What I See in Patients With Chronic Headaches and Migraines
What I see in clinic, almost every time, is that the headache pattern isn't really about the head. It's the downstream signal of a system that's been holding too much for too long. The question isn't usually "what triggered this migraine?". It's "what made the threshold for triggering one so low in the first place?"
Most of the patients we see, and especially the women, have at least three things running quietly in the background.
An overactivated nervous system: stress that's never quite reset, a sense of being switched on all the time, sleep that doesn't repair you. This is the soil migraines grow in. You can take all the painkillers you like, but if the system underneath is still running hot, the headaches will keep finding their way through.
Chronic neck, shoulder, and jaw tension, particularly in patients who hold the head forward at a screen for hours each day, who clench through stress, or who carry their week in their upper back. Most tension-type headaches are mechanical at their root.
Hormonal patterns, and this one I see constantly. Cycle-linked migraines that arrive the same day every month. Perimenopausal headaches that started in the late thirties or early forties. Migraines that began after pregnancy and never quite settled. These patterns are often dismissed or under-investigated because most preventive medications aren't designed around them. They're a real specialism for me, and one of the reasons many of the women coming through the clinic for headaches and migraines have come specifically because someone finally took the hormonal pattern seriously.
Disrupted sleep, and not just the hours but the quality. Headaches and poor sleep feed each other in a loop that's difficult to break with willpower alone.
Medication overuse. Daily painkillers can, over time, create a rebound headache pattern that becomes its own problem. We see this often. It's not a personal failing, it's how the system responds when it's been held together with paracetamol for too long.
"Headaches and migraines almost always have a pattern underneath them. That pattern is what we treat, not the next attack."
Deanna Thomas, Lead Acupuncturist
Acupuncture works for headaches and migraines because it addresses several of these patterns at once. Not by switching anything off, but by giving the nervous system enough consistent, well-timed input to settle. Acupuncture is what we'd call dose-dependent: meaning the cumulative effect of a course of treatment is what tends to produce a meaningful change, not a single session. This is why NICE recommends a course of up to 10 sessions over 5 to 8 weeks, and why we structure treatment around a course rather than one-offs.
A note on hormonal migraines
A significant proportion of the migraine patients I see are women whose attacks are linked to their hormonal pattern. Cycle-linked migraines, perimenopausal headaches, postnatal migraines that wouldn't settle. My postgraduate diploma is in Obstetrics & Gynaecology specifically, which means I'll look at your headache pattern alongside your cycle, your sleep, and your wider women's health picture rather than treating the headache as if it exists on its own.