Headache

Based on early epidemiological and clinical research, the Ad Hoc Committee on Classification of
Headache (1962) differentiated 15 types of headache. It is at present recognized that psychological
factors can play a considerable role in any type of persistent pain problem (Melzack, 1973; Sternbach,
1978; Weisenberg, 1977), and can therefore influence each kind of headache. Accordingly, there are
three major headache types to which psychological factors appear to contribute, which are as
follows:

 Vascular headache of the migraine type;

 Muscle contraction headache; and
 A combination of these two referred to as the mixed or combined headache.

Migraine headache:
The Ad Hoc Committee on Classification of Headache (1962) defined migraine as recurrent attacks
of headache, widely varied in intensity, frequency and duration. The attacks are commonly
unilateral in onset; are usually associated with anorexia and, sometimes, with nausea and
vomiting; some are preceded by, or associated with conspicuous sensory, motor, and mood
disturbances; and are often familial.

The most common prodromal signs in migraine include the following:

 Scotomata;
 Hemianopia;
 Unilateral paresthesia; and
 Speech disorder.

Other accompaniments include abdominal distension, cold cyanosed extremities, vertigo, tremors,
pallor, dryness of the mouth, excessive sweating, chilliness, anorexia, and disturbances in water
metabolism as evidenced by edematous skin and urinary frequency with pale urine of low specific
gravity (Dalessio, 1972).

Muscle contraction headache:

The Ad Hoc Committee on Classification of Headache (1962) defined muscle contraction headache as
an ache or sensation of tightness, pressure or constriction; widely varied in intensity, frequency
and duration; sometimes long· lasting, commonly occipital; and associated with sustained muscle
contraction in the absence of permanent structural change, usually as part of the individual's
reaction during life stress.

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Data obtained from 1,420 cases of MCH (Friedman, 1979) indicate that the more common
characteristics of MCH involve a moderate to variably severe non-throbbing headache that is most often
bilaterally localized in the occipital, frontal or occipital and sub-occipital regions. The average
frequency is in excess of five headaches per month. The average duration is 4 hours, with half the
patients experiencing more than 7 hours of headache. Associated symptoms include fatigue, anxiety,
tension, dizziness, and "bright spots in front of the eyes." Prodromata, nausea, and vomiting are
generally absent. Pain onset is typically gradual, and there is a preponderance of female cases (78%).
Questionnaire and interview data suggest that in the majority of cases (77%) the headaches were
attributed to "emotional" or "situational factors."

Personality factors associated with headache:

Although one cannot speak of an actual 'headache type' of person, those suffering from the symptom are
frequently found to have strong anxiety components, ambition, aspirations to dominate, perfectionist
tendencies and the resultant chronic overstrain placed on the individual. In his confrontation with real
contingencies, the high standards the patients set himself lead to anxiety, frustration and suppressed
aggressivity. This may be expressed in the basic physical deportment as chronic tension. In summary,
we may speak of the patient's conflict as not being able to achieve the ends he considers desirable.

Migraine constitutes a particular form of headache characterized by a throbbing pain localized mainly to
one side of the head. Other symptoms include nausea, vomiting, photophobia and concomitant
neurological disturbances. The patients frequently harbour suppressed feelings which are described by
Fromm-Reichmann as being a mixture of hostility and envy directed particularly against any form of
intellectual achievement.

One could regard migraine as a form of 'swindle': it serves to conceal emotional conflicts that the patient
'need not' communicate. These patients can obtain secondary compensations from the attacks, which
provide an opportunity of dominating the family and punishing their milieu in general.

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