Psychogenic Headache

Question 1

Definition

Answer 1

Headache, like tiredness, is one of those symptoms that may reflect a ‘hidden agenda’.

Pt may be;

• depressed (overt or masked) or
• have a true anxiety state.

Question 2

Most characteristic features

Answer 2

Headache is present virtually every minute of the day for weeks or months on end.

It is common for patients to deny that they are anxious, depressed or unduly stressed.

For this reason a detailed history is important to identify lifestyle factors and historical events that can be associated with headache.

Some patients are fearful of their headache lest it represents a cerebral tumour, stroke or hypertension and need appropriate reassurance.

Question 3

Pitfalls

Answer 3

Conversion reactions and other aspects of compensation rewards, especially following an accident (e.g. rear-end collision), may make the symptom of headache difficult to manage.

Headache, like backache, is one of the prime symptoms perpetuated or exaggerated for secondary gain.

Severe headaches, especially simulated migraine, are common ‘tickets of entry’ for drug addicts seeking narcotics from empathic practitioners.

Such patients require very skilled management.