I think about my sister first.
She was around ten the first time I remember her going quiet in a very specific way—not upset, not tired, but disappearing while still in place. We would be together in a room, but she wasn’t fully in it anymore. The light was too bright. The sounds too loud. Her small hands pressed hard against her head like she was trying to hold something in—or keep something out.
We didn’t really understand what we were witnessing.
In the house we grew up in, pain—especially the kind you couldn’t see—wasn’t put into words. We were raised in a deeply religious environment that valued endurance, gratitude, and quiet strength. Pain was something to move through. Something to pray about. Something that, if you handled it correctly, would somehow refine you and bring you closer to God. This conditioning started at an early age.
So my sister’s migraines became something smaller, dismissed.
“It is just a headache.”
“She’s sensitive.”
“She has to learn to push through.”
“She needs to pray more.”
Maybe these words weren’t meant to be harsh. But they landed that way anyway.
Because what she learned slowly, and over time, was that her pain needed to make sense to other people before it could be taken seriously.
My sister learned how to measure, explain, and decide if it was “bad enough” to mention.
And even then, there was always that quiet question in the room:
Is this real?
Years later, I found myself asking the same question—just in a different voice.
My migraines came later, not in childhood, but in adulthood. At first, they were occasional. Inconvenient, but manageable. I could still show up. Still be dependable. Still be the person others could count on.
Until my body shifted.
Perimenopause didn’t arrive all at once. It never does. It came in fragments—sleepless nights, hot flashes, moods that didn’t quite settle, a sense that something, maybe everything, was changing.
And with change, my headaches became migraines. They became less negotiable.
No longer something I could work around. They became something that required me to stop.
And even then, I noticed it—the instinct to override.
I can still get through this session.
I need to push a little longer.
Somewhere in me, the adult me, was the same message my sister learned at ten years old:
Pain is inconvenient.
We, as women, especially, are expected to show up and accommodate around it.
Headaches and migraines are often minimized in everyday conversation and framed as something to take a pill for or ignore until they pass.
But for many women, they are not a minor inconvenience.
They are a chronic neurological condition that touches everything—mood, relationships, parenting, work, identity.
Migraines affect roughly one in eight people, and nearly one in five women in the United States. Women are two to three times more likely to experience migraines than men, particularly during hormonally active years (Burch et al., 2015; Lipton et al., 2007).
It is also one of the leading causes of disability worldwide—especially during the very years women are often carrying the most responsibility (Ashina, 2020).
And still, it is so often misunderstood.
In my work as a therapist, I hear versions of this story again and again.
Not just the pain, but what happens around the pain.
The hesitation before mentioning it.
The apology for needing to rest.
The guilt for not being fully available.
And when women do ask for support, the story is almost always the same - something shifts.
There is a look. They are told what they should be doing differently—a subtle change in tone.
“It’s probably just stress.”
“Have you tried drinking more water?”
Something inside of women tightens—not just from the migraine, but from knowing that they are now responsible for explaining.
This is where stigma lives.
Not always in obvious dismissal—but in accumulation. In the moments where pain is questioned, reframed, or quietly doubted.
Research shows that migraine carries a significant and often overlooked layer of stigma—affecting how people are treated, how care is accessed, and how individuals begin to see themselves. For many, especially those with more frequent migraines, that stigma becomes part of the experience itself (Casas-Limón et al., 2024).
It happens outwardly -
in comments like “it’s just a headache.”
It happens structurally -
in how difficult it can be to access care or accommodations.
And then, eventually, it happens internally.
That’s the part that stays, becomes ingrained.
Maybe I’m just overreacting.
I should be able to handle this.
It’s here that I think about my sister again.
How young she was when she started learning that. How early she began negotiating with her own body.
Migraine is not a failure of resilience.
It is a complex neurological condition involving brain signaling, sensory processing, hormonal shifts, and genetic vulnerability. It often includes light sensitivity, nausea, and cognitive fog—symptoms that not only hurt but also disrupt how a person moves through the world (Buse et al., 2012; Ashina, 2020).
And when that reality is minimized, something else gets layered on top:
Guilt.
Self-doubt.
Disconnection from our body’s own signals.
A different approach begins with something simple—but not easy.
Listening.
Not just to others - but to our own body.
Research supports approaches that help individuals relate differently to pain—not by eliminating it, but by reducing the added suffering that comes from fighting, dismissing, or overriding it (Wells et al., 2014; Seng et al., 2015).
For many women, this is unfamiliar territory.
Because they’ve spent years doing the opposite.
A gentle starting place might look like:
• Noticing early cues without dismissing them
• Pausing before pushing through, even briefly
• Using grounding practices—breath, stillness, prayer, reflection
• Shifting the internal tone, from pressure to permission
Not permission to give up—but permission to respond differently.
This is the work I often find myself doing with clients, and with myself.
Not just helping them manage symptoms, but helping them rebuild trust with their own experience.
Because for many women, the pain is only part of the story. The deeper work is untangling years of not being believed by others, and then eventually by themselves.
So when a woman says she is hurting, the most meaningful response is not advice.
It’s the absence of that quiet, questioning pause.
It’s presence and belief.
Because I still think about my sister, ten years old, trying to make sense of something no one had words for.
And I think about how different that experience might have been if someone had said:
I believe you.
-Denica Gordon-Mandel, M.A., MSW, LCSW, & Director, Women’s Wellness Program at CBH Partners
References
• Ashina, M. (2020). Migraine. New England Journal of Medicine.
• Burch, R. C., et al. (2015). The prevalence and burden of migraine and severe headache in the United States. Headache.
• Buse, D. C., et al. (2012). Chronic migraine prevalence and burden. Neurology.
• Casas-Limón, J., Quintas, S., López-Bravo, A., Alpuente, A., Andrés-López, A., Castro-Sánchez, M. V., Membrilla, J. A., Morales-Hernández, C., González-García, N., & Irimia, P. (2024). Unravelling migraine stigma: A comprehensive review of its impact and strategies for change. Journal of Clinical Medicine, 13, 5222.
• Lipton, R. B., et al. (2007). Migraine prevalence and impact. Neurology.
• Seng, E. K., et al. (2015). Behavioral approaches to migraine management.
• Wells, R. E., et al. (2014). Mindfulness meditation for migraine. Headache.