Podcast Summary: "Unpacking the Mystery of Headaches"

Podcast: Am I Doing It Wrong?
Hosts: Raj Panjabi Johnson & Noah Michelson
Guest: Dr. Christopher Gottschalk (Headache Specialist, Yale)
Date: January 29, 2026

Episode Overview

In this eye-opening episode, Raj and Noah dive into the confusing and often-misunderstood world of headaches—especially migraines—alongside one of the field’s foremost experts, Dr. Christopher Gottschalk. The discussion challenges long-held beliefs, scrutinizes common triggers, addresses societal stigma, and explores both mainstream and unconventional treatments for headaches. By the episode’s end, listeners will have a drastically different, clearer perspective on what headaches really are, why they happen, and how best to respond to them.

Key Discussion Points & Insights

1. What Is a Headache? What Is a Migraine?

• Definition:

  • Headache: Pain in any region of the head, caused by a spectrum of issues (03:26–03:39).

  • Migraine: The vast majority of recurrent headaches that interfere with day-to-day life are migraines, even if you don’t call them that (04:43–05:00).

    “If people have headaches that are getting in their way…that is almost certainly migraine.”
    — Dr. Gottschalk (04:43)

• Types:

  • Primary Headaches: The headache itself is the disease (e.g., migraine, cluster headaches).
  • Secondary Headaches: A symptom of another medical problem (e.g., brain tumor, aneurysm).

• Prevalence:
  Statistically, 95% of cases where people seek help for headaches are ultimately diagnosed as migraines (15:30).

2. Busting Headache and Migraine Myths

• Dr. Gottschalk emphatically rejects the “triggers” folklore—such as dehydration, stress, or eating certain foods—as primary causes (07:47).

  “The whole concept of triggers is just completely wrong.”
  — Dr. Gottschalk (07:47)

• Commonly-cited triggers like stress or bad sleep are often symptoms of migraine beginning, rather than the cause (11:21–13:14).

  “Your brain is getting ready to have a migraine for a long time before the actual thing happens.”
  — Dr. Gottschalk (12:11)

• “Sinus headache” is largely a marketing invention, not a distinct clinical entity (17:20–18:04).

3. Specific Caused Headaches vs. Migraine

• TMJ/bruxism (teeth grinding) and sleep apnea can cause or worsen headaches, but these are different from migraines (09:55–11:15).
• Identifying features helps distinguish between these specific causes and true migraines.

4. Headache Location and Severity: Does It Matter?

• The location of the pain (front, back, side) is usually not helpful in distinguishing causes—most are related to the same nerve networks (20:39–22:11).
• Exception: A headache that’s present when standing and disappears when lying down suggests a spinal fluid leak and requires medical attention.

5. Genetics, Frequency, and Stigma

• Migraine is hereditary; if family members have it, you’re at higher risk (22:17).

• Frequency varies—some have a couple per year, others several per week.

• Medication mismatch, head injury, and sleep apnea are common contributors to frequency.

• On society & stigma:

  • Migraine is invisible and predominantly affects women, contributing to minimization and disbelief (08:31–09:28).

  • Stigma and lack of validation worsen outcomes (51:05–52:41).

    “If somebody experiences stigma all the time...their quality of life is much worse than somebody who never has that reaction from people.”
    — Dr. Gottschalk (52:33)

Treatments and Remedies

Over-the-Counter (OTC) Medications

• NSAIDs (ibuprofen/Motrin, Aleve/naproxen) are generally more effective than acetaminophen (Tylenol) for most headache sufferers (26:48–28:04).

• Excedrin: No meaningful difference between “Excedrin,” “Excedrin Migraine,” and “Tension Headache Relief”—just marketing (29:11–29:18).

• The goal: Whichever you take, the headache should be gone in two hours and not come back (28:04).

  “I would like to be sure that when you treat a headache, it’s gone in two hours and doesn’t come back.”
  — Dr. Gottschalk (27:32)

Prescription Medications

• “Triptans” (e.g. Imitrex) are most effective within the first 1-3 hours of a migraine attack (44:18–46:16).
• New treatments (e.g., Nurtec) show promise, especially if taken early, even before pain begins.

Non-Medication Remedies & Myths

• Physical interventions: Pressure points may offer mild relief for mild headaches only (35:08).

• Peppermint oil can help: It cools sensitized nerves and may reduce pain (36:05).

• Caffeine: Withdrawal causes headaches, and sudden cessation can worsen migraines for regular drinkers (37:10).

• Cannabis: Mixed evidence; works for some, but not a consistent standard of care (38:38).

• Psilocybin & psychedelics: Emerging evidence, particularly for cluster headaches and some migraines. Highly promising, but not yet “standard” (39:33–42:29).

  “These drugs that have a strong serotonin activity are fabulously effective [for headaches].” — Dr. Gottschalk (41:05)

Practical & Preventative Advice

• If a headache is disabling your life (even occasionally), seek professional support.

• When to worry:

  • Sudden, severe headache that becomes excruciating within minutes (“worst headache of your life”) warrants immediate medical care (48:13).
  • Onset of new headaches past age 60, particularly with neurological symptoms, warrants evaluation.

• Lifestyle tweaks (sleep, exercise, “mindfulness”) are good for general health but not cures or guarantee of prevention. Hedging “blame,” however, needs to end (49:47–50:55).

  “It is not true that people get headaches because they’re not taking care of themselves. That’s just blaming the victim.”
  — Dr. Gottschalk (50:31)

• Early intervention is key: Take effective medication as soon as symptoms start to maximize results (44:18, 56:30).

• Supportive environments greatly improve quality of life for headache/migraine sufferers (51:05–52:41).

Notable Quotes & Memorable Moments

• “The whole concept of triggers is just completely wrong.” — Dr. Gottschalk (07:47)

• “If people have headaches that are getting in their way…that is almost certainly migraine.” — Dr. Gottschalk (04:43)

• “Sinus headache is a problem? Sorry, no such thing…that came from advertisers.” — Dr. Gottschalk (17:20)

• “Having headaches is not a moral failing. The stigma…can be super damaging to our health.” — Noah Michelson (56:41)

• “If you ever have headaches that ruin your day…you deserve good treatment because you don’t have to live with that.” — Dr. Gottschalk (24:20)

• “If you were quadriplegic twice a month, you’d go to a doctor. Why not for migraine?” — Dr. Gottschalk (25:18)

• "It’s not your fault... That embedded notion that headache is a sign of some moral weakness—absolutely not." — Dr. Gottschalk (32:22)

• “No one knows what [the switch] is…We just need people to get funding to study that and figure it out.” — Dr. Gottschalk on psilocybin (42:31)

Important Timestamps

• 02:15 – Hosts introduce topic and guest
• 03:26–05:00 – Defining headache vs. migraine
• 07:47 – “Trigger” myth debunked
• 08:31 – Discussion of stigma, especially for women
• 09:55–11:15 – Differentiating migraines from specific mechanical causes
• 12:11 – Early symptoms of migraine misinterpreted as “triggers”
• 15:30 – Most headaches reported to doctors are migraines
• 17:20–18:04 – “Sinus headache” as marketing myth
• 24:20 – When to see a doctor
• 25:16 – Migraine as world’s most disabling disease
• 26:48–28:04 – NSAIDs superior to Tylenol for headaches
• 29:11–29:18 – Excedrin “migraine” = regular Excedrin
• 31:52 – Migraine biology and nausea
• 37:10 – Caffeine withdrawal headaches, regular use
• 39:33 – Psilocybin/psychedelic research for headache treatment
• 44:18–46:16 – Early treatment effectiveness
• 48:13 – When to seek urgent care for headache
• 49:47–50:55 – Lifestyle advice, victim-blaming, and prevention
• 51:05–52:41 – Impact of stigma and support on quality of life
• 56:06–56:49 – “Better in Five” Takeaways

“Better in Five” — Top Five Takeaways (56:06–56:49)

1. Most headaches are actually migraines.
2. Pain may have specific causes (e.g., teeth grinding), but that's different from migraine.
3. Advil, Motrin, and Aleve tend to work better than Tylenol for most headaches.
4. Seek immediate care if you experience sudden severe headache pain.
5. Headaches are not a moral failing; stigma worsens suffering.

Tone and Takeaways

The conversation is at once compassionate, myth-busting, scientific, and validating. The episode reassures sufferers that headaches aren’t their fault or a sign of weakness, encourages earlier and more effective interventions, and highlights how crucial compassion and support are to quality of life.

Host Reflection:

“What I learned is that that’s not my fault, actually, and we shouldn’t be so hard on ourselves.” — Noah Michelson (57:15)

For Listeners:

Anyone suffering from headaches will benefit from this episode’s demystification, receive practical advice, and, perhaps most refreshingly, feel reassured that validating and treating their pain is both scientific and compassionate.