When headache signals hypoglycemia: Clinical recognition and management.

Headache is an underrecognized manifestation of hypoglycemia in individuals with diabetes. Although hypoglycemia is well known to produce autonomic and neuroglycopenic symptoms, headache is frequently overlooked as a potential indicator of low glucose, which may lead to unnecessary diagnostic evaluation and missed opportunities to prevent recurrent episodes. A landmark pre-CGM study reported hypoglycemia-related headache in 43% of insulin-treated individuals experiencing hypoglycemia, although contemporary prevalence estimates remain uncertain. Recognition of the temporal relationship between headache episodes and glucose fluctuations is essential for accurate diagnosis. Continuous glucose monitoring can help identify symptomatic and asymptomatic hypoglycemia associated with headache and support prevention through real-time alerts and pattern recognition. This review summarizes the pathophysiology, clinical presentation, diagnostic evaluation, and management of hypoglycemia-related headache and provides a practical clinical approach, including a diagnostic algorithm, to assist clinicians in evaluating headache complaints in patients with diabetes.