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Headache, Hypnosis and Stress, a Case History
By Dr. Larry Deutsch
Now, more that ever, concerned physicians are beginning to ask about and understand the role of non-drug therapies to assist patients with headache. These therapies, alone or in combination with medications can significantly impact on headache treatment.
This pleases me. As a Family Physician and Clinical Hypnotist with thirty years experience in the field, I applaud this trend. Certainly, a capable and compassionate physician will struggle to assist his/her patient find headache relief by whatever methods, complimentary, traditional or both. Much can be gained if we look at hypnosis as a helpful tool in the battle for headache relief.
As our understanding of how the brain works and which compounds or "neurotransmitters" control our pain response develops, we begin to suspect that relaxation therapies including hypnosis, may alter in a positive and fundamental way our brain chemistry such that pain relief is more likely. An interesting study was performed with patients who learned relaxation skills. The researchers checked the subjects' monoamine oxidase levels-since monoamine oxidase is what metabolizes serotonin, a pain relief chemical, and found changes in those levels consistent with what you would expect with preventive drug therapy! The study suggests that it is not just a matter of feeling relaxed that's important but actually learning via these relaxation therapies to turn off and on certain pain pathways in the nervous system by changing monoamine oxidase levels and consequently serotonin levels.
In this article, I would like to introduce you to hypnosis and self-hypnosis as a modality of pain relief for patients who suffer from headache. Hypnosis is fun, effective, relaxing and has no side effects.
What is this thing they call hypnosis? No, Virginia, it is NOT clucking like a chicken, barking like a dog or being 'put under,' helpless and at the control of the master. Rather, for most people, most of the time, it is a focused state of attention or harmony. It is easily achieved by visiting a professional skilled in hypnosis. This pleasant state has two fascinating and useful properties:
- It is profoundly relaxing. In our stressful lives what person would not enjoy a few minutes of deep relaxation in the middle of the day from hell!
- The mind becomes open to positive and therapeutic suggestions. Only suggestions given with your permission and for your own benefit are accepted. No one can be forced or coerced into doing something they do not wish to do.
Let's take a look at a case history and see how it all fits together. Mr. X, a hard driving chief financial officer of a high tech company is known as the "firing man" and is responsible for downsizing a company whose expenses exceed its revenues, and whose market share is declining. His neurologist has referred him to me for help with his chronic daily headache that has not responded well to numerous medications. His executive decisions in the short run will result in layoffs and suffering for many. However, with his expertise, talent, intelligence and hard work, he may "turn the company around" and in the long run, his efforts will benefit far more people than those who will suffer in the short term. He is not well liked by his co-workers and worries a lot about his health and finances. He is a pleasant man, but rather intense and self confident to the point of arrogance. At this time, he is wiling to consider non-drug therapies to diminish the pain and discomfort of his daily headaches.
As I get to know him, I will develop for him the three elements essential to our success:
- First, in order to benefit from the therapy he must be motivated. Motivated to want to use hypnosis for his purposes, not mine, and motivated to put aside ten minutes each day to develop, via hypnosis, relaxation sufficient to impact on the pain chemicals in his brain.
- Second, I must establish with him a positive and supportive rapport. Trust is an essential element of the hypnotic process. For this gentleman who is used to firing people and always being in control in a "one up one down" situation, I must simply be his assistant. Without this rapport, hypnosis will not be effective.
- Third, I must make sure he has sufficient hypnotizablity. Most of us can experience hypnosis without difficulty. Probably, only about 10 percent of us will not be able to enjoy the hypnotic process. I have little to worry about with this patient. Most high functioning individuals in our society have good hypnotic skills, as hypnotizability is associated with creativity, intelligence and imagination.
After a brief explanation of hypnosis and after gaining his permission, Mr. X was hypnotized to enjoy some deep relaxation. Of course, like many patients he had expected to be 'put under" as he had seen on the stage. Prior to his hypnosis, he was informed that this would not happen but nonetheless, in spite of his level of awareness, the relaxation and ability to accept suggestion would be pleasing to him.
With this mixture of trust, motivation (based on correct information) and hypnotizablity, I was not at all surprised that Mr. X achieved some initial success at relaxation using hypnosis and self-hypnosis.
Mr. X was pleased and agreed to return for further sessions. Not surprisingly, he canceled most of them because he was too busy at work! Nonetheless, he was very positive about the hypnosis that we did. He reported that the relaxation lessened the pain from his headache.
It is a principal of hypnosis that all suggestions require reinforcement. Additionally, practice and repetition are required to develop these skills so they can produce both a biologically medicated pain relief (via altered brain chemicals) and a psychological harmony that helps the patient deal more easily with daily stress.
As with most of my patients, I asked Mr. X to set aside ten minutes daily (preferably at work and without interruption) to listen to an audiocassette that I created for him to recapture the relaxed feeling and increased suggestibility that he experienced in my office. With some practice on his part, I was confident that these daily and pleasant practice sessions would reinforce positive suggestions relating to his particular headache and attitude toward work.
Results have been very satisfactory so far. Mr. X has not returned for further work. When last I inquired he reported an improvement in the severity of his daily headache. Once again, he said he had little time for therapy but he was enjoying the ten minute practice sessions via his personalized audio cassette.
This particular case history will illustrate to the reader the value of using non-drug therapies to assist in pain control. Human beings are complex creatures who may have many different "triggers" for headache. Some of these triggers are stress and psychologically mediated. By dealing effectively with these "triggers" we may assist in pain control with less or no drugs.
To summarize, hypnosis is effective and fun and provides a powerful complimentary or stand-alone therapy to those who suffer from headache. Stress reduction and relaxation techniques have an important role to play in the treatment in one of the more vexing problems physicians face in practice, the patient with headache. A recent paper, 'New Treatment Options In Migraine' by neurologists Drs. Brandes, Edvinson, Marcus, and Rapoport rates relaxation therapies as "effective" as a non-drug therapy for migraine.