[Interaction of phsychologic and somatic factors in headache (author's transl)]

It appears that a uniform "psychosomatic headache" does not exist. This is due to 1. the variety of phenomenology, 2. the variety of causes and 3. the variety of results in the psychodiagnostic and psychotherapeutic field. Analysis of the factors active in headache was attempted in a field study and on the basis of a systematic survey of many years of clinical experience. Within the framework of the concept of multifactorial causation of headaches we found 3 particularly important factors: vasolability, depression and the cervical spine. From the psychodynamic situation disturbing factors appear to be able to produce or maintain headache in this way. Physical examination by itself without taking psychodynamics into account will have to be called just as incomplete as an approach based exclusively on depth psychology alone. The questions on endogeneicity versus exogenicity have to be thought about both from points of phenomenology and individual analysis of the psychodynamic background of every patient, as part of a complex concept of treatment. Headache as an early sign of schizophrenia is rare but should not be forgotten. Among the many factors causing headache it is by no means always clear what is cause and what effect. Often there appears to be interaction which continues in the end autonomously or increases. It has been described on the example of the painspiral in the region of the cervical spine. For diagnosis we try to determine the various pathogenic factors via an anterospective program of examination. This will serve as the basis for our "targetted polypragmasia" i.e. we attempt to influence at one and the same time many of the factors which have been recognized as pathogenic. Drugtherapy apart we favor somatic vegetative stimulation. The results of our field study (strong preponderance of headaches among the non-manual professions together with clinical experience) support our view that in this way we enter an etiologically highly effective circuit. The effectiveness of phsychotherapy lies for the greater number of headache-patients within the zone of initial clearance, less in the direct action on the syndrome of pain. As main therapy psychotherapy has proved effective only in individual cases of predominantly psychogenic headache. We could also discuss the role of neuroleptic sleep cures which soothe psychologically and act also biochemically. No short-cuts and no sound simple prescriptions for the treatment of headache could be given. But the author hopes to have contributed to understanding of a complex field which may result in multi-layered but also clearly defined factors and their more effective therapy.