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MIGRAINE TREATMENT: STRESS AS PROVOCATIVE FACTOR
Stress can undoubtedly act as a provocative factor in many patients and a logical form of treatment is to lessen this, if possible.
Frustrating situations are met with in nearly all walks of life. One patient told his story as follows:
From the standpoint of migraine, the year beginning 1 July was noteworthy because of the infrequency and mildness of attacks; during this period the amount of work in which I had been engaged just filled each day, making it possible to maintain certain personal ideals of perfection. Since November the greatest amount of concentration has been directed to quantitative determinations in a large number of microscopic sections of tissues. Frequent short periods of this rather monotonous work during almost every day had not been unpleasant. On 4 February it was suggested that an attempt be made to complete this research sufficiently to present an abstract of the work to a scientific society within 16 days for consideration as a presentation at a later date. Accepting this suggestion I therefore increased my concentration on this problem by working in the evenings. It soon became evident that the amount of work accomplished was falling far short of any schedule that would produce a sufficient number of figures within this time, and furthermore, the work was for the first time becoming distasteful. In the night, after the second evening in the laboratory I was awakened by an ache over the right eye associated with nausea. After a period of semi-wakefulness, sleep was resumed and the next day the only trace of a headache was pain on the right side of the head on coughing. After the third evening of laboratory work I was awakened at 4 a.m. by an ache over the left eye associated with nausea. Unlike the symptoms of the previous night they rapidly increased in severity until it became necessary to get in a hot bath to secure some relief. When I returned to bed, the pain and nausea resumed their former severity and 1 gram of codeine finally relieved their symptoms and allowed a few hours of sleep. During the entire next day there were nausea and a constant severe generalized headache extending downward into the back of the neck, which was made worse by walking, talking or reaching. The following morning the symptoms had vanished.
This story will strike a chord with almost every migraine sufferer. Although it is possible to explain this sort of tension on a biochemical basis, too few studies have been done in chronic stress situations to pinpoint the problem but the existence of two different personality types is pertinent. Type ‘B’ people who thrive on challenges get a ‘charge or kick’ by being active and doing things and may in fact be depressed and lethargic when under-stimulated; with this personality, absence of stress may spark off headaches. The patient above is an example of a Type ‘A’ personality, who reacted badly to stress.
*43/152/5*

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