Home PageBlogMigraine Headache in a Resistant Patient

Milton H. Erickson

Unpublished manuscript, 1936.

Estimated reading time: 6 minutes, 42 seconds.

An admonition from William Alanson White, M.D., then Superintendent of St. Elizabeth’s Hospital, was given to this writer early in his psychiatric career, and a year or so later he was again given the same admonition by Adolf Meyer,

M.D. Both strongly advised the writer never to refuse to consult with a patient. A single interview graciously granted during which the patient’s story was listened to attentively, while not especially remunerative, had often permitted them to encounter many unusual instances of psychopathology and to achieve, in many cases, astonishingly effective results. These results had sometimes proved to be far better than the doctors had considered possible at the time of the interview, even if long-term therapy could have been instituted. They likened such instances to the processes of behavior wherein “love at first sight” has drastically and positively altered the lives of various individuals. One such historical example was the schoolteacher who thought it wrong for an adult man making his living as a tailor (Andrew Johnson) to be so uneducated. The events that unfolded began with teaching and led to love, marriage, a law degree, a judgeship, and eventually the presidency of the United States.

Adolf Meyer particularly stressed the utility of hypnosis in eliciting the potentialities of these transient patients and urged this writer to see such patients for both the educational values of the experience and the possibility of effecting unexpected results. Throughout the passing years the writer has conducted many “one-shot” interviews and sometimes as much as 20 years later has received an appreciative letter or a personal visit confirming the therapeutic impact of the brief encounter.

One such case is as follows: In 1936 the author lectured to his first class of medical students at the Wayne State University College of Medicine. During one of the last two lectures of the year the subject of hypnosis was discussed. One of the students hostilely and aggressively interrupted the lecture to denounce hypnosis as a hoax and challenged the author to hypnotize him. He proceeded to berate the author; one of his classmates who was well known to the author rushed up and quietly explained that no notice should be given to the student’s misconduct. He was a known sufferer of migraine headaches, which developed unexpectedly; the headaches were always preceded by an outburst, as had just occurred; this behavior was merely the prodomes of a migraine headache, which would last for one to three days; and finally, such outbursts would occur in the most unexpected of situations—on the street, in the classroom, at parties, football games, etc.

After the outburst the student would slowly become flushed of face and neck, followed shortly by projectile vomiting, and culminating in a violent, incapacitating headache of perhaps several days’ duration. He had been examined by many competent physicians and had almost been refused admission to the medical school. So far no medication or treatment had been found for his malady. (Several of the rest of the class members confirmed this account of the student’s history.)

Within 10 minutes the student apologized for his conduct, declared that he was in the process of developing a migraine headache for which nothing could be done, in that about 15 or 20 minutes he would begin vomiting; after that happened, could he and a friend be excused so that he could be taken home. He also explained that his emotional outburst was a part of the aura. He was still getting angrier within himself, but he wanted to stay at the lecture as long as possible since past experience had taught him how to judge his condition. Consent was given, but a challenge was issued that he might try hypnosis since nothing else had worked. He bristled at this suggestion, but suddenly said, “Well, I’ve got nothing to lose but my breakfast, so go ahead with your silly hypnosis.”

He was asked to take a seat in front of the class, facing the author and with his back to the audience. Slowly it was explained that he was to rotate his chair (it was a four-legged chair) bit by bit until he had made a complete turn of 360 degrees. His hostile manner and attitude suggested the inadvisability of attempting any routine traditional technique.

Additionally, such a technique as moving his chair in a circle as he sat in it would be utterly incomprehensible to him as well as a difficult task. Yet, by so doing, he would be caught in the situation of actually participating with the author in a joint undertaking.

Thus, he would validate by his own actions the idea that he was going into a trance.

As he gradually rotated his chair, the author explained to the class that the subject would do this task slowly, that each little movement would become slower and more difficult, that there was no hurry, no rush, that the subject could take his time and ought to, that each time he moved his chair a little, he would feel increasing fatigue and sleepiness, that the chair would seem to get more and more difficult to move, that his efforts would increasingly become less and less effective, and that shortly his eyes would close, he would take a deep breath, he would give up trying to move the chair, and simply relax by going into a deep trance.

All of the above was said as if it were no more than an explanation to the rest of the class. Thus, the subject would hear these suggestions as an explanation to the class but not as commands personally addressed to him. He would develop no counterset to the suggestions and would thus tend to respond to them more readily since he was already cooperating by slowly rotating his chair. Another important factor was the impending threat of a disabling migraine headache and the undoubtedly strong desire to escape from it in some way, even if that “way” appeared silly to him. Indeed, the entire situation favored the development of a trance state—the long history of migraine, the prodromes of hostility, aggressiveness, and belligerency, his own feeling of helplessness, his unwillingness to experience the projectile vomiting, and his dread of the utterly painful incapacitation that awaited him.

By the time he was facing the audience, he had developed a deep trance. He was peremptorily told that the author was now in charge of him and that all instructions were to be carried out. To this he nodded his head affirmatively. He was instructed to awaken, to speak derogatorily about hypnosis and the author, and to declare that such nonsense as hypnosis made him sick to his stomach. He should then try to prove that statement by going to the window, opening it, and trying to vomit projectilely, but that he would fail completely.

He was aroused, appearing surprised to find himself facing his classmates, made several unpleasant remarks as instructed, and then opened a window overlooking a vacant lot. He apparently did his best to vomit but failed, stating, “By this time I should have lost the lining of my stomach, but I’m beginning to feel better. I always vomit when I am about to have a migraine and I sure had all the warning signs this morning. But if I can’t vomit, perhaps I won’t have it [the migraine].”

This utterance was seized upon by the author to expand the idea that maladies, whether psychogenic or organic, followed definite patterns of some sort, particularly in the field of psychogenic disorders; that a disruption of this pattern could be a most therapeutic measure; and that it often mattered little how small the disruption was if introduced early enough. After some discussion of this for the class (and as disguised suggestions to him) he was challengingly asked if he thought there was such a thing as hypnosis and did he dare to volunteer to be a subject.

His reply was most informative: “I just told you it was silly nonsense, but I’m beginning to believe in it and I almost feel that you could hypnotize me. But what I don’t understand is that something has happened to my headache. I knew this morning when I woke up that I was going to have one, and when I came into this classroom I was in my usual, helpless, ugly mood. But now I feel fine.”

The answer given was, “It’s all very simple, and as I explain you will go into a trance, a deep trance, remember everything, and then awaken, knowing that you never need to have another migraine headache. So rouse up!” He awakened from the trance that developed as the above remarks were made and had a total recovery of all events.

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