Chapter 52 Headache and Primal Scene

Paper read at the 18th International Psycho-Analytical Congress, in London, on the 29th of July, 1953 and published in 1954 in the International Journal of Psycho-Analysis, 35: 219–223.

Analysis of a group of patients who, in addition to their psychoneurotic disturbances, had been suffering for several years from headaches of both the common and the migraine type, revealed to me that they presented certain characteristics in their psychological structure and that the headaches were related to phantasies of the primal scene and to the specific way in which the ego attempted to elaborate the situation. Furthermore, it was possible for me, up to a certain point, to clarify the relationship between the common headache and migraine.

The limited extent of this paper prevents me from furnishing the ample supporting material and also obliges me to be somewhat schematic in the exposition of my findings.

My experience deals above all with female patients, of whom I shall select three: O. B., with typical migraine, from scintillating scotoma to the final vomiting; E. S., with common headaches; and M. C., with rather atypical migraine, i.e. a case intermediary between the first two patients. The material from these patients as here set forth should not be taken separately, but rather as fragmentary aspects of a whole to be regarded as if it belonged to one single patient.

In their structures all the patients possessed a common foundation in which the depressive position predominated. The basic conflict was the same, both in the cases of headache and in those of migraine. The deep psychological material showed that there is no reason to separate migraine from other kinds of headache. The two possess the same mechanism and

content. The only difference lies in the intensity of the process. Whereas in the common headache the sufferings are restricted to the head, in the migraine – owing to the greater intensity of the conflict – the head is not sufficient to express it and the patie