Many people turn to comfort foods and drinks when a migraine attack strikes, often craving sweet things — cookies, chocolate, and, quite commonly, Coca-Cola.
But sugar can be a migraine trigger for many, not to mention too much of it can lead to a number of chronic health conditions. Instead, many people use sugar substitutes or artificial sweeteners to get their sweet fix.
There are a lot of different varieties of sugar swaps to choose from, some more natural than others, and you’ll find them in products everywhere. But can these artificial sweeteners lead to more migraine attacks? What are the best ones to use if you live with migraine? We’ll help you understand the pros and cons so you can make an informed choice.
What Are Artificial Sweeteners?
Artificial sweeteners are sugar substitutes often used to cut calories, to manage conditions like diabetes, or by those who follow a ketogenic diet. Stevia, aspartame, sucralose, and sugar alcohols are popular options, but not all sugar substitutes are created equal.
- Acesulfame potassium, or Ace-K (sold under the brand names Sunett and Sweet One)
- Advantame
- Aspartame (sold under the brand names NutraSweet, Equal, Sugar Twin)
- Neotame (sold under the brand name Newtame)
- Saccharin (sold under the brand names Sweet’N Low and Necta Sweet)
- Sucralose (sold under the brand name Splenda)
Artificial sweeteners are often found in processed foods marketed as “diet” or “light” because they contain fewer calories than white table sugar. Who wouldn’t want to shave 150 calories off their daily calorie allotment simply by switching from regular soda to diet soda, for example? It makes room for other food!
Sugar substitutes are also found in yogurt, cookies, other prepackaged snacks, some flavored bottled waters, health supplements like protein powders and electrolytes, medications, and so much more. To know just what is going into your body, read the labels on the package. Manufacturers slip in ingredients that you may not be aware of.
What’s the Problem With Artificial Sweeteners?
Sugar alternatives seem like a miracle food, a nectar from the gods: no calories, no effect on blood sugar levels, sugarlike taste. The perfect substance? Well, not quite.
The six FDA-approved artificial sweeteners listed above have been studied multiple times. Each result comes back as safe for consumption at the levels found in foods, but this doesn’t mean they’re good for someone with migraine.
Do Artificial Sweeteners Cause Migraine Attacks? What the Research Says
Some migraine patients have reported that artificial sweeteners contribute to their headaches or migraine attacks, with sucralose and aspartame being the two biggest culprits.
As with all food triggers, it varies from person to person. If you want to reduce your sugar consumption, there are many artificial sweeteners to consider.
“Artificial sweeteners are frequently reported to trigger migraine attacks,” says Andrew Charles, MD, professor of neurology and director of the UCLA Goldberg Migraine Program in Los Angeles. “The challenge with artificial sweeteners is determining whether it is the sweetener itself that triggers a migraine attack rather than other contributing factors, like inconsistent meals or caloric intake.”
Clinical evidence linking aspartame (which is the sweetener used in Diet Coke, among many other products) to migraine is unclear.
“Some people report that consuming products containing aspartame can lead to the onset of a migraine within a few hours,” says Fred Cohen, MD, assistant professor of medicine and neurology at the Icahn School of Medicine at Mount Sinai in New York. “While the exact mechanism isn't fully understood, it's believed that aspartame may interfere with serotonin levels or lead to increased excitability in the brain, which could contribute to migraine attacks,” he says.
Although this link could potentially create an issue for those with migraine, more research on aspartame and its link to neurobehavioral health is needed to draw a fair conclusion.
Dr. Cohen says that sucralose has also been mentioned as a migraine trigger for some, though there is less research on this substance.
No other artificial sweeteners have been linked to migraine attacks, and the evidence on aspartame is weak. Still, people have reported headaches, dizziness, and nausea as side effects of consumption.
“It’s important to note that individual sensitivities vary, and not everyone will experience migraine attacks after consuming artificial sweeteners,” says Cohen. “However, for those who are sensitive, cutting back on or eliminating these sweeteners may help reduce the frequency and severity of their migraine attacks.”
If you suspect artificial sweeteners might be a trigger for you, tracking your symptoms with an app or migraine diary can be helpful. Migraine food triggers are different for every migraine patient. If you suspect you are sensitive to aspartame or any other synthetic sweetener, it’s probably wise to avoid it.
Does Stevia Trigger Migraine?
Stevia, one of the most popular and widely used sugar substitutes, is made from the leaves of the stevia plant. Though it was approved by the FDA in the United States in 2008, it’s been used for centuries in South America and has been commonly used in Japan since the 1970s.
Stevia is much sweeter than real sugar. You can substitute one teaspoon of stevia extract for each cup of sugar, but the product is a little different.
While some people with migraine do report experiencing headaches or migraine attacks after consuming products with stevia, there haven’t been any verifiable reports of stevia triggering migraine attacks.
Do Sugar Alcohols Trigger Migraine?
Sugar alcohols occur naturally in certain fruits and vegetables, and are made artificially, as well.
These carbohydrates have a chemical structure resembling both sugar and alcohol, but they don’t contain ethanol like alcoholic beverages. Sugar alcohols are considered nutritive sweeteners, which means they can affect blood sugar levels. Patients with diabetes should read the nutrition label for total carbohydrate content. Sugar alcohols may not spike blood sugar as much as other sugar substitutes, but they do affect glucose levels.
Unlike other artificial sweeteners, sugar alcohols tend to be less sweet than table sugar. They typically have fewer calories than regular sugars because they are only partially absorbed and metabolized by the body. But they contain more calories than artificial sweeteners, lying comfortably in the middle of regular and artificial sweeteners, and can be useful for diabetic, low-carbohydrate, or reduced-calorie diets.
- Erythritol
- Isomalt
- Lactitol
- Maltitol
- Mannitol
- Sorbitol
- Xylitol
Not all of the sugar alcohols pass through the blood after eating. Some of them pass into the small intestine and large intestine (colon), where they are fermented by bacteria. Know what this does? You guessed it — unfortunately, it can lead to a buildup of gas and abdominal discomfort. It can act as a laxative in some people who are sensitive to sugar alcohols when eaten in large amounts.
Though no connection to migraine attacks is noted with sugar alcohols, you may want to try small doses of sugar alcohols to test your personal tolerance. A possible health concern with sugar alcohols is that they vary in their effect on blood sugar. If you’re diabetic, keep an eye on your glucose levels while using sugar alcohol to see how your body reacts.
Watch Out for the Calorie Creep
Relying on artificial sweeteners for weight loss may backfire and cause weight gain. The FDA recommends an average daily intake of 15 milligrams (mg) or less per kilogram (kg) of body weight.
Moderation Is Key With Artificial Sweeteners
Eat consistent, healthy meals filled with fresh whole foods to keep migraine attacks to a minimum. For those who aren’t following a low-carbohydrate diet, consuming sugar — processed or natural — is best done in moderation. Reach for a blended sorbet with frozen fruit instead of eating those cookies or cakes.
But food is only one factor that causes rising blood sugar. Many things impact blood sugar levels, such as stress and changes in hormone levels.
And you don’t necessarily need to avoid sugar altogether. Enjoying a small amount of sugar after a healthy meal with protein can temper spikes in glucose levels. It may even help prevent a sugar-related migraine attack.
How you react to some of these sugar swaps can also depend on factors like genetics and the presence of any underlying conditions. If you have certain GI disorders, you may be more sensitive to them.
Evidence is lacking on the effects of long-term or prolonged use of sugar substitutes, as well as on the quantities that may or may not trigger migraine attacks.
Natural Sweeteners as Alternatives
Want to reduce your sugar intake and limit your artificial sweetener use? Try some of these natural sugar alternatives:
- Agave syrup is on the low-glycemic index, so if you have diabetes, it may help you control your blood sugar levels. Agave nectar dissolves quickly and is great for adding to cold drinks.
- Allulose is a relative newcomer on the sugar substitutes block, discovered in the 1940s but not on the shelves until the 2010s. It’s a naturally occurring sugar found at low levels in figs, raisins, wheat, maple syrup, and molasses. It’s been touted as tasting similar to sugar, without the bitter or chemical aftertaste found in some other artificial sweeteners. The FDA considers it GRAS, and it doesn’t affect your blood sugar or insulin levels.
- Brown sugar is a perfect sweetener for baking and making a marinade. Although it is still sugar and will affect the body similarly, it does contain slightly higher amounts of minerals such as iron and calcium.
- Coconut sugar has a neutral flavor similar to cane sugar, and it works well in baking. Replace brown sugar at a 1-to-1 ratio. It is important to note that coconut sugar contains glucose, sucrose, and fructose; therefore, your body will digest it as it would sugar.
- Date sugar, made from dehydrated and ground dates, is healthier than refined white cane sugar and has the highest antioxidant content. Date sugar is also a rich source of minerals and fiber. Since it contains natural sugars, it can increase blood sugar levels.
- Maple syrup is straight-from-the-tree, unprocessed sweetness that’s great in hot tea and baked goods. Maple syrup has beneficial nutrients such as manganese, which is essential for energy production, and it has antioxidant defenses. However, it is higher in calories.
- Monk fruit (and monk fruit extract) is a natural, zero-calorie sweetener made from a small melon that has been cultivated in the remote mountains of Southern China for centuries. It’s 250 times sweeter than sugar and has the potential to be a low-glycemic natural sweetener. The FDA has listed monk fruit as GRAS for everyone, including pregnant women and children. Like coconut sugar, monk fruit contains glucose, sucrose, and fructose; therefore, your body will digest it as it would sugar.
Community Experiences With Artificial Sweeteners
We asked members of the Migraine Again community if artificial sweeteners were a trigger for them. While a handful of people said they’re not, many more said they are:
Aspartame is the worst. I can’t even chew gum for more than a minute without it bothering me. I avoid artificial sweeteners in general for the most part. — Becky B.
Definitely! Haven’t used any of them for years. I just use the real stuff, local honey or pure maple syrup. — Cari S.D.
Aspartame is evil. — Paul S.
I’m a Type 1 diabetic and as such, still use artificial sweeteners. My favorite is still the OG, saccharine. The blue stuff, Equal, triggers migraines so I stay away from it. The other more current sugar-free options, I don’t care for their taste. — Anne Marie E.
Definitely. Sucralose and aspartame are poison to me. — Elyse T.
Aspartame and Splenda are triggers for me. I substitute with stevia leaf sweetener. — Lisa L.
Yes they do! Any artificial sweetener disagrees with me one way or another. — Sheryl J.
Yes! A bit of sugar is harmless enough. — Kirsty C.
I went on a Crystal Light kick one summer before I was chronic, and wondered why I had “a headache” every day. Aspartame is not my friend. — Jill O.D.
They are a horrible trigger for me. I avoid them. Sometimes they sneak them in there though. — Nancy J.
Yes! I try to avoid them all. I know glucose (white sugar) and fructose and high fructose corn syrup are not healthy for us, but all of the sugar/sweetener options make me feel bad, to say nothing of the aftertastes! I try to limit processed sugar, and avoid any sugar substitutes. — Leila K.
YES! I cannot do any diet pop for this reason. I’m totally fine with real sugar and prefer it to the artificial stuff! — Kis L.
YES! They've been a trigger for all my life. — Michelle J.M.
I had a sugar-free muffin from Dunkin’ Donuts once and got the worst migraine. — Lin S.
Artificial sweeteners always start a migraine for me. No drinks, cold or hot, with artificial sweeteners. — Nina S.
What they use instead:
Date syrup! — Rachel S.
Only sweeteners I can do are honey, sugar and agave nectar. Everything else is a migraine trigger. — Marie
I use pure maple syrup instead. — Jill P.G.
I use honey or nothing. — Daisy M.W.
I use honey or regular sugar. I can tolerate stevia. — Paula B.
Final Thoughts
Now that you’ve learned a little about artificial sweeteners, it’s time to put them to the test. Try different types one at a time and keep a detailed diary of any migraine symptoms you might have after using them. There isn’t a lot of conclusive evidence that artificial sweeteners trigger migraine, but sucralose and aspartame might be the most risky. Consult with your healthcare provider about which options might be safest for you.
Narrow down the sugar swaps that work best for you. There’s no reason you shouldn’t be able to enjoy a sweet treat here and there without worrying about paying for it with an attack.