What migraine really is - and what it’s trying to tell you.
You know the type. Maybe you are the type.
Always reachable. Always professional. Always smiling, no matter what’s going on behind it. The colleague who’s last to leave. The friend you can always call.
The person who never gets sick - until they collapse.
And then, usually on a weekend, when things are finally allowed to slow down: the migraine.
Not just a headache. The kind where light hurts, sound hurts, thinking hurts. The kind where you barricade yourself in a dark room and just want it to stop.
Then: an ibuprofen. Another one. Over the weeks, eventually, the whole pack.
Why the weekend, of all times? Because stress letting up can trigger an attack too - often called a weekend or let-down migraine.
But first: what actually is migraine?
The brain that listened too well
Migraine isn’t imagined. It isn’t a question of willpower either.
Migraine has a genetic basis - some people’s nervous systems react differently: more sensitively, faster to stimuli. Biology. Not a personality trait.
But - and this is the crucial point:
Migraine causes: predisposition meets triggers
There are many triggers: lack of sleep, hormonal changes, skipped meals, shifts in the weather, caffeine - too much of it, a sudden stop if you usually drink it daily, or a late coffee that quietly costs you sleep. Stress is one of the most common - and it’s what this article is about.
Why do migraines happen? What’s going on in your body:
The brain itself has no pain sensors.
What you feel during a migraine comes from what surrounds it: the meninges (the membranes around the brain), the fine blood vessels within them, and a network of nerves - above all the trigeminal nerve, which supplies the face, temples and forehead.
Simplified, a migraine attack goes like this:
A wave of electrical activity spreads across the cortex (cortical spreading depression) - in migraine with aura, you can feel it as flickering or visual disturbances.
The pain system in the head is activated.
Certain messenger substances are released - above all CGRP. They strongly widen blood vessels and trigger inflammation in the meninges.
The result: throbbing pain, sensitivity to light, nausea.
In short: your nervous system goes into a state of emergency.
And that state of emergency has warning signs. Often hours, sometimes days in advance.
The question is: did you hear them?
The body whispers before it screams
There’s a phrase in German that sums up a whole mentality: Stell dich nicht so an. It means something like: stop being so sensitive, quit whining, get a grip.
That mentality runs deep. In the way we push through exhaustion instead of taking it seriously. In the way we nod in meetings while everything in us says no. In the way we swallow anger because it’s seen as unprofessional. Because we don’t want to make trouble. Because we know how it’ll go if we do.
But anger doesn’t disappear just because you don’t show it. Mostly, it goes into your own muscles.
Migraine and neck pain
Neck, shoulders, jaw.
The classic migraine trouble spots are also the classic places we store stress.
That’s not a metaphor - that’s anatomy. Chronic tension in the neck and shoulders directly affects the nerve and blood supply to the head. There’s a well-described connection between the head’s pain system and the neck (the trigeminocervical complex). It explains why neck pain so often comes with migraine. No coincidence.
Two things are worth knowing here. Neck pain as part of a migraine is something different from a headache that originates in the cervical spine - that’s a condition of its own (cervicogenic headache). And not every headache that comes with tension is a migraine: tension-type headache usually feels dull and pressing, like a band around the head, mostly on both sides, without nausea - and it doesn’t get worse when you move. If you’re unsure which one you have, a headache diary and a medical check help.
German has another expression for pushing through: Arschbacken zusammenkneifen - literally “squeeze your butt cheeks together”. It means gritting your teeth and getting on with it, whatever it costs. Turns out it’s more than a figure of speech.
Body therapists often describe a link between the pelvic floor and the neck - one that science still has more to explore. When we put ourselves under pressure, literally and figuratively, many people tense both at once. Try it: clench your glutes for a second and notice what happens in your neck.
Your body isn’t a random generator. It sends signals on purpose.
Quietly at first: tension here, trouble sleeping there, irritability, a pulling pain in your neck on stressful days. And if those signals are consistently ignored - because there’s no time, because you shouldn’t make a fuss, because something still needs doing - then it screams.
Then comes the migraine.
Medication overuse headache: the ibuprofen problem
Ibuprofen helps. That’s true. Short-term, acute, as an emergency fix - yes.
But taking painkillers too often risks what’s called medication overuse headache (often called rebound headache). For simple painkillers like ibuprofen and other NSAIDs, that starts at around 15 days a month; for triptans and combination painkillers, at just 10 days - in each case for more than three months. The medicine meant to help becomes a trigger itself: the pain system grows more sensitive, the headaches more frequent.
On top of that, long-term, high-dose ibuprofen can damage the stomach and kidneys.
Nobody reaches for the pack that often because they don’t know better.
You do it because you have to function. Because there’s no time to be ill.
Because the alternative - lying in the dark and waiting - doesn’t feel like a solution either.
But a pill that dulls the pain without looking at the pattern behind it is always treating the symptom. Sometimes the right thing. Never enough.
Important: New, unusually severe or sudden-onset headaches always need a medical check - as do headaches with paralysis, speech problems or fever, and any migraine attack that lasts longer than 72 hours.
Botox for migraine: what it really does (and what it doesn’t)
Botox is used to treat chronic migraine - that means headaches on 15 or more days a month for more than three months, at least 8 of them with migraine features. And it works for some people.
But not the way it’s often explained.
The popular version goes: Botox relaxes the muscles - less frowning, less tension, fewer migraines. Sounds logical, but it’s only half true.
The actual mechanism: Botox blocks the release of certain messenger substances from nerve endings. So it intervenes directly in the pain signalling system, not just in muscle tension.
That means it dampens the pain signal. But it doesn’t train anything. A paralysed muscle can’t learn.
A blocked nerve signal doesn’t disappear - it comes back as soon as the Botox wears off.
Botox is a plaster.
Not a bad one - for some people a useful one - but it doesn’t address the cause.
Learning to say no, on the other hand, is anything but attractive at first. It takes time.
Sometimes it takes therapeutic support - because saying no is more than saying a sentence. It means tolerating that others suddenly find you less convenient. That you’re no longer the one people can always call. That that’s okay.
That’s no small exercise.
But it changes something in the baseline tension that costs your body every day. And without an injection.
What actually helps
First things first: there are effective medical treatments for migraine - for acute attacks, triptans, for example; for prevention, various medications and newer treatments that target the messenger CGRP, either as an injection (antibodies) or as a tablet (so-called gepants). If you get migraines often, see a neurologist. What I’m describing here works alongside that: on the pattern behind it.
Biofeedback for stress and migraine: out of helplessness
One of the most frustrating things about migraine is the feeling of helplessness: the pain comes, and all you can do is wait.
That’s not quite true.
Biofeedback is a method where you learn to consciously influence physical processes that normally run on their own: heart rate. Muscle tension. Skin conductance. In some approaches, blood flow too.
Your nervous system runs largely on autopilot.
But it can be influenced - through breathing techniques, targeted relaxation, and visual feedback that shows you in real time what happens in your body when you change something.
In psychosomatic rehab clinics, for example, people work with a visual display of their blood flow - shown as a waterfall on a screen. Hooked up to electrodes, they learn to regulate that waterfall. With measurable effects - even later, long after the screen is gone.
Sounds like science fiction, but it’s well-researched practice.
The real value isn’t only physiological: you’re influencing something you thought you had no control over.
That changes your relationship with your body fundamentally. “The pain happens to me” slowly becomes: I can do something.
Biofeedback is offered by psychologists, doctors and other health professionals. Look for someone licensed in a health profession, ideally certified by the Biofeedback Certification International Alliance (BCIA, bcia.org). Whether insurance or your health system covers it varies a lot - it’s worth asking.
Saying no: therapy for your body
This might sound confusing at first. But it may be the most direct route to the cause.
If you chronically ignore signals - your own needs, your own limits, your own exhaustion - your nervous system learns exactly that: to ignore.
And at some point, the body has to get louder just to be heard.
Saying no is self-care.
And if self-care counts as rude, that’s the real problem.
It’s the difference between:
I feel this is my limit - and say no.
And: I feel this is my limit - override it - and I’m flat on my back two days later.
That’s not a metaphor. That’s stress physiology.
Taking the small signals seriously
Migraine has warning signs. Usually.
A pull in the neck. Light sensitivity that isn’t pain yet. A mood that tips. Yawning that’s strangely deep. Even a sudden craving for coffee can be one of them - sometimes the coffee before an attack isn’t the trigger, but the response to a tiredness that’s already part of the warning phase.
If you recognise these signals early, you can respond early. Not necessarily with pills - but with a break. With darkness. With: I’m taking ten minutes now, before I can’t anymore.
Using that early-warning system is preventive health care.
How it all fits together
Migraine isn’t simply a neurological problem that happens at random.
It’s often the loud end of a long chain of quiet compromises.
Too many yeses. Too little listening. Too much swallowed.
That doesn’t mean your migraine is your fault. It means your physical health is at stake when you keep working against your own signals.
The pill is sometimes the right call. But the question worth asking is:
What was your body trying to say - before it had to scream?
If you’d like support finding the pattern behind your stress: that’s what therapy or mental support is for.
Elena Tinkloh aka Tink is a licensed psychotherapist in Germany (CBT) who helps people reconnect body and nervous system.
