Ask The Experts: Dr. Egilius Spierings Explains Why Chronic Migraine Is Far More Than “Just a Headache”
Dr. Egilius Spierings, a headache-and-face-pain expert and author of HEADACHES: Why You Have Them — What You Can Do About Them, has spent decades at the forefront of neurology and headache medicine, combining clinical expertise with a deeply holistic understanding of chronic migraine and its impact on the human body. From his early fascination with the nervous system in the Netherlands to serving as director of The Headache Research Foundation in Boston and as a clinical professor at Tufts University Schools of Medicine and Dental Medicine, Dr. Spierings has devoted his career to helping patients whose lives are disrupted by debilitating headaches and complex face-pain conditions.
Question: What originally inspired you to specialize in neurology and headache medicine?
Answer: In my later years in high school, when I decided to become a physician, I also developed an interest in the nervous system. In fact, I wrote my graduation biology paper on the function of the nervous system, which led to an interest in both neurology and psychiatry. I went to medical school in the Netherlands, where we combine the premedical and medical education in a 7-year program. I was a third-year student, actually still pre-med, when my interest in neurology brought me to a migraine symposium at the school. There I met John. R. Graham, MD, MACP, an internist from Boston and director of The Headache Research Foundation. He invited me to study with him in Boston, which I did several times as a medical student and for 1 year as his fellow in headache management.
When I finished my training in neurology, with additional education in pharmacology (PhD), neurosurgery, and psychiatry, I succeeded him in 1986 as director of the Foundation and assistant professor of neurology at Tufts University School of Medicine, working alongside the world-renowned neurologist Louis R. Caplan, MD.
Question: What specifically drew you to helping patients with chronic migraine?
Answer: Since the end of the last century, we have come to divide migraine into episodic and chronic, depending on the overall frequency of the headaches, which I like to refer to as overall headache burden. When this burden is less than half the month, we call the condition episodic; when it is half the month or more, we refer to it as chronic. Of course, in this definition, half a month is arbitrary and, hence, of no biological or medical significance. In fact, most patients with chronic migraine have daily or almost daily headaches, with superimposed, frequently occurring migraine headaches.
Considering the condition in those two subdivisions, however, made me aware of an undoubtedly much more important medical distinction, namely that episodic migraine patients, apart from their migraine headaches, tend to be healthy from a general medical perspective, while those with chronic migraine tend to be burdened, in addition to their migraine headaches, with multiple medical and psychiatric conditions, which we refer to as comorbidities.
Anxiety and depression are almost invariably present in patients with chronic migraine, and so are fatigue and insomnia. Musculoskeletal disorders are also very common, particularly chronic neck and jaw pain, as well as chronic low-back pain. The same is true for upper and lower gastrointestinal conditions, such as chronic nausea, acid reflux (GERD), chronic constipation, and irritable bowel syndrome (IBS).
The question that I pondered for a long time was whether this is just a random collection of disorders that these patients acquire over time, maybe even as a result of their intense and disabling migraine headaches.
As I started to explore these conditions and began treating patients for them in addition to their headaches, I learned that improving them often also helped their migraine headaches. However, it was difficult to conceive that they were part of the migraine condition, but then what is it that ties them together, and what is their relation to migraine?
I ultimately concluded that what connects this seemingly random collection of disorders is fatigue. It indicates a lack of metabolic energy, which every one of the billions of cells in our body needs to function.This is what these patients seemed to lack, and I coined the term “systemic endocrine-metabolic syndrome” (SEMS) to describe it all.
It particularly affects the relaxation of the postural muscles, those in the neck, shoulders, upper back, jaws, lower back, and calves, and those in the stomach and large bowel. It renders those muscles tight with the tense neck and jaw muscles driving headache frequency to daily or almost daily occurrence, and the spastic stomach and large-bowel muscles resulting in poor emptying with chronic nausea, acid reflux (GERD), chronic constipation, and irritable bowel syndrome (IBS) as a result.
When, in addition to this syndrome, migraine is present, which is a genetically-determined and inherited vulnerability to intense and disabling headaches, chronic migraine becomes part of the presentation. However, it is a separate condition, although affected by the disorders resulting from the syndrome that I called SEMS, accounting for the high frequency of the headaches that characterize chronic migraine.
Conclusion:
As migraine awareness continues to grow worldwide, Dr. Spierings believes that the future of care lies in looking beyond isolated symptoms to understand the broader physical and metabolic patterns that affect each patient. His work challenges long-held assumptions about chronic headache disorders and offers hope to millions of people who have struggled for years without meaningful relief. Through a combination of neurological expertise, integrative thinking, and compassionate patient care, Dr. Spierings continues to push the conversation around migraine medicine in new and important directions.
