Psychosomatic Medicine 18:334-346 (1956)
© 1956 American Psychosomatic Society

Studies of Ulcerative Colitis

IV. The Significance of Headaches

¹ Departments of Psychiatry and Medicine of the University of Rochester School of Medicine and Dentistry and The Strong Memorial and Rochester Municipal Hospitals, Rochester, N. Y.

Data on 23 consecutive patients with ulcerative colitis revealed that 20 had suffered from headaches. These headaches include migraine, muscle-tension, and hysterical conversion mechanisms.

Twelve patients, who had acute attacks of colitis and relatively symptom-free intervals, invariably had their headaches when a remission was beginning or when colitis was not present. Eight patients with chronic colitis tended to have their headaches when diarrhea was less and bleeding absent.

When 56 headache periods and 43 bleeding periods were studied, a striking difference was discovered between the psychological conditions existing at the time of each. In general, headaches occurred when the patients felt in control, had taken an active or aggressive stand, made a decision, or thought something through and this was followed by conscious or unconscious guilt, but the significant object relationship was not seriously jeopardized. In contrast, bowel bleeding occurred when the patient to varying degrees was feeling helpless, hopeless, or despairing, generally in relationship to a real, threatened, or fantasied object loss.

The bearing of these findings on the pathogenesis of ulcerative colitis and their implications for the problem of specificity are discussed.