Understanding Headaches and Migraines: Expert Insights for Finding Real Relief

If you’ve tried everything for headache relief with no lasting results, you’re not alone. Headaches affect an astonishing 40% of the global population, impacting more than 3 billion people worldwide. Yet despite being the most common form of pain, headaches remain one of the most misunderstood and dismissed health conditions.

Dr. Ella Akkerman, a board-certified neurologist at VSI with over 15 years of experience, recently joined our Get Back to Your Life podcast to discuss what’s really happening in your brain during a headache, why proper diagnosis changes everything, and how you can find real, lasting relief.

The Invisible Burden of Chronic Pain

Headaches are often called an “invisible illness,” and for good reason. When 30% of the population suffers from chronic pain, the challenge isn’t just physical. It’s deeply emotional and social as well.

“Pain is so difficult, especially for people with chronic pain,” explains Dr. Akkerman. “All they rely on is us understanding them. And how do we understand it? How do we see it? We can’t. We don’t see chronic pain. We just observe suffering.”

This invisibility leads many sufferers to feel misunderstood, defensive, and even doubted by others. They learn to hide their pain, pushing through each day while dealing with interrupted sleep, lost productivity, and diminished quality of life. The emotional toll compounds the physical suffering, creating a cycle that’s difficult to break without proper support and treatment.

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What Is Actually Happening in Your Brain During a Headache?

Head pain is generated by the trigeminal nerve system, which originates deep in the brainstem and extends throughout the blood vessels, membranes covering the brain, and sinuses. These nerves act as pain receptors, transmitting signals to the brain for interpretation. In people who develop chronic pain, this feedback loop can become self-perpetuating, continuing even without specific triggers.

“People who develop chronic pain often develop this loop of pain that is self-propagating,” Dr. Akkerman explains. “It’s like a short circuit that just keeps going and going. That’s why people have chronic pain that is very difficult to control, because you have to break that short circuiting.”

Types of Headaches

Most headaches are primary headaches, meaning they’re not caused by an underlying condition. Within primary headaches, there are three main types. Tension headaches are the most common, affecting up to 80% of the adult population at some point. Migraines affect approximately 15% of the population and involve not just pain but a constellation of symptoms. Cluster headaches are rare but can be extremely disabling, occurring in groups for weeks at a time.

Secondary headaches are caused by underlying medical conditions like high blood pressure, infections, or tumors, which is why proper medical evaluation is essential.

Common Triggers

Understanding your triggers is essential for prevention. Genetics plays a role, as some people are predisposed to migraines based on family history. Sleep disruptions are one of the most common factors among patients with poorly controlled headaches. Women are two to three times more likely to experience migraines than men, largely due to hormonal fluctuations during the menstrual cycle.

Other common triggers include dehydration, caffeine fluctuations, stress, skipped meals, weather changes, bright lights, strong smells, and excessive screen time. Dr. Akkerman recommends keeping caffeine consumption consistent at about 200 milligrams per day (roughly two 12-ounce cups of coffee) and consuming it only before noon to avoid sleep disruption.

The Holiday Season Challenge

The period between Thanksgiving and New Year’s often sees an uptick in headaches. During winter months, shorter days lead to higher cortisol levels, lowering your pain threshold. The holidays also bring schedule changes, increased alcohol and sugar consumption, irregular meal times, and heightened stress. “You have to be like marathon runners,” advises Dr. Akkerman. “Know when you’ve pushed yourself hard and give your body a chance to recoup and recover.”

When to Seek Immediate Help

Certain warning signs require immediate medical evaluation. If you suddenly develop the worst headache you’ve ever had, seek immediate attention. Headaches accompanied by changes in vision, sudden loss of function, difficulty speaking, weakness, or numbness could indicate a stroke. Headaches with fever and stiff neck could indicate meningitis. Be cautious of silent migraines as well, as those can occur without the typical head pain. If you’re experiencing headaches 15 or more days per month, or if you’re scheduling your life around headaches, it’s time to see a specialist.

Treatment Options

Lifestyle Modifications

Before turning to medication, optimizing your daily habits can significantly reduce headache frequency. Prioritize consistent sleep, staying hydrated throughout the day, eating regular meals at consistent times, and creating time for self-care activities like walking, yoga, or meditation. Track your headache patterns to identify triggers.

Acute and Preventative Treatment

The key to treating migraines effectively is acting immediately when symptoms begin. “The longer you wait with migraine pain, the harder it’s going to be,” warns Dr. Akkerman. Over-the-counter nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen are first-line treatments. When you feel a migraine starting, immediately move to a dark, quiet room.

For those experiencing headaches at least once a week, preventative medication may be appropriate. The most exciting recent development is a class of medications targeting CGRP (calcitonin gene-related peptide), a chemical specifically associated with migraine pain. “They decrease frequency and intensity of migraines by at least 30 to 40% and even more for some patients,” explains Dr. Akkerman. “They’re generally very safe and have very few side effects because they’re so specific to migraine pain.”

Special Considerations for Women

Many women notice their migraines cluster around their menstrual cycle, particularly during the premenstrual phase. During these vulnerable times, be especially mindful of other triggers by prioritizing sleep, staying well-hydrated, and managing stress. The hormonal fluctuations during perimenopause can significantly amplify migraine patterns, though many women experience improvement after menopause as hormones stabilize.

A Message of Hope

The longer you live with chronic migraines, the more entrenched the pain pathways become in your brain. This is why Dr. Akkerman urges people not to wait to seek help. “We literally have to shut down your brain and reset it when you’re dealing with chronic pain. And the longer you’ve lived with it, the harder it’s going to be.”

The science of migraine and headache treatment has advanced dramatically in recent years. With proper diagnosis and a comprehensive treatment plan, most people can achieve significant improvement in their quality of life. Your brain is your most sensitive organ, often the first to signal when something in your life needs attention. Listening to those signals and taking action is an act of taking care of yourself.

Ready to Take Control of Your Headaches?

Dr. Ella Akkerman is here to help. With over 15 years of experience treating headaches, migraines, and other neurological conditions, Dr. Akkerman combines clinical expertise with personal understanding to help patients find real relief.

Learn more about our neurology services or schedule a consultation. Your journey to headache relief starts with a single step.