Look what they’ve learned about Head aches
Clip this article and next time your head aches maybe you’ll find out why — thanks to the discoveries of a medical-research team in Montreal who began by wondering about that common “pain in the neck”
DURING the last seven years medical scientists at McGill University in Montreal have learned more than has ever been known before about that age-old human affliction, the headache.
Basing their experiments on the knowledge that ninety percent of headaches are caused by emotion they have pinned down the type of worry responsible for the pain. In addition they’ve provided the first clear conception of what happens inside the head when the pain is in progress.
Robert B. Malmo, leader of the fifteen-man McGill research team, has reached the conclusion that “Headache-prone people suffer from a form of anxiety neurosis. They regard everyday difficulties as emergencies and cannot make up their minds how to cope with them. The mental conflict involved sets up a physical chain of events leading to pain in the head. It was not by chance that the term ‘headache’ came to have the same meaning as the word ‘problem.’ ”
Malmo has made his deductions from a study of muscles at the back of the neck and in the shoulders. These muscles react to psychological disturbances. Simultaneously blood vessels in the head expand and cause the ache.
Man has always been vaguely aware of this relationship between emotion, neck muscles and cranial blood vessels. If a clerk starts to worry about his rating with the boss the muscles at the back of his neck contract, the blood vessels in his head expand and other clerks in the office, noting his distress, say: “One day that guy will burst a
blood vessel.” As the clerk goes on brooding the blood vessels in his head swell so much he gets a headache. All this time the muscles at the back of his neck have been shrinking deeper and deeper. Now they begin to tire and to ache. The clerk becomes exasperated and says of his boss: “He
gives me a pain in the neck.”
According to Malmo, such common remarks, for generations regarded as mere figures of speech, can now be looked on as literal medical truths, and the discovery of the mechanism of headaches explains why they are often preceded, accompanied or followed by neck aches and shoulder aches.
Malmo is an American who took his doctor’s degree in psychology at Yale, served during the last war in the medical branch of the United States Army, and joined McGill in 1947 as associate professor in the Department of Psychiatry. He now has two chief associates, both Canadians. One is Charles Shagass, a Montrealer, who has a medical degree and a master’s degree in psychology. The other is John F. Davis, an Ottawan, who first qualified as an electrical engineer, then as a physician, and finally joined McGill as an expert in the electronic instruments used in medical research. All three are in their late thirties.
The funds for their experiments are provided by the Surgeon General’s Office of the United States Army. The U. S. brass has been interested in headaches since the last war when it was found that eight percent of the men rejected on medical grounds were chronic victims of this complaint and that half the American combatants removed from battle after psychological crack-ups reported headaches.
McGill was entrusted with the experiments because, under the influence of Dr. Wilder Penfield, the celebrated neurologist, the university’s medical faculty has become one of the world’s foremost for the study of the substance and the fantasy of the brain. McGill scientists are among the leaders in psychosomatic medicine, the study of the relationship between psychological and physiological disorders.
Malmo’s findings are of interest to civilian as well as military medicine. Surveys indicate that in Canada and the United States one out of every four people complains of some sort of headache every day. Canadian and U. S. drugstores sell more headache remedies than any other kind of patent medicine. Headaches cost industry millions of lost manhours. Like the common cold the headache is one of the most widespread human ailments. Because the headache rarely threatens life, there has been little research into its causes in the past, and the project Malmo heads at McGill is the most extensive study yet made.
Most of Malmo’s experiments are conducted with an electromyograph. This instrument records the
contraction and expansion of muscles like a seismograph records the tremors of the earth. Even when an individual is relaxed his muscles are continually contracting and expanding. When a person is under mental stress various sets of muscles contract more, increasing the range of the pulsation.
Malmo believes that different kinds of mental stress affect different sets of muscles. He has gathered enough evidence to suggest, for example, that sexual worries make the leg muscles contract and hostility makes the arm muscles contract. “It is not heyond the bounds of reason,” he says, “that other specific passions, say greed or envy, make the finger muscles or the back muscles contract.”
After severe or prolonged contraction the muscles ache. Many common aches and pains may have psychological origins.
In his headache experiments Malmo attaches electrodes to the neck muscles. From these he runs a wire to the electromyograph. In the electromyograph a pen responds to the movement of the muscles. It shows the pulsation in ink on an unrolling strip of paper in the form of a continuous letter “w.” During mental stress the deeper contraction of the muscles is represented by an increase in the size of the “wwwwws” until they look like this: “WWWWW.” The stronger the
activity of the muscles the greater is the head pain.
These medical detectives can now “see” a picture of the headache waxing and waning
Working independently of Malmo is Dr. M. M. Tunis, a McGill biologist who has developed an instrument which records the expansion and contraction of the blood vessels in much the same way that the electromyograph records the muscle movement.
By taking recordings from the muscles and the blood vessels both Malmo and Tunis can get a picture of a headache and its degree of intensity. They are able to “watch” a headache waxing and waning. Malmo believes that the muscles respond first to psychological stress and that in headaches the dilation of the blood vessels causing pain in the scalp is a secondary action.
Neither Malmo nor Tunis nor any other authority knows the exact connection between the muscular action in the neck and the vascular action in the head during a headache, but time and again their instruments have shown that both disturbances are concurrent throughout the pain.
The belief in links between emotion, muscles and blood vessels is in line with the biological theory that all animal life is equipped by nature with a mechanism which during an emergency releases adrenalin into the blood stream and tenses the muscles for flight or fight. If this delicate mechanism gets out of balance in a human being he becomes too jumpy. He exaggerates or fancies dangers. The muscles, weary of constant tension, ache.
Between 300 and 400 patients at the Allan Memorial Institute, McGill’s psychiatric clinic, volunteered their services as guinea pigs for Malmo. Psychoneurotics were chosen not because they suffer more headaches than normal people but because they worry more.
The different kinds of worry from which psychoneurotics suffer often lead to different kinds of muscular afflictions. Some, for example, get nervous tics; some limp; others, though suffering from no physically detectable cardiac disease, get palpitations of the heart. Malmo decided that since psychoneurotics show stronger muscular reactions to mental stress they would be better for his purposes than normal people. About half his psychoneurotic subjects suffered from varying degrees of headache and half were headache-free.
Before he started his experiments Malmo studied every type of headache known to medical science and ruled out as irrelevant the categories that have nonemotional origins.
The first of these is the least common and most dangerous headache. It is caused by a growth, tumor or abscess, or by a membrane swollen by fever like meningitis, or by an infection like a mastoid lump pressing on pain-sensitive fibres inside the skull. These represent an infinitesimal fraction of headaches and are usually treated by surgery.
Another group outside the scope of Malmo’s experiments are the headaches caused by noxious chemical agents which swell the blood vessels in the head in the same way that emotion does. These chemicals include carbon monoxide, found in car-exhaust fumes and overcrowded underventilated rooms; carbon dioxide which is present in air at high altitudes; the nitrates used in the industrial production of fertilizers and explosives; and alcohol. They are the sources of the headaches that are picked up in garages, air liners, stuffy buildings, factories and cocktail bars. But these amount to only about ten percent of headaches. The remaining ninety percent are emotional and therefore within the span of Malmo’s researches.
Malmo next studied the most familiar emotional headache. Its name is migraine. Its precise extent is difficult to gauge because it is believed that fewer than half the cases are reported to doctors. But W. G. Lennox, an American authority on seizures, studied 15,000 patients and found that eight percent suffered from migraine.
A typical migraine attack begins with a feeling of unusual well-being and high spirits. During this phase the blood vessels in the head are shrunk to an abnormal degree but the muscles in the nape of the neck are beginning to oscillate. Then the victim starts to suffer from vertigo, spots before the eyes, tremors, dry mouth, pallor, and alternating periods of sweating and shivering. Sometimes there is vomiting. Simultaneously the blood vessels in the head swell beyond the normal and
the neck and shoulder muscles begin an accelerated pulsation. Head pains are felt first, neck and shoulder pains later. The pains may be of any duration from a few minutes to several weeks. They range from the barely perceptible to the most agonizing. Often they start at sunup and end at sundown, the victim wants nothing more than to be left alone in a darkened room, and at night sleeps normally.
No social, intellectual, racial or economic group is immune from migraine. It can attack people at any age but it usually starts in adolescence. Most of migraine’s victims have relatives who suffer from the same complaint. When the bout is over the victim once more enjoys a period of well-being and is happy, talkative and energetic, with a good appetite. He wants to go to parties, and is unwilling to go to bed early.
Malmo read the histories of many migraine cases studied at Cornell University by Harold G. Wolff, one of the world’s leading authorities on this complaint. These revealed sufferers who, as children, had tended to be delicate, shy and polite. They took excessive care of their toys and clothes, but occasionally would burst out in fits of obstinacy and defiance and reveal a “chip on the shoulder”
Headache-prone people are often aloof, easily miffed. They usually chase perfection
attitude. During adolescence they were preoccupied with moral and ethical problems, particularly concerning sex, and were disappointed with others who were not so meticulous. As adults they were clean, well-dressed, yet exceptionally conservative. The women tended to sacrifice physical appeal for severe neatness. Both men and women made a fetish of perfectionism. One woman proudly called herself “a Dutch cleanser” and her husband put his finger on the cause of her frequent headaches when he said, “She’d be better if she threw away that mop.” A man made a bedtime ritual of arranging towel, soap, toothbrush, shaving brush, razor and hairbrush in a set pattern in anticipation of the morning’s toilet. In general these people were successful yet they were continually harassed by the conviction that they had not made enough of their opportunities. Sometimes their headaches occurred during holidays when they were frustrated by not being at work. In other cases headaches struck when the victims were up against a test, and anxiety to excel drove them to mental exhaustion. An army lieutenant always got an attack of migraine when he was made orderly officer. A schoolteacher suffered attacks when she attempted a difficult post-graduate course.
The Wolff studies at Cornell, which helped lay the foundation for what Malmo is doing at McGill, showed that migraine case« are usually cautious in society. They affect a cold aloof air but if others
display no warmth toward them they are hurt, although too proud to show it. The bottling up of their grief adds to their mental st ress.
While Wolff’s male subjects seemed to enjoy satisfactory sex lives, four fifths of t he women were maladjusted. Such women outwardly tried to give the impression of leading happily married lives.
Wolff classified migraine subjects as “tense, driving, perfectionist, order-loving rigid persons who, during periods of threat or conflict, become progressively more fatigued.”
With his associates, Shagass and Davis, and 12 assistants, Malmo set himself the task of pinpointing the cause of this taut ness that marks all emotional headaches.
The first experiment consisted of a series of psychiatric interviews with headache-prone and headache-free subjects. During the interviews elect rodes on the muscles of the subject’s neck were connected to an electromyograph. At the same time a tape recording of the conversation was made. When the interview was over, electronics expert Davis synchronized electromyograph recordings and tape recordings. It was found that in the case of headache-prone subjects the muscles at the back of the neck showed a much greater activity when they were talking about matters which distressed them.
One subject was a blacksmith known to have borne resentments against his father, for whom he worked. With great difficulty psychiatrists persuaded him to talk about a painful incident in his youth. The blacksmith recalled how he raised a sledgehammer and just as he was about to bring it down on a piece of hot metal held in tongs by his father he was seized by a murderous impulse. He resisted the temptation to strike his father but the recollection of the incident had been on his conscience ever since. As he talked about it he developed a headache.
A woman patient of Hungarian birth who had been hostile to her husband was induced to recall, much against her will, the time when she said to him “I wish you’d drop dead.” A few days later at his work the husband was fatally injured. The woman went to see him in hospital. Just before he died he said to her: “Well, you got your wish.” This memory had been partly responsible for the woman’s mental breakdown. As she discussed it she got a headache.
A younger woman, a clever and highly paid private secretary, was fundamentally so timid she could never protest when people took unfair advantage of her diligence. Her efforts to conceal this weakness had resulted in such a nervous strain that she had become mentally ill. She was shown a National Film Board psychiatric short entitled, Margaret—The Feeling of Rejection. The central character was a girl suffering from much the same disadvantage as herselfa lack of parental love and home security during childhood. When the movie was over the psychiatrists asked her to talk about it. She did so hesitantly and even then protested that the girl in the movie was not a bit like herself. During this she developed a headache.
Malmo says this experiment convinced him that conflict was at the root of headaches. Although the three subjects described here each showed many subtle variations of emotion, conflict was the common denominator of their trouble. Conflict also identified them with the reactions of all the other headache-prone subjects.
The blacksmith was in a state of conflict over the hostility he harbored toward his father and the deference he felt he owed him. The Hungarian woman was in a state of conflict between her hatred of her husband and her remorse over the bitter remark so shortly before his death. The secretary was in a state of conflict between her resentment at being overworked and her fear of the consequences if she protested. All were in conflict over whether or not to tell the psychiatrist of these secret troubles. . That conflict was recorded by electromyograph. Whenever the discussion touched on distressing subjects the instruments showed sharp bursts of muscle activity in the neck.
Malmo devised another experiment which put his subjects into a state of conflict. John Davis rigged up a machine called a thermal stimulator. It works this way: a subject puts his head into a frame before a powerful electric lamp. The electric lamp is enclosed in a bullet-shaped shield. A shutter opens a tiny aperture in the nose of the shield and permits a fine pencil of light to escape. So concentrated is this light it is capable of inflicting a pinprick of pain on human skin. The strength of the shafts of light may be varied. The subject is told that his forehead will be exposed to twelve shafts of light, each of three seconds’ duration. Between each shaft there will be an interval of one and a half minutes. He is asked to withstand the pain and to keep his head in the frame. If the pain becomes too severe he is told he may press a button at his right hand. His reactions are charted in detail by various electronicinstruments. An electromyograph records the activity of the muscles at the back of the neck and in the right arm. A pneumograph records the patient’s breathing rate. An electrocardiograph picks up his heart beats.
Seventy-five psychiatric patients volunteered to submit themselves to the “conflict machine.” Eleven doctors and nurses on the Allan Memorial Institute staff acted as “controls,” the • scientific term for people used as normal comparisons. About half the psychiatric patients suffered from headaches ranging from rare to frequent and from mild to severe. The others were headache-free.
All submitted themselves to the 12 flashes of light. Some flashes were slightly painful, none unbearably so. The subjects, however, had no idea how strong the next flash would be. During the intervals between flashes they worried. Malmo says: “The uncertainty
caused a maximum expectancy and we were able to determine the degree of apprehension by our recordings.”
The most anxiety was shown by the headache-prone psychiatric patients and the least by the “con-
trols.” The headache-free psychiatricpatients showed a degree of anxiety that fell fairly equally between that of the other two groups.
The most noticeable difference lay in the reaction of the neck muscles. While those of the “controls” hardly changed their pulsations those of the headache-prone subjects rose to sharp peaks of agitation as the moment of exposure to the flash drew near.
Although there was no marked difference between the three groups in heart rate or breathing rate there was a significant rise in blood pressure in the headache-prone. Their right-arm muscle tension also showed a higher rise indicating a stronger temptation to press the button and signal the pain as unbearable.
“Altogether,” says Malmo, “the experiment showed that the headacheprone were in a state of conflict as to whether they should avoid the pain or withstand it according to the doctor’s instructions.” Thus some headache victims are constantly torn between what they want to do, what they are capable of doing, and what they think they ought to do.
Malmo believes that some headaches normally attributed to chemical causes are aggravated by mental stress. There is a widespread tendency, for example, to exaggerate the danger of headache arising from the toxic effects of constipation. People who have been conditioned since childhood to fear sickness should they fail to evacuate once a day become anxious during constipation. The ensuing headache often results more from their nervous tension than from constipation.
The hang-over headache still puzzles medical men because it occurs not when the blood vessels are fully dilated but when the alcohol is receding from the body and vascular contraction is taking place in the head. The latest theory is that the pain is due partly to the effects of alcohol and partly to the nervous raggedness caused by excessive talking, laughing, singing and dancing, late hours, exhaustion and, finally, remorse.
An excruciating headache can occur in the paranasal sinuses of the forehead during a bad cold. This was once ascribed to the pressure of infected and engorged membranes against painsensitive fibres. It has been discovered however that the pain-sensitive fibres in a paranasal sinus are few and not easily hurt. Suspicion that something else was amiss arose from the fact that sinus headache waxes and wanes at the same time every day. In the case of the average person this is between nine in the morning and five at night—the normal working hours.
Experiments have shown that separately neither the engorgement of membranes nor the swelling of blood vessels is capable of producing the pain. But when both occur at the same time the pain, a dull aching distress, usually on one side of the head, can be prostrating.
It is now believed that sinus headache has its origins in the bad cold but that the pain is caused by the additional pressure of blood vessels dilated by worry over whether the cold will hamper the victim at his work. This theory is supported by the fact that when the patient is persuaded to go to bed and forget all about his work the pain usually subsides.
Neuralgia, the face pain, results from swelling blood vessels and in general may be attributed to psychological stresses. It is a predominantly whiterace ailment and more than twice as many women are affected as men. In women neuralgia often coincides with the mental conflicts of the menopause.
Headaches also result from arterial hypertension, or high blood pressure. Their mechanism is similar to that of migraine and their origins are rooted in troubles of the mind.
Headaches which result from noxious impulses spreading from diseased teeth, diseased ears, diseased jaws, distorted eye muscles, or the growth of tumors and abscesses, or the infections of fevers, are biological and usually free from psychological complications.
So is the famous ice-cream headache. This stems from the fact that intense cold has the effect of sharply contracting muscles. When ice cream is held against the roof of the mouth for longer than normal periods the particular muscles affected are those in the forehead. As soon as the ice cream leaves the roof of the mouth and passes into the throat the pain dies away.
Some headaches are subdued by taking aspirin, the mildest of the sedatives. Others are severe enough to require codeine, a derivative of morphine. This should be taken only under medical supervision. Prostrating headaches are often relieved by an intramuscular injection of ergotamine tartrate. All these drugs shrink blood vessels. But they are palliatives, not cures.
People suffering from one of the emotional headaches can only recover by reducing nervous tension. Frequent long baths help by relaxing aching muscles. Swimming, athletics, music, reading, painting and hobbies of all kinds take the patient’s mind away from his troubles and help to avoid head pains. If any recreation is carried to excess, however, fatigue will result and the good will be undone.
Movies help many headache sufferers because they are a distraction. But violent movies depicting gang warfare, major catastrophes and emotional turmoil should be avoided.
The finest therapy, according to doctors, is to refrain from attempting to be better than the next man and to stop being afraid of tomorrow.