A Series of Clinical Notes on Headache

One of the most baffling problems in medical therapeutics is that dealing with the treatment of headaches. The main reason for this lies in the failure to detect the exact etiology of headaches, and, strange to say, the causal factor, the psychic, which should most obviously, because of its frequency, force itself upon medical practitioners, is the one most neglected. The following eight cases is a series in which the complaint, headache, was particularly distressing and in some cases the patient was incapacitated for work.

Headache, in fact, was the “disease” of the soul for which relief was sought after all sorts of futile attempts had been made along the lines of orthodox rules of treatment. This paper is intended as a contribution to the subject of therapy of headaches and a plea for the investigation, i.e., by the psychoanalytic method, of exact psychic factors involved in obstinate cases, for it is only in this way that cure can be hoped for. I do not intend to survey the entire field concerning headaches but merely to present in briefest form the cases which have come to me during a period of about six months, and to demonstrate the varied applicability of psychoanalysis. All cases except the second have been completely analyzed and the results have been entirely successful.

Case 1: Mr. P., a skilled workman, is thirty-eight years of age and has had headache of an unusually persistent type for the past two years. It is present day and night, sometimes maddening in character but sometimes only a small remnant of it hangs on. The pain is usually situated in the left temporal region and at intervals shoots through the head to the right side. Sometimes a particularly intense pain is localized in the left parietal region, from which it spreads forwards in an unvarying path into the region of the left eye and causes an unpleasant degree of photophobia. At the fifth session I suddenly conceived the idea that these manifestations occurring in a man in the most dire eco