36
High frequency of ambitendency (problem solving style)
Discussion and conclusion
in cluster headache groups and in migraine with or without
aura groups indicate a strong decrement of efficiency and
vacillation and ambitendency in problem-solving and deci-
sion-making processes, with the subsequent risk to avoid
making decision and to have a severe “failure” both in con-
ceptual expression and in behaviour and affectivity. This
leads to an incapacity to adapt responses to stimulus and to
take on responsibility, as well as to an inhibited sense of duty.
On the contrary, tension headache patients exhibit ten-
dency to an immediate response, scarcely oriented to reflec-
tion, more typical of a “randomly” processing style
(extratensive), oriented to trial and error problem solving.
All groups show difficulties in affect management with
evident coarctation and decrements in adaptive resources.
Moreover, all groups – mainly cluster headache subjects –
exhibit an affective regression (bot, M, A), with typically
infantile way of relation. This provokes disorders in self-
representation, as well as marked disturbances in interper-
sonal contact, deficient in empathic values and identification
that social life requires. These data are more evident in
migraine with aura group than in others, even if with nearly
insignificant differences. Unlike old data described in liter-
ature, low H% in all groups confirm that headache subjects
exhibit an incapacity to socialize which is similar to affec-
tive coarctation. In this sense migraine with aura group
seems to be more compromised than other groups, even if
with little difference.
Also for affective inhibiting interference, reflection
processes are concrete, simple, analytical (D%) and stereo-
typic in all groups – with the exception of cluster headache
group, showing a stronger trend to conceptual variability –
and they are more evident in tension headache subjects.
By contrast, cluster headache group exhibit a significant
decrement in perceptual accuracy (that is the ability to evalu-
ate perception in an adequate way), whereas other groups show
a better perceptual accuracy, even though lower than normal.
The capacity for rational control on affectivity is low in
all groups – that is typical of a perceptual, mental, stereo-
typic reflection style – especially in tension headache group.
Hypochondriac tendency is particularly evident in clus-
ter headache group, whereas it is absent in the other groups.
Finally, all groups exhibit nuclei of neurotic distress,
predominantly phobic-type (red and dark shock), with free
anxiety (colour). They can be found especially in migraine
with aura group, showing deficits in phallic aggression and
decision-making processes. This distress affects both per-
sonal and sexual and libidinal aggression.
Our study supports the hypothesis that the various kinds of
headache can be associated with psychosomatic diseases, in
that they have a similar Rorschach profile which – for its
characteristics – is typical of alexithymia, as indicated in the
work on psychosomatic disorders, which is the reference
point of our study [11]. According to these parameters
headache patients are conceptually poor, with strong
deficits in imaginative and symbolic functions, in affective
and empathic capacity and in socialisation. What is more,
they exhibit difficulties in adaptive resources and decision-
making capacity and they show to be rigorous, ambivalent,
nearly obsessive. Among all groups, tension headache
group is the most similar to alexithimic syndrome, although
various subgroups are quite homogeneous in Rorschach
profile without significant differences in relation to alex-
ithymia parameters as well as to other studied Rorschach
parameters.
All groups present a depression nucleus and a neurotic dis-
tress nucleus. Headache with aura group has more phobic ele-
ments, whereas cluster headache group exhibit free anxiety.
Relation with reality is rigid, stereotypic, almost obses-
sive, with the exception of tension headache subjects, who
show a trend to immediate, not filtered, impulsive response,
but are always deficient in conceptual and imagine contents.
Only cluster headache group present a trend to concep-
tual variability, even if limited in comparison with normal
values. All groups – especially cluster headache group –
homogeneously exhibit deficiency in affectivity and adap-
tive resources, social contact, identification, responsibility
and decision-making and marked difficulties in adaptation
and reality testing. Frequent hypochondriac disorders, as
well, have been found in cluster headache group.
These findings support the following observations:
1. Despite little differences in some specific parameters or
personality sectors, headache subjects appear to be quite
homogeneous in perceptual and processing styles, affec-
tivity and adaptive resources.
2. These data are similar to what has been found in psy-
chosomatic illness.
3. Independently on neuropsychological, neuroanatomical
and functional substratums of these behaviours, a psy-
chotherapeutic approach to headache can be useful in
addition to common pharmacological therapy.
4. Data expressed by the analysis of Rorschach parameters
certainly exclude an analytical-type psychotherapeutic
approach (it is well-known that psychosomatic subjects
can hardly be treated with psychoanalytic therapy). In
fact, in headache patients mental symbolism and capaci-
ty to express feelings and emotion in interpersonal con-
tacts are underdeveloped, which makes an analytical
approach impossible, requiring conceptual capacity and
rich affective and emotional experience. On the contrary,
On the contrary, cluster headache subjects show a preva-
lence of association between dark and colour shock, with
low red shock, indicating bare distress for unknown. It may
be expresses more interior struggle with authority and sec-
ondary disorders deriving from this struggle: sin, judge-
ment, rebellion and anguish.
Speck
