Psychosomatic Medicine 11:251-256 (1949)
© 1949 American Psychosomatic Society

A Formulation of the Dynamics of the Migraine Attack

In two individuals it was possible experimentally to induce psychologic stress which led to the predictable physiologic phenomena of a typical migraine attack. For some time these subjects had been gradually accumulating fatigue, tension, and resentment. When confronted with a situation which produced intense anger and frustration, they developed a typical high-intensity vascular headache. These headaches were interrupted by the administration of ergotamine tartrate which abolished the painful vasodilatation.

Decrease in frequency and ultimate cessation of migraine attacks was observed as a man exhibited progressive deterioration due to paresis. The resulting cerebral damage produced personality changes which eliminated the need for compulsive behavior which had previously led to his headaches. Similar though less dramatic changes which occur with aging are likewise followed by disappearance of headache.

The migraine attack may be considered one of the phases of an inappropriate protective or adaptive reaction involving cranial circulatory apparatus which is manifest when the subject has reached the limit of his capacity to tolerate tension, hostility, frustration, and fatigue.