With rising blood sugar, he switched to diet soda. Then he had the worst headache daily: What triggered it?

A doctor found that a patient’s daily migraines were triggered within 30 minutes of drinking Diet Coke due to aspartame sensitivity. (Image via Pexels)

A 42-year-old corporate professional would have episodic headaches at first. Over time, the pain became more intense, then intolerable. By the time he came to see me, he would suffer headaches daily that disrupted his life. During history-taking, I found that he was in the prediabetes stage, fuelled by irregular diet, long sedentary hours and stress. He was also addicted to Coke, having three cans a day. But given his elevated blood sugar levels and the fact that he couldn’t think without the soda pop, he had switched over to Diet Coke. Therein lay the problem.

He told me that he would develop a headache within half an hour of drinking the beverage. Now what many people do not know is that aspartame, the artificial sweetener, while keeping your blood sugar levels in check can trigger headaches and migraines in certain people, particularly among long-time users.

The research is mixed on the subject but once aspartame breaks down in the body, its components might interfere with brain chemicals like serotonin and dopamine, which regulate mood and pain, potentially leading to headaches. A byproduct of aspartame, formaldehyde, has been found to trigger allergic reactions and headaches in some sensitive people. Some theories suggest it over-stimulates nerve cells in the brain, which can trigger migraines.

As I said, there are conflicting studies. Some randomised trials show aspartame can trigger headaches in certain people, with those suffering from migraine most likely to react. Aspartame can increase cortisol and free radicals, raising oxidative stress in the brain, which may cause headaches. Sometimes, it constricts blood vessels, altering blood flow and triggering headaches.

Now if you are having Coke Zero, you are having sucralose, which is a zero-calorie, artificial sweetener made from sugar (sucrose), but chemically modified so the body doesn’t absorb it for energy. Can this cause headaches? Here the evidence is not as strong. A 2006 report describes a patient whose migraine stopped when sucralose was removed from their diet.

Sucralose usually alters gut bacteria as 85 to 90 per cent of it passes through the gastro-intestinal tract. In animal studies, sucralose has decreased beneficial gut microbes, leading to bloating and inflammation. Both of these can trigger headaches.

Saccharine, which is zero calorie and used in some isabgol brands, may lead to nausea and headaches in vulnerable diabetes patients.

I asked my patient to limit soda drinks and replace them gradually with lime or any other fruit-infused water, coconut water, iced teas, cold brews and kombucha tea. I asked him to keep himself hydrated.

I advised him to take Vitamin B12 and magnesium supplements as they help reduce migraine. Low B12 levels can raise levels of an amino acid called homocysteine in the blood, a condition associated with migraine attacks and damage to blood vessel lining. Supplements prevent this. Vitamin B12 also neutralises nitric oxide, which causes headaches by causing inflammation and widening blood vessels. Besides, B12 protects the myelin sheath, or the covering for nerve cells. Any deficiency can lead to nerve irritation, a headache trigger. B12 is crucial for red blood cell production, ensuring proper oxygen delivery to the brain. Low oxygen results in headaches.

Magnesium helps prevent migraines by stabilising nerve cells, regulating brain chemicals, controlling blood vessel dilation and blocking pain signals. With supplements, my patient’s sleep got better.

That’s simple. Track your food/drink intake and headache occurrences to find patterns. Then cut back on artificial sweeteners to see if headaches go down. Discuss diet and triggers with a healthcare professional, especially if you suffer from migraines.

Also, food is only one factor that raises blood sugar. Stress and hormonal changes drive up levels too. In such cases, you do not necessarily need to avoid sugar altogether. Enjoying a small amount of sugar after a healthy meal with protein can temper spikes and prevent migraine attacks.

(Dr Tickoo is Director, Internal Medicine, Max Healthcare)