Tuesday, February 25, 2014

Headache! Is There a Pill for That?

I have written previously about chronic pain; the categories of pain, and the differences in how I approach them. Headache is not different from these, except in that when your head is affected, your whole being seems out of whack in a different way from when your leg or your back aches. We are our heads--as if the bodymind totality is more bound up in the head than elsewhere, as if our very identity exists in the brain moreso than in lower regions. This then seems to exacerbate the problem when the head hurts. It feels at once more frightening and more intolerable. After all, while we would not prefer to live without a leg, we indeed could, while living without a head is rather non-negotiable. "What if there is really something wrong in my head that has not been located?" is a common fear associated both with headaches and with vertigo and other symptom patterns present above the neck. We always want that symptom gone and with it, the fear.

I offer today two stories--two clients whose heads had symptoms, whose fears made the symptoms worse, and whose lives, when the fears were allayed at a very deep level, could return to normal.

Client one came to me with vertigo and a panic disorder that was rapidly restricting his life. He was becoming afraid to travel, afraid to enjoy life, and afraid he was seriously ill. The onset of this was simple: an MR done to rule out anything dangerous related to his mild vertigo had shown a small, benign vacuole in his head--a small space of nothing. Despite being assured that this was not medically significant, it put him into a tailspin, making the vertigo worse to the point where he felt as if his head and body were not attached properly, his eyes and head not functioning together; and creating a deep-seated fear of death, and what was, to him, worse, of abandoning his beloved wife when he died.

Our work together consisted of a combination of Rational Emotive Therapy to work on his irrational fear that he was solely responsible for his wife's wellbeing; a burden which was causing him undo stress, as well as his fear that death was somehow imminent despite medical evidence to the contrary. This also involved helping to stop the vertigo, a symptom of stress, as it turned out, rather than of tissue damage. When we could correlate the worsening of the vertigo with increases in his worry and distress, he began to be less afraid of it and more able to calm himself and reduce the symptom. The application of hypnosis, both as a self-soothing technique and as a means of deeply understanding the patterns he had created, facilitated his healing process.

As I have been heard entirely too many times, to say, while the pain IS in your head, it is also real. So too, the vertigo. This client had vertigo; he did not imagine it so, but it was caused by stress rather than physical disease, and quite amenable to stress-reduction techniques.

Client two was a younger person with the typical stressors of today's teens, that center around school, social issues, and extra-curricular activities such as sports. A perfectionistic student, who aimed to please, he was also in soccer and determined to do well despite a certain fear of balls hurtling at his head. About 9 months before he appeared in my office, there had been an incident at a soccer game. The exact nature of the incident was not certain, as no one had seen exactly what had occurred, and the youngster did not remember the game at all, but what was known was there had been some contact with his head during the game, and he had a headache. The headache worsened over time, and the student was eventually diagnosed with concussion and advised to rest and enter rehabilitative treatment. Each dose of rehabilitation appeared to worsen rather than improve the symptoms. The headache was averaging 8.5 out of 10, and was debilitating and frightening.

In my office, the student was clearly afraid, and his breath shallow. The story, which included several negative medical tests looking for damage to brain tissue, seemed more one of progressive doses of fear than of debilitating injury. The young man was terrified of this weird thing called hypnosis in which his mind might be controlled. We worked delicately in small doses, with me demonstrating hypnosis on myself first. As the student became able to enter hypnosis, his breath spontaneously deepened, and his pain remitted. In three sessions, we were able to look back at the fateful game day and see that the injury itself was less a factor than the terror of a threatened injury and the fear of serious head damage, which had been exacerbated by subsequent medical interventions and failures to improve. The 8+ pain became 4, and the client became able to notice his own held breath, and the way in which embedded fear caused the breath-holding. Then indeed what remained was rehabilitation; teaching him how to cope with potential fears and alleviating them internally via the technique of Rational Emotive Therapy as well as the self-soothing therapeutic imagery he was taught under hypnosis.

Now certainly not every case of headache or vertigo is related only to fear, but when conventional treatments fail to attain anticipated improvements, or even lead to worsening of symptoms, a look at motivation is in order. What else might be involved in this symptom of the head that is causing it to follow this particular pattern? In cases such as this, there is indeed, no pill for that. The fear will resist all treatments, forcing a good look at the deeper psychological factors involved in what is happening.

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