Psychogenic Headaches

It should be obvious that virtually all types of headaches are, at least to some extent, dependent on emotional factors and individual personalities. In addition, psychotic patients and those suffering from anxiety neuroses are prone to describe pressure sensation, pain in the vertex or in the occiput, a sensation of bands about the head, or a sensation of something being driven into the skull (clavus hystericus). Their description of the severity, continuity, and bizarre features of the headache is usually sufficient to indicate the diagnosis. Most essential to the diagnosis is evidence for a basic personality disorder, of which the headache is but a part. The headache appears or disappears with the mental state that engendered it (Packard, 1979). It should be emphasized, however, that although depression (as well as other affective disorders) may produce headache (Weatherhead, 1980), chronic nonpsychogenic headaches may produce depression (Martin, 1978; Cox and Thomas, 1981).