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Psychiatric Headache

A Clinical Study

Department of Psychiatry, Manchester Royal Infirmary

ABSTRACT

All patients suffering from psychogenic headache, alone or with other symptoms, who were admitted as in-patients over a two-year period to the Psychiatric Unit of the University of Manchester were studied. Patients with migraine or organic brain disease were excluded.

The group comprised nineteen male and thirty-four female patients. The patients suffering from headache were compared with all the other patients, 69 males and 117 females, admitted to the Unit over the same period with the exclusion of patients with organic brain disease. Amongst the female patients the headache group contained a significantly higher proportion of patients classified as suffering, alone or in combination with a psychosis, from an insecure personality disorder (which corresponds to the anankastic or sensitive obsessional personality disorder.).

Within the headache group the pattern of headache was strikingly constant amongst the various diagnostic and personality groups. The pattern was that of a constant bilateral frontal pressure. It is tentatively postulated that "psychiatric headache" is perhaps a pre-formed mechanism which can be triggered by many stresses.

This study suggests that female sufferers from an insecure personality disorder are more likely to possess this mechanism than those possessing other personality structures. They are also more likely to consider the headache as being caused by "nerves".

It was found that the prognosis of the headache was that of the underlying psychiatric condition.