Psychological aspects of headache

Abstract

Summary Headache is one of the most common symptoms encountered in clinical practice. Its conceptual problems are those of pain in general and some of the theories concerning pain, especially those attempting to relate psychological and physical aspects, are considered. The classifications which have been suggested for headaches associated with emotional causes are described and it is shown that these are of limited clinical value. Some of the psychogenic causes of headache are considered and the associations of the symptom with various psychiatric illnesses are described. Headache is especially likely to be found with depressive illnesses. The treatments for various psychological types of headache are reviewed.

Evaluation of orofacial pain and psychological comorbidities in health sciences university students

“…Researchers found that the psychosocial alterations may aggravate the intensity and duration of pain particularly in chronic pain and patients with chronic temporomandibular disorders [2]. These patients may have a larger emotional component of pain than a sensory one [3] and aggravation of the pain occurs by a psychogenic exaggeration of somatic pain or through the hysterical mechanism [4].…”

Psychogenic orofacial pain: literature review, development of a diagnostic questionnaire and three cases report.

“…Pain is one of the commonest symptoms encountered in clinical practice and the head is a frequent site of pain. Headache is an experience of everyday occurrence, from which almost everybody suffers on some occasion and its significance will vary from the serious to the trivial (2). Chronic facial pain is an important health problem.…”

“…It may be that whenever the mother, say, has a headache, her relatives are expected to pay her a great deal of attention with the result that the child soon learns to adopt the same approach. The child may have a familial tendency to headache of some kind, but will come to use the symptom in an emotional way and always feel that insufficient attention is given to it by others (2). Rejected children who experience pain…”

“…and distress in which their parents take little interest may subsequently tend to complain excessively in an attempt to gain attention and for fear of being unnoticed. In addition, as in the case of depression, pain may sometimes be a symptom equivalent for anxiety and for other emotional conflicts and there are three ways whereby psychological factors can evoke pain: by psychogenic magnification of physical pain, by emotional stress creating muscle tension and producing muscular pain, and more specific regional pain produced by hysterical mechanism or by anxiety (2).…”

“…Some investigators have also shown that a diagnosis of unexplained orofacial pain is reached only after numerous clinicians from various specialties have seen the patient to exclude an organic cause (13). It the last few years, somatization and even hysteria have been associated with psychogenic pain and one study (2) contends that a positive diagnosis of hysteria may be complex and will depend upon a psychiatric assessment from which relevant psychogenesis and evidence of conversion involving the translation of emotional problems to a physical complaint, an unconscious and complex neurotic mechanism, rather than a means of manipulating others can be observed (2). Patients suffering from psychogenic headache may appear calm and relaxed while describing the presence of severe disabling pain (7).…”