This article was downloaded by: [Queensland University of Technology] On: 13 October 2014, At: 04:31 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
International Journal of Clinical and Experimental Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/nhyp20
Hypnotic treatment of headache and vertigo in skull injured patients a
a
Claes Cedercreutz , Raimo Lähteenmäki & Jukka Tulikoura
a
a
Hamina Hospital , Hamina, Finland Published online: 01 Feb 2008.
To cite this article: Claes Cedercreutz , Raimo Lähteenmäki & Jukka Tulikoura (1976) Hypnotic treatment of headache and vertigo in skull injured patients, International Journal of Clinical and Experimental Hypnosis, 24:3-4, 195-201, DOI: 10.1080/00207147608416201 To link to this article: http://dx.doi.org/10.1080/00207147608416201
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or
indirectly in connection with, in relation to or arising out of the use of the Content.
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This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
The International Journal of Clinical and Experimental Hypnosis 1976, Vol. XXIV, No. 3, 195-201
Downloaded by [Queensland University of Technology] at 04:31 13 October 2014
HYPNOTIC TREATMENT OF HEADACHE AND VERTIGO I N SKULL INJURED PATIENTS CLAES CEDERCREUTZ, RAIMO LAHTEENMAKI, JUKKA TULIKOURA',
AND
Hamina Hospital, Hamina, Finland
Abstract: Symptoms of headache and vertigo were treated using direct hypnotic suggestions of symptom relief in 155 consecutive skull injured patients. Posttraumatic headache and vertigo were completely relieved after an average observation period of 1 year 10 months in 50% and 58% of the patients, and partially relieved in 20% and 16% respectively. Most of the relief was achieved after about 4 weekly sessions and, particularly with the headaches, only if treatment began within a few weeks of the injury. Therapeutic outcome was correlated with depth of hypnosis achieved for both headache (r = .44, p < .0001)and vertigo (r = .47, p < .0001) symptoms. Patients who could not even achieve light hypnosis obtained no therapeutic improvement, but patients who experienced only light hypnosis were as clinically responsive as those achieving deep hypnosis.
Posttraumatic headache and vertigo is a relatively common complaint among patients who have suffered head injuries. In a survey conducted in 1969, letters were sent to all patients who had been hospitalized a t the Hamina Hospital with skull injuries since 1965, asking them if they had continued to have persistent headaches or vertigo following their injury (Cedercreutz & Kampman, 1970). From the 182 letters mailed, there were 161 replies. Headaches had persisted in 34% of these patients and vertigo was still experienced by 30%. Earlier investigators have reported a similar rate in the persistence of these symptoms in skull injured patients. Brenner, Friedman, Manuscript submitted October 25,1974;final revision received November 12,1975. I Reprint requests should be addressed to Claes Cedercreutz, Sairaalank 9,49400 Hamina, Finland. * The authors wish to express their sincere appreciation for the time generously given by Dr. Frederick J. Evans (The Institute of Pennsylvania Hospital and University of Pennsylvania, U. S. A.), who reanalyzed some of the data, made valuable substantive suggestions during the completion of the manuscript, and helped stylistically in clarifying the English presentation of this material. 195
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Merroy, and Denny-Brown (1944) followed up skull injured patients for 3 years and reported that 32% of patients still had severe headaches. Similarly, Zetterholm (1947) reported that 30% of his patients continued to experience headaches. Projecting from these figures, in Finland which has a population of 5,000,000 and where there are about 7,000 patients hospitalized with skull injuries every year, the number of patients seeking treatment for persistent headaches may be as many as 2,000 patients each year. In spite of its incidence there has been no satisfactory method of treating these patients. In earlier times patients were kept in bed until the headache disappeared-often as long as 4 weeks. If the headaches continued, they were not allowed to work for 6 months to 1 year. More recently, patients have been encouraged to get up as soon as possible and resume working regardless of the headache. In some hospitals active neck exercises are practiced, but no dramatic therapeutic results have been reported. Harding (1967) reported that migraine headaches can be relieved using hypnotic techniques in about 38% of his patients, and significantly ameliorated in 32%. Following these impressive results, it occurred to us that posttraumatic headache might also be responsive to hypnosis, particularly if we were correct in assuming that both kinds of headache are of vascular origin. The program involving the treatment of posttraumatic headache and vertigo with hypnosis was begun in 1969. Encouraging results were obtained in 27 cases (Cedercreutz & Kampman, 1970) and later with a n additional 87 cases (Cedercreutz & Lahteenmaki, 1973). Results obtained from the treatment of skull injured patients with headache and vertigo by hypnosis with a total of 155 patients (including the 87 patients previously reported) are presented in this report. METHOD
Patients All patients suffering from the posttraumatic syndrome who could not obtain relief within 1 week of hospitalization were offered free treatment using hypnosis. This sample consisted of 155 consecutive cases who accepted the offer of hypnotic intervention. There were approximately equal numbers of males and females ranging in age from 8 to 80, with a median age of 45. There were 47 patients who suffered only from posttraumatic headaches, 15 patients who suffered only from posttraumatic vertigo, while the remaining 93 patients had both symptoms. There were no age or sex differences in the distribution of the two symptoms in the sample. Results derived from the 155
HYPNOSIS FOR HEADACHE OF SKULL INJURED
197
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patients will be reported separately for the 140 who had headache as a presenting symptom, and the 108 who suffered from vertigo.
Procedure Each patient was treated using hypnosis during each of from 1to 10 sessions lasting from 20 to 30 minutes. The therapeutic sessions were usually held a week apart. Therapeutic suggestions were repeated several times. In administering these suggestions it is particularly important to use the same words that the patient uses when describing his own pain. For example, in some early cases when the patient reported having “burning” and “sticking” pain sensations, only the burning pain disappeared because the therapist forgot to use the word “sticking” in the suggestions. Subsequent suggestions using the omitted descriptive term often led t o the disappearance of the sensation. When treating the vertigo, it is necessay to work with all of the situations in which the patient has experienced vertigo. A typical suggestion might be as follows: When you wake up you will have no vertigo. From a lying position you can get up to a sitting opsition and from sitting to standing without any vertigo. From standing you can go to a sitting or a lying position without vertigo. You can bend your head to the right or to the left without vertigo.
Evaluating Depth of Hypnosis. Depth of hypnosis was evaluated on a 4-point scale. Deep trance with spontaneous amnesia was experienced by 15% of the patients. Medium trance, defined in terms of catalepsy of the arm and the reaction to the suggestion that a mosquito was sitting on the patient’s forehead and stinging him, was experienced by 48% of the patients. Light trance, in which the patient reported feeling a little drowsy and that he may have seen a butterfly flying over his nose and possibly a partial response to either the catalepsy or the mosquito suggestion, was experienced by 25% of the patients. Hypnosis had no effect in the remaining 12%. The distribution of hypnotic susceptibility was not different in those patients suffering from headache and from vertigo.
RESULTS The median number of hypnotic treatment sessions required for those patients whose headache and vertigo was subsequently cured or ameliorated was between three and four. If a relapse occurred, it usually occurred within a month after the last session. If the patient seemed symptom free o r improved a t the end of a month, the result was usually lasting. The patients were observed for an average of 1year and 10 months
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C E D E R C R E U T Z , LAHTEENMAKI, AND TULIKOURA
following the completion of treatment. There were respectively 50% and 58% of headache and vertigo symptoms completely alleviated, and an additional 20% and 16% of patients obtained significant amelioration of these symptoms. The relationship between depth of hypnosis and clinical improvement in both headache and vertigo symptoms in the skull injured patients is presented in Table 1. The correlation between depth of hypnosis (on a 4-point scale) and therapeutic outcome (on a 3-point scale) was .44 ( p < .001) for patients with headaches and .47 ( p < .001) for patients with vertigo. However, there was a marked tendency for this correlation to be nonlinear. In fact, it is quite apparent in Table 1 that none of the patients who were completely insusceptible to hypnosis obtained complete or even partial relief from either symptom. However, even patients capable of only light trance were just as likely to benefit from the hypnosis treatment as those capable of experiencing deep hypnosis. For example, although 68% of the deep trance patients at least had the severity of their headaches markedly reduced, 75% of the light trance patients gained similar relief, but none of the completely unhypnotizable patients were relieved. It would be expected that the therapeutic effects would be more positive if the hypnotic treatment program began as soon after the injury as possible. In Table 2, the percentage of patients who obtained positive therapeutic results who were seen less than 6 months after the injury is compared to the outcome in those patients whose first therapeutic session occurred from 6 months to 12 years after the initial injury. For patients with headache there is a strong relationship between the duration of the symptom and the likelihood of therapeutic benefits (x2 = 9.84, df = 2; p < .005): the likelihood of obtaining significant relief from posttraumatic headache is markedly TABLE 1 RELATIONSHIPBETWEENDEPTHOF HYPNOSIS AND CLINICALIMPROVEMENT IN HEADACHE AND VERTIGO SYMPTOMS IN 1 5 5 CONSECUTIVE SKULLINJUREDPATIENTS Headache ( N = 140) Depth of Hypnosis
Ameliorated
Sy;L;m
Vertigo
N;zf-
Symptom
Free
Deep Medium Light No effect
N r
13 38 0
0 20 8 0
70
28
19
+.44 ( p < .0001)
6 7 9
(N = 108)
Ameliorated No Effect
No Effect
2
20
13 36 14 0
2 9 6 0
8 6 12
42
63
17
28
+.47 ( p < ,0001)
199
HYPNOSIS FOR HEADACHE OF SKULL INJURED
TABLE 2 FREQUENCY (%) OF PATIENTS WITH POSITIVE THERAPEUTIC OUTCOME RELATED TO DELAYFROM ACCIDENT TO ONSETOF TREATMENT FOR HEADACHE AND VERTIGO SYMPTOMS
-
Headache Time to Treatment Onset
Vertigo
Am+ liorated
No Effect
Ametiorated
NO
Effect ~
Less than 6 mo. More than 6 mo.8
83 57
49 21
10 18
24
N
140
70
28
X' a
N
Sjmp tom Free
~ _ _ _ _ _ _
~~~
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N
Symp torn Free
9 . 8 4 ;< ~ .01
41 22
8
18
18
67 41
9
10
42
108
63
17
28
1.93;~ < .30
Range up to 12 years.
greater if therapy begins shortly after the original trauma. However, a similar relationship was not obtained for patients with vertigo (x2 = 1.93; p > .30), Apparently the effectiveness of treating vertigo is not related to the length of time the patient has had the symptom.
DISCUSSION These results indicate that hypnosis is an appropriate treatment procedure for those patients with posttraumatic skull injuries who complain of headache and vertigo beyond a 1-week observation and hospitalization period. An average of four sessions of treatment, primarily consisting of direct suggestions under hypnosis, was sufficient to eliminate both of these symptoms in about half of the 155 consecutively seen skull injured patients. The incidence of these symptoms was significantly reduced in an additional 20%. However, the data indicates that hypnosis will be successful in alleviating headaches only if treatment is begun reasonably soon after the injury. It was our impression that patients who had the headaches for even as little as 6 weeks following the trauma had a poor prognosis. The length of time since the injury does not seem to be a particularly important variable in the treatment of the vertigo symptoms. The overall improvement in the symptoms was correlated with depth of hypnosis. However, little clinical effect with either headache or vertigo was observed in patients who were totally insusceptible to hypnosis. Significant clinical improvement could be obtained even if only relatively light stages of hypnosis could be induced. It should be emphasized that the headache and vertigo treated by
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hypnosis in this sample were not neurotic or psychosomatic symptoms. After some accidents resulting in skull injury, a posttraumatic neurosis may be observed. However, the method of treating the accompanying neurotic symptoms is quite different from the treatment of the vertigo or headache symptoms. For example, if the patient has been inside a car and has had difficulties in getting out of the car when injured, he may develop claustrophobia symptoms. Such a patient may never enter a car or a bus again, and will subsequently walk or bicycle to his work for years. Quite often a patient has been very frightened and he will have nightmares. In some instances these symptoms can be cured using regressive techniques under hypnosis. Typically, the patient is hypnotized, and it is suggested that he will “see” the accident anew and without fear. One session is sometimes sufficient t o alleviate these symptoms. Even in such patients the direct alleviation of the posttraumatic headache and vertigo symptoms requires separate additional treatment. In summary, it is concluded that hypnosis is an appropriate treatment for those skull injured patients who continue to suffer with headache and vertigo. A few sessions of direct suggestions under hypnosis will be quite effective in treating these patients, particularly if therapy is commenced shortly after the injury and if the patient is capable of experiencing even light stages of hypnosis.
REFERENCES BRENNER, C., FRIEDMAN, A. P. MERRITT,H. H., & DENNY-BROWN, D. E. Posttraumatic headache. J . Neurosurg., 1944,1, 379-391. CEDERCREUTZ, C.,& KAMPMAN, R. Beseitigung posttraumatischer Kopfschmerzen durch Hypnose. LHypnotic treatment of posttraumatic headache.] Hypnose psychosom. Med., 1972,21,150-151. CEDERCREUTZ, C . , & LKHTEENMXKI, R. Behandling av posttramatisk huvudvark med hypnos. [Hypnotic treatment of posttraumatic headache.] Finska Lak.-Sullsk. Handl., 1973,117 (l),42-47. HARDING, C.H.Hypnosis in the treatment of migraine. In J. Lassner (Ed.),Hypnosis and psychosomatic medicine: Proceedings of the International Congress for Hypnosis and Psychosomatic Medicine, Paris (France), 1965. Berlin: Springer-Verlag, 1967. Pp. 131-134. ZETTERHOLM, S. Blood-spinal fluid permeability to bromide in closed head injuries. Acta psychiat. Suppl., 1947,4 3 4 6 (Suppl. 45).
Hypnosebehandlung von Kopfschmerzen und Schwindelanfallen bei Menschen mit Schadelverletzungen Claes Cedercreutz, Raimo Lahteenmaki, und Jukka Tulikoura Abstrakt: Man behandelte Kopfschmerz- und Schwindelsymptome, indem man direkte Hypnosesuggestionen fiir Symptomerleichterung bei 155 aufeinanderfolgen-
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HYPNOSIS FOR HEADACHE OF SKULL INJURED
201
den Patienten mit Schadelverletzungen gebrauchte. Posttraumatische KopfschmerZen und Schwindelanfalle wurden nach einer durchschnittlichen Beobachtungsperiode von 1 Jahr und 10 Monaten bei 50 Prozent und 58 Prozent vollig, und bei 20 Prozent und respektiven 16 Prozent zum Teil behoben. Nach ungefahr 4 wochentlichen Sitzungen war der grosste Teil der Erleichterung erzielt, jedoch nur, und das besonders im Falle der Kopfschmerzen, wenn die Behandlung innerhalb einiger Wochen nach der Verletzung begann. Das therapeutisch erzielte Ergebnis, auf Tiefe der Hgpnose bezogen, war r = .44, p < .0001 fur Kopfschmerzsymptome und r = .47, p < .0001 fur Schwindelsymptome. Patienten. die nicht einmal in die leichteste Hypnose versetzt werden konnten, erfuhren keine therapeutische Besserung, doch reagierten Patienten, die nur eine leichte Hypnose erreichen konnten, klinisch in gleicher Weise wie die, die tiefe Hypnose erreichten. Le traitement hypnotique de la cephalke et du vertige chez des patients qui ont subi des blessures craniennes Claes Cedercreutz, Raimo Lahteenmaki et Jukka Tulikoura
Resume: Traitement de symptbmes de cephalee e t d’ktourdissement, par des suggestions hypnotiques directes de soulagement symptomatique, chez 155 victimes eonskcutives de blessures crkniennes. Aprhs une pkriode d’observation moyenne de 1 an e t 10 mois, les ckphalkes e t les ktourdissements post-traumatiques ont ktb respectivement compktement klimines chez 50 et 58% des patients, et partiellement soulagks, chez 20 et 16% des patients. Le plus grand effet de soulagement a 6tC ressenti apres environ 4 seances hebdomadaires, et, particulierement dans le cas des ckphakes, seulement si le traitement a debut6 pas plus de quelques semaines aprhs la blessure. Le succes thkrapeutique a Btk mis en corrblation avec la prodondeur de I’hypnose atteinte, B la fois pour les s y m p t h e s de ckphalee (r = .44), p < .0001) et de vertige (r = .47, p < .0001). Les patients qui ne pouvaient m&mepas atteindre un Ctat d’hypnose lkgere n’ont obtenu aucune amklioration thkrapeutique, mais les patients qui ont seulement fait I’expkrience d’une hypnose lkgere ont autant rkagi, d‘un point de vue clinique, que ceux qui ont atteint une hypnose profonde.
Tratamiento hipnbtico de la jaqueca y del vertigo en pacientes con traumatismos craneanos Claes Cedercreutz, Raimo Lahteenmaki, y Jukka Tulikoura Resumen: Los sfntomas de jaqueca y vertigo. en 155 pacientes con traumatismos craneanos, fueron tratados por medio de sugestiones hipn6ticas directas de alivio. Tras un perfodo rnedio de observaci6n de 1 aiio y 10 meses, se constat6 un alivio total de la jaqueca y el vertigo postraumhticos en 50% y 58% de 10s pacientes, y una mejorfa parcial en 20% y 16% respectivamente. Gran parte de la remisi6n de 10s sintomas se obtuvo tras 4 sesiones semanales y-sobre todo en el caso de las jaquecas - s610 si el tratamiento se iniciaba pocas semanas despues del accidente. El resultado terapkutico fue correlacionado con la profundidad del estado hipn6tico alcanzado, tanto en el tratamiento de la jaqueca (r = .44, p < .0001) como en el del vertigo (r = .47, p < .0001). Los pacientes que ni siquiera alcanzan un trance hipn6tico ligero, no experimentan ningtin progreso terapkutico; sin embargo, aqukllos que tan s610 conocen un estado hipn6tico leve manifiestan una sensibilidad elfnica equiparable a la de 10s sujetos capaces de trance profundo.
International Journal of Clinical and Experimental Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/nhyp20
Hypnotic treatment of headache and vertigo in skull injured patients a
a
Claes Cedercreutz , Raimo Lähteenmäki & Jukka Tulikoura
a
a
Hamina Hospital , Hamina, Finland Published online: 01 Feb 2008.
To cite this article: Claes Cedercreutz , Raimo Lähteenmäki & Jukka Tulikoura (1976) Hypnotic treatment of headache and vertigo in skull injured patients, International Journal of Clinical and Experimental Hypnosis, 24:3-4, 195-201, DOI: 10.1080/00207147608416201 To link to this article: http://dx.doi.org/10.1080/00207147608416201
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or
indirectly in connection with, in relation to or arising out of the use of the Content.
Downloaded by [Queensland University of Technology] at 04:31 13 October 2014
This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
The International Journal of Clinical and Experimental Hypnosis 1976, Vol. XXIV, No. 3, 195-201
Downloaded by [Queensland University of Technology] at 04:31 13 October 2014
HYPNOTIC TREATMENT OF HEADACHE AND VERTIGO I N SKULL INJURED PATIENTS CLAES CEDERCREUTZ, RAIMO LAHTEENMAKI, JUKKA TULIKOURA',
AND
Hamina Hospital, Hamina, Finland
Abstract: Symptoms of headache and vertigo were treated using direct hypnotic suggestions of symptom relief in 155 consecutive skull injured patients. Posttraumatic headache and vertigo were completely relieved after an average observation period of 1 year 10 months in 50% and 58% of the patients, and partially relieved in 20% and 16% respectively. Most of the relief was achieved after about 4 weekly sessions and, particularly with the headaches, only if treatment began within a few weeks of the injury. Therapeutic outcome was correlated with depth of hypnosis achieved for both headache (r = .44, p < .0001)and vertigo (r = .47, p < .0001) symptoms. Patients who could not even achieve light hypnosis obtained no therapeutic improvement, but patients who experienced only light hypnosis were as clinically responsive as those achieving deep hypnosis.
Posttraumatic headache and vertigo is a relatively common complaint among patients who have suffered head injuries. In a survey conducted in 1969, letters were sent to all patients who had been hospitalized a t the Hamina Hospital with skull injuries since 1965, asking them if they had continued to have persistent headaches or vertigo following their injury (Cedercreutz & Kampman, 1970). From the 182 letters mailed, there were 161 replies. Headaches had persisted in 34% of these patients and vertigo was still experienced by 30%. Earlier investigators have reported a similar rate in the persistence of these symptoms in skull injured patients. Brenner, Friedman, Manuscript submitted October 25,1974;final revision received November 12,1975. I Reprint requests should be addressed to Claes Cedercreutz, Sairaalank 9,49400 Hamina, Finland. * The authors wish to express their sincere appreciation for the time generously given by Dr. Frederick J. Evans (The Institute of Pennsylvania Hospital and University of Pennsylvania, U. S. A.), who reanalyzed some of the data, made valuable substantive suggestions during the completion of the manuscript, and helped stylistically in clarifying the English presentation of this material. 195
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Merroy, and Denny-Brown (1944) followed up skull injured patients for 3 years and reported that 32% of patients still had severe headaches. Similarly, Zetterholm (1947) reported that 30% of his patients continued to experience headaches. Projecting from these figures, in Finland which has a population of 5,000,000 and where there are about 7,000 patients hospitalized with skull injuries every year, the number of patients seeking treatment for persistent headaches may be as many as 2,000 patients each year. In spite of its incidence there has been no satisfactory method of treating these patients. In earlier times patients were kept in bed until the headache disappeared-often as long as 4 weeks. If the headaches continued, they were not allowed to work for 6 months to 1 year. More recently, patients have been encouraged to get up as soon as possible and resume working regardless of the headache. In some hospitals active neck exercises are practiced, but no dramatic therapeutic results have been reported. Harding (1967) reported that migraine headaches can be relieved using hypnotic techniques in about 38% of his patients, and significantly ameliorated in 32%. Following these impressive results, it occurred to us that posttraumatic headache might also be responsive to hypnosis, particularly if we were correct in assuming that both kinds of headache are of vascular origin. The program involving the treatment of posttraumatic headache and vertigo with hypnosis was begun in 1969. Encouraging results were obtained in 27 cases (Cedercreutz & Kampman, 1970) and later with a n additional 87 cases (Cedercreutz & Lahteenmaki, 1973). Results obtained from the treatment of skull injured patients with headache and vertigo by hypnosis with a total of 155 patients (including the 87 patients previously reported) are presented in this report. METHOD
Patients All patients suffering from the posttraumatic syndrome who could not obtain relief within 1 week of hospitalization were offered free treatment using hypnosis. This sample consisted of 155 consecutive cases who accepted the offer of hypnotic intervention. There were approximately equal numbers of males and females ranging in age from 8 to 80, with a median age of 45. There were 47 patients who suffered only from posttraumatic headaches, 15 patients who suffered only from posttraumatic vertigo, while the remaining 93 patients had both symptoms. There were no age or sex differences in the distribution of the two symptoms in the sample. Results derived from the 155
HYPNOSIS FOR HEADACHE OF SKULL INJURED
197
Downloaded by [Queensland University of Technology] at 04:31 13 October 2014
patients will be reported separately for the 140 who had headache as a presenting symptom, and the 108 who suffered from vertigo.
Procedure Each patient was treated using hypnosis during each of from 1to 10 sessions lasting from 20 to 30 minutes. The therapeutic sessions were usually held a week apart. Therapeutic suggestions were repeated several times. In administering these suggestions it is particularly important to use the same words that the patient uses when describing his own pain. For example, in some early cases when the patient reported having “burning” and “sticking” pain sensations, only the burning pain disappeared because the therapist forgot to use the word “sticking” in the suggestions. Subsequent suggestions using the omitted descriptive term often led t o the disappearance of the sensation. When treating the vertigo, it is necessay to work with all of the situations in which the patient has experienced vertigo. A typical suggestion might be as follows: When you wake up you will have no vertigo. From a lying position you can get up to a sitting opsition and from sitting to standing without any vertigo. From standing you can go to a sitting or a lying position without vertigo. You can bend your head to the right or to the left without vertigo.
Evaluating Depth of Hypnosis. Depth of hypnosis was evaluated on a 4-point scale. Deep trance with spontaneous amnesia was experienced by 15% of the patients. Medium trance, defined in terms of catalepsy of the arm and the reaction to the suggestion that a mosquito was sitting on the patient’s forehead and stinging him, was experienced by 48% of the patients. Light trance, in which the patient reported feeling a little drowsy and that he may have seen a butterfly flying over his nose and possibly a partial response to either the catalepsy or the mosquito suggestion, was experienced by 25% of the patients. Hypnosis had no effect in the remaining 12%. The distribution of hypnotic susceptibility was not different in those patients suffering from headache and from vertigo.
RESULTS The median number of hypnotic treatment sessions required for those patients whose headache and vertigo was subsequently cured or ameliorated was between three and four. If a relapse occurred, it usually occurred within a month after the last session. If the patient seemed symptom free o r improved a t the end of a month, the result was usually lasting. The patients were observed for an average of 1year and 10 months
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C E D E R C R E U T Z , LAHTEENMAKI, AND TULIKOURA
following the completion of treatment. There were respectively 50% and 58% of headache and vertigo symptoms completely alleviated, and an additional 20% and 16% of patients obtained significant amelioration of these symptoms. The relationship between depth of hypnosis and clinical improvement in both headache and vertigo symptoms in the skull injured patients is presented in Table 1. The correlation between depth of hypnosis (on a 4-point scale) and therapeutic outcome (on a 3-point scale) was .44 ( p < .001) for patients with headaches and .47 ( p < .001) for patients with vertigo. However, there was a marked tendency for this correlation to be nonlinear. In fact, it is quite apparent in Table 1 that none of the patients who were completely insusceptible to hypnosis obtained complete or even partial relief from either symptom. However, even patients capable of only light trance were just as likely to benefit from the hypnosis treatment as those capable of experiencing deep hypnosis. For example, although 68% of the deep trance patients at least had the severity of their headaches markedly reduced, 75% of the light trance patients gained similar relief, but none of the completely unhypnotizable patients were relieved. It would be expected that the therapeutic effects would be more positive if the hypnotic treatment program began as soon after the injury as possible. In Table 2, the percentage of patients who obtained positive therapeutic results who were seen less than 6 months after the injury is compared to the outcome in those patients whose first therapeutic session occurred from 6 months to 12 years after the initial injury. For patients with headache there is a strong relationship between the duration of the symptom and the likelihood of therapeutic benefits (x2 = 9.84, df = 2; p < .005): the likelihood of obtaining significant relief from posttraumatic headache is markedly TABLE 1 RELATIONSHIPBETWEENDEPTHOF HYPNOSIS AND CLINICALIMPROVEMENT IN HEADACHE AND VERTIGO SYMPTOMS IN 1 5 5 CONSECUTIVE SKULLINJUREDPATIENTS Headache ( N = 140) Depth of Hypnosis
Ameliorated
Sy;L;m
Vertigo
N;zf-
Symptom
Free
Deep Medium Light No effect
N r
13 38 0
0 20 8 0
70
28
19
+.44 ( p < .0001)
6 7 9
(N = 108)
Ameliorated No Effect
No Effect
2
20
13 36 14 0
2 9 6 0
8 6 12
42
63
17
28
+.47 ( p < ,0001)
199
HYPNOSIS FOR HEADACHE OF SKULL INJURED
TABLE 2 FREQUENCY (%) OF PATIENTS WITH POSITIVE THERAPEUTIC OUTCOME RELATED TO DELAYFROM ACCIDENT TO ONSETOF TREATMENT FOR HEADACHE AND VERTIGO SYMPTOMS
-
Headache Time to Treatment Onset
Vertigo
Am+ liorated
No Effect
Ametiorated
NO
Effect ~
Less than 6 mo. More than 6 mo.8
83 57
49 21
10 18
24
N
140
70
28
X' a
N
Sjmp tom Free
~ _ _ _ _ _ _
~~~
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N
Symp torn Free
9 . 8 4 ;< ~ .01
41 22
8
18
18
67 41
9
10
42
108
63
17
28
1.93;~ < .30
Range up to 12 years.
greater if therapy begins shortly after the original trauma. However, a similar relationship was not obtained for patients with vertigo (x2 = 1.93; p > .30), Apparently the effectiveness of treating vertigo is not related to the length of time the patient has had the symptom.
DISCUSSION These results indicate that hypnosis is an appropriate treatment procedure for those patients with posttraumatic skull injuries who complain of headache and vertigo beyond a 1-week observation and hospitalization period. An average of four sessions of treatment, primarily consisting of direct suggestions under hypnosis, was sufficient to eliminate both of these symptoms in about half of the 155 consecutively seen skull injured patients. The incidence of these symptoms was significantly reduced in an additional 20%. However, the data indicates that hypnosis will be successful in alleviating headaches only if treatment is begun reasonably soon after the injury. It was our impression that patients who had the headaches for even as little as 6 weeks following the trauma had a poor prognosis. The length of time since the injury does not seem to be a particularly important variable in the treatment of the vertigo symptoms. The overall improvement in the symptoms was correlated with depth of hypnosis. However, little clinical effect with either headache or vertigo was observed in patients who were totally insusceptible to hypnosis. Significant clinical improvement could be obtained even if only relatively light stages of hypnosis could be induced. It should be emphasized that the headache and vertigo treated by
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CEDERCREUTZ, LAHTEENMAKI, AND TULIKOURA
hypnosis in this sample were not neurotic or psychosomatic symptoms. After some accidents resulting in skull injury, a posttraumatic neurosis may be observed. However, the method of treating the accompanying neurotic symptoms is quite different from the treatment of the vertigo or headache symptoms. For example, if the patient has been inside a car and has had difficulties in getting out of the car when injured, he may develop claustrophobia symptoms. Such a patient may never enter a car or a bus again, and will subsequently walk or bicycle to his work for years. Quite often a patient has been very frightened and he will have nightmares. In some instances these symptoms can be cured using regressive techniques under hypnosis. Typically, the patient is hypnotized, and it is suggested that he will “see” the accident anew and without fear. One session is sometimes sufficient t o alleviate these symptoms. Even in such patients the direct alleviation of the posttraumatic headache and vertigo symptoms requires separate additional treatment. In summary, it is concluded that hypnosis is an appropriate treatment for those skull injured patients who continue to suffer with headache and vertigo. A few sessions of direct suggestions under hypnosis will be quite effective in treating these patients, particularly if therapy is commenced shortly after the injury and if the patient is capable of experiencing even light stages of hypnosis.
REFERENCES BRENNER, C., FRIEDMAN, A. P. MERRITT,H. H., & DENNY-BROWN, D. E. Posttraumatic headache. J . Neurosurg., 1944,1, 379-391. CEDERCREUTZ, C.,& KAMPMAN, R. Beseitigung posttraumatischer Kopfschmerzen durch Hypnose. LHypnotic treatment of posttraumatic headache.] Hypnose psychosom. Med., 1972,21,150-151. CEDERCREUTZ, C . , & LKHTEENMXKI, R. Behandling av posttramatisk huvudvark med hypnos. [Hypnotic treatment of posttraumatic headache.] Finska Lak.-Sullsk. Handl., 1973,117 (l),42-47. HARDING, C.H.Hypnosis in the treatment of migraine. In J. Lassner (Ed.),Hypnosis and psychosomatic medicine: Proceedings of the International Congress for Hypnosis and Psychosomatic Medicine, Paris (France), 1965. Berlin: Springer-Verlag, 1967. Pp. 131-134. ZETTERHOLM, S. Blood-spinal fluid permeability to bromide in closed head injuries. Acta psychiat. Suppl., 1947,4 3 4 6 (Suppl. 45).
Hypnosebehandlung von Kopfschmerzen und Schwindelanfallen bei Menschen mit Schadelverletzungen Claes Cedercreutz, Raimo Lahteenmaki, und Jukka Tulikoura Abstrakt: Man behandelte Kopfschmerz- und Schwindelsymptome, indem man direkte Hypnosesuggestionen fiir Symptomerleichterung bei 155 aufeinanderfolgen-
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HYPNOSIS FOR HEADACHE OF SKULL INJURED
201
den Patienten mit Schadelverletzungen gebrauchte. Posttraumatische KopfschmerZen und Schwindelanfalle wurden nach einer durchschnittlichen Beobachtungsperiode von 1 Jahr und 10 Monaten bei 50 Prozent und 58 Prozent vollig, und bei 20 Prozent und respektiven 16 Prozent zum Teil behoben. Nach ungefahr 4 wochentlichen Sitzungen war der grosste Teil der Erleichterung erzielt, jedoch nur, und das besonders im Falle der Kopfschmerzen, wenn die Behandlung innerhalb einiger Wochen nach der Verletzung begann. Das therapeutisch erzielte Ergebnis, auf Tiefe der Hgpnose bezogen, war r = .44, p < .0001 fur Kopfschmerzsymptome und r = .47, p < .0001 fur Schwindelsymptome. Patienten. die nicht einmal in die leichteste Hypnose versetzt werden konnten, erfuhren keine therapeutische Besserung, doch reagierten Patienten, die nur eine leichte Hypnose erreichen konnten, klinisch in gleicher Weise wie die, die tiefe Hypnose erreichten. Le traitement hypnotique de la cephalke et du vertige chez des patients qui ont subi des blessures craniennes Claes Cedercreutz, Raimo Lahteenmaki et Jukka Tulikoura
Resume: Traitement de symptbmes de cephalee e t d’ktourdissement, par des suggestions hypnotiques directes de soulagement symptomatique, chez 155 victimes eonskcutives de blessures crkniennes. Aprhs une pkriode d’observation moyenne de 1 an e t 10 mois, les ckphalkes e t les ktourdissements post-traumatiques ont ktb respectivement compktement klimines chez 50 et 58% des patients, et partiellement soulagks, chez 20 et 16% des patients. Le plus grand effet de soulagement a 6tC ressenti apres environ 4 seances hebdomadaires, et, particulierement dans le cas des ckphakes, seulement si le traitement a debut6 pas plus de quelques semaines aprhs la blessure. Le succes thkrapeutique a Btk mis en corrblation avec la prodondeur de I’hypnose atteinte, B la fois pour les s y m p t h e s de ckphalee (r = .44), p < .0001) et de vertige (r = .47, p < .0001). Les patients qui ne pouvaient m&mepas atteindre un Ctat d’hypnose lkgere n’ont obtenu aucune amklioration thkrapeutique, mais les patients qui ont seulement fait I’expkrience d’une hypnose lkgere ont autant rkagi, d‘un point de vue clinique, que ceux qui ont atteint une hypnose profonde.
Tratamiento hipnbtico de la jaqueca y del vertigo en pacientes con traumatismos craneanos Claes Cedercreutz, Raimo Lahteenmaki, y Jukka Tulikoura Resumen: Los sfntomas de jaqueca y vertigo. en 155 pacientes con traumatismos craneanos, fueron tratados por medio de sugestiones hipn6ticas directas de alivio. Tras un perfodo rnedio de observaci6n de 1 aiio y 10 meses, se constat6 un alivio total de la jaqueca y el vertigo postraumhticos en 50% y 58% de 10s pacientes, y una mejorfa parcial en 20% y 16% respectivamente. Gran parte de la remisi6n de 10s sintomas se obtuvo tras 4 sesiones semanales y-sobre todo en el caso de las jaquecas - s610 si el tratamiento se iniciaba pocas semanas despues del accidente. El resultado terapkutico fue correlacionado con la profundidad del estado hipn6tico alcanzado, tanto en el tratamiento de la jaqueca (r = .44, p < .0001) como en el del vertigo (r = .47, p < .0001). Los pacientes que ni siquiera alcanzan un trance hipn6tico ligero, no experimentan ningtin progreso terapkutico; sin embargo, aqukllos que tan s610 conocen un estado hipn6tico leve manifiestan una sensibilidad elfnica equiparable a la de 10s sujetos capaces de trance profundo.
