[Psychotherapy of patients with frequent migraine attacks]

Forty-one women (mean age 36.6 years) with migraine without aura were studied and psychotherapeutic preventive treatment was conducted. Attack frequency was 5.8 a month, attack duration--29.5 h, intensity on visual analogue scale--8.2 scores. Clinical effect of the psychotherapeutic method was evaluated using clinico-neurological, experimental psychological and electrophysiological testing. During the treatment course, the patients self-rated the frequency, intensity, duration and characteristics of attacks and quantity of medications in a diary. A battery of psychological tests included Beck and Hamilton scale, Spilberger Inventory, Bass-Darky, Ammon, Plutcheck, Munstenberg tests and coping strategy in stress. Neurophysiological study was conducted using contingent negative deviation (CND) pre- and after treatment. Psychotherapeutic treatment was aimed at identification of patient's usual reaction style, kind of interrelations with other people, education, presence of psychotraumatic situations, reaction to disease and treatment. Several factors contribute to migraine severity: presence of deficit aggression in the form of autoaggression, personality features discrepancy, unconscious desire to be ill, passive pain coping strategies resulting in strengthening pain sensations and emotional disorders aggravation, tension of psychological defense, indicating psychological maladaptation, prevalence of unproductive mechanisms. The psychological peculiarities identified in the patients were subjected to psycho correction. An improvement of clinical (reduction of attack frequency and duration, pain relief) and psychoautonomic indices as well as electric brain activity normalization (decrease of early CND wave) were achieved. Correlation analysis of treatment efficacy confirmed, in general, the right choice of psycho-correction targets.