms. It was hard for me to get free of because I had been on it for years. In the end I succeeded by using St John’s Wort to ride it out. But that was me.

I’m awake at 3 am feeling pretty rough. Heart palps and a doom feeling that I can’t shake. IBS is continuous … sounds like a symphony orchestra down there. Might see the doc tomorrow.

Keep me in the loop with your Lex withdrawal. Sorry it hasn’t helped.


Sorry the Paxil is making you feel so crummy. Maybe try the St. John’s Wort again? Did you read the book 5HTP? It mentions Ginko Biloba is good for bringing blood supply to the brain and is recommended in addition to 5HTP and St. John’s Wort…I wish I would have tried this stuff first before committing to the prescription stuff, but I think my doctor felt I was in need of more than herbs…

Getting off Lexapro sucked for me and I was only on 5 mg. I was on 2.5 for a month and then 5 for almost a month and quit cold turkey because the doctor said my dose was too low and it wouldn’t matter. B.S.!!! So go slow…I had terrible rebound anxiety (I was also taking Ativan at night to sleep and quit that cold turkey as well…I wasn’t so smart back then!!) didn’t sleep for 16 days…just little hours here and there…it was awful. If I had to do it over again, I would titrate slowly and do valium or Klonopin to take off the edge while coming down.
There is an amino acid called L-Theanine, and it works as a natural relaxant…so I tried it a few times and was surprised it had a decent effect. For those trying to wean off the benzos or use when you don’t need something quite so strong.