Meeting of the Psychoanalytic Association of New York

February 17, 1964. A FURTHER CONTRIBUTION TO THE PSYCHOANALYTIC STUDY OF MIGRAINE AND PSYCHOGENIC HEADACHES: THE RELATION OF MIGRAINE TO DEPRESSION, STATES OF WITHDRAWAL, PETIT MAL, AND EPILEPSY. Melitta Sperling, M.D.

This study is a continuation of Dr. Sperling's previous work, reported in 1952. She then described patients suffering from migraine as predominantly orally fixated individuals with very low frustration tolerance. Libidinal development

was incomplete and object relations showed marked ambivalence and sadomasochistic attitudes. The basic denominator was a pregenital character structure. Further, Dr. Sperling noted that the psychosomatic patient, like the neurotic, represses his dangerous impulses and internalizes his conflicts; thus he is not in conflict with his real objects, environment, or society, but discharges the repressed impulses in his somatic symptoms which represent the expression and fulfilment of specific fantasies and impulses of a pregenital nature. The specific dynamics of migraine headaches were described as unconscious fantasies and impulses to kill the frustrating object by an attack upon the head. These patients had sought treatment not because of headaches but because of depression.

The present study describes further work with migraine patients and provides additional material on the relations between migraine and depression on the one hand and between migraine and states of withdrawal, petit mal, and epilepsy on the other.

Dr. Sperling relates the phenomenon of alternating symptoms of depression and migraine to sudden changes in object relationships. In the psychosomatic patient there is an increase in object cathexis in the situation of loss or threatened loss of object. In the case of depression there is a decrease in object cathexis and withdrawal from the external object. Narcissistic injuries, real or imagined, bring about these fluctuations in object cathexis. In discussing the relation of migraine headaches to