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In an early report of her psychoanalytic study of migraine and psychogenic headache, Dr. Sperling remarked that there was insufficient awareness of the need for psychiatric or psychoanalytic treatment for migrainous attacks unless they were associated with other obvious and disturbing neurotic symptoms. The cases she now reports vividly illustrate her conclusion that psychosomatic diseases should be considered as pregenital conversion neuroses and she has described the specific
dynamics of migraine headaches as unconscious fantasies and impulses to kill the frustrating object by an attack upon the head.
Although relatively long term follow-up studies on her patients have indicated that treatment based on these concepts has been remarkably successful, it seems possible that the patients who came to her represent an especially disturbed group. It would therefore be interesting to find out whether people who have migraine but do not consult a psychiatrist have accident proneness to such a striking extent.
The second phenomenon she emphasizes in this communication concerns changes in sensory perception and what she alludes to as disturbances in certain ego functions such as speech, writing, and reading as prodromal symptoms. Dr. Sperling considers these phenomena as varying expressions of an acute struggle between the life and death instincts.
In a previous paper she stated that she has concerned herself solely with the study of psychic and not with physiological mechanisms. Her data therefore do not account for the fact that sometimes the sensory aura persists without headache and vice versa. A neurologist would, of course, relate the ego disturbance primarily to alterations in arterial circulation to specific parts of the brain.
The term migraine was derived from the Greek word hemicrania and classic migraine is a one sided headache. It would be interesting to know whether Dr. Sperling has been able to relate the side affected to specific fantasies. Since as age advance