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Psychosomatic Medicine 11:53-56 (1949)
© 1949 American Psychosomatic Society

Psychologic Factors in the Etiology and Treatment of Chronic Headache

CHARLES BRENNER M.D.1, ARNOLD P. FRIEDMAN M.D.1, and SIDNEY CARTER M.D.1

1 Division of Neuropsychiatry of Montefiore Hospital, and the Department of Neurology, College of Physicians and Surgeons, Columbia University

In the present paper we have endeavored to discuss and illustrate a number of factors with which we have been impressed by our experience with several hundred patients with chronic headache. Headache has very often been found to be present in patients who had suppressed (or were unconscious of) strong feelings of resentment or anger. A variety of other mechanisms have of course been observed: hysterical identification or conversion through symbolic displacement, satisfaction of a need for punishment, hypochondriasis of psychotic type, high degree of secondary gain, etc.

The great importance in psychotherapy of the physician-patient relationship has been emphasized. Even in those patients to whom formal psychotherapy is not given, the therapeutic results often depend in large measure on the psychologic effect of the treatment situation on the patient and especially on the emotional relationship between patient and physician. Wherever possible ventilation of wholly or partly unconscious emotional conflicts is of course therapeutically valuable, as is suitable environmental manipulation.




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