The Development of Acute, Transient Migraines During a Psychoanalytic Treatment

The purpose of this paper is to study the emergence of a new symptom, classical migraine headaches, in a patient completing the fourth year of psychoanalytic treatment. When she first presented, her level of functioning was impaired despite her intelligence and the acquisition of a professional degree. She reported feelings of depression and was demonstrably self-attacking. In the course of the first four years of therapy, she characteristically used depression, anxiety and acting out as defensive strategies. No significant somatic symptoms had been reported or observed during that period. Following a dream in which the patient revealed aggressive feelings toward the analyst, which were otherwise unexpressed, the migraine attacks began. These attacks were both acute and transitory, interrupting the patient's functioning for a three-week period. The symptoms included unilateral head pain, nausea, slurred speech and disorientation as well as other cognitive disturbances. Migraines, which are defined as physical events with an almost infinite number of presentations, “may also be from the start, or later become, an emotional or symbolic event” (Sacks, 1985, p. 8). The diagnosis was confirmed by several neurologists consulted by the patient, one of whom reported to the patient that the symptom was related to tension.

It is not the purpose of this study to establish a general understanding of the etiology of migraines. The paper addresses the emotional factors occurring concurrently with the patient's regression to