by Deborah Wirtel*

I read this book at the suggestion of a woman I know from America Online. She told me I wouldn’t have Migraines if I got my emotional life in order. She read this book and her Migraines were cured.

I took this as a challenge, although I know the physiological reasons behind Migraine. But I wanted to see what an MD had to say about Migraines and the link to our minds.

Sarno calls his theory Tension Myositis Syndrome (page xii), a painful but harmless change of state in muscles. “This book is about emotions, illness and wellness, how they are related and what one can do to enhance good health and combat certain physical conditions,” writes Sarno. He states that physical pain, anxiety and depression manifest from repressed rage and anger.

Sarno attributes many physical maladies to his TMS theory. These include most low back pain and leg pain; most neck, shoulder and arm pain; fibromyalgia; carpal tunnel syndrome; gastrointestinal disorders, skin disorders and Migraine. Sarno diagnoses his patients with TMS when, upon normal physical exam, no abnormalities are found (page 30). Even if he finds an abnormality, he states that the pain is usually out of proportion to the abnormality found, thus the abnormality is not the cause of pain.

The pathophysiology of TMS is as follows:

Repressed unconscious emotions (rage)

abnormal autonomic activity

reduction of local circulation of blood (ischemia)

mild oxygen deprivation

muscle pain, nerve pain and/or numbness, tingling, weakness, tendon pain
 

The only way to treat TMS is by examining why you have repressed rage or anger. Once you have figured this out, Sarno says, you are on your way to being pain-free.

Conventional medicine has no part in treating TMS. “Mindbody symptoms exist to serve a purpose. If you thwart that purpose by taking away the symptoms without dealing with its cause, the brain will simply find a substitute symptom or disorder,” (Page 39).

What is that purpose? Sarno says the pain serves to smother the emotions so they don’t break through to the conscious mind.

Sarno deals mostly with back pain (his previous book is titled, Healing Back Pain). However, he does address several other disorders and pain syndromes, and Migraine is on his list of maladies that have a mindbody connection.

On page 111, Sarno writes of his own experience with Migraine. He had suffered with Migraines for six years when a colleague mentioned a medical paper (not cited) that suggested that “migraine headache was the result of repressed anger.” Sarno had already started to form his theory that psychological factors were common in day-to-day medical problems, so he gave the idea a try. “When next the premonitory ‘lights’ began, I sat down and thought about what anger I might be repressing. Years later it is clear to me what I was repressing, but at the time I had no idea. However, to my astonishment, the headache never came. Nor have I ever had another migraine headache, though I have continued to have the ‘dancing lights’ to this day. The ‘lights’ tell me that I am repressing anger, and sometimes I have to think very hard to figure out the reasons for the anger.”

I find many flaws in Sarno’s TMS theory. First Sarno admits to no psychoanalytical education (page 33).

Second, his definition of Migraine is incorrect; on page 111 he writes, “Migraine….is thought to be caused by sudden constriction of a single blood vessel within the substance of the brain.”

However, we know this definition is incorrect. From the M.A.G.N.U.M. (The National Migraine Association) web site: “Migraine is disease, a headache is only a symptom. Migraine pain is caused by vasodilation in the cranial blood vessels (expansion of the blood vessels), while headache pain is caused by vasoconstriction (narrowing of the blood vessels). During a migraine, inflammation of the tissue surrounding the brain, i.e., neurogenic inflammation, exacerbates the pain.”

Third, the TMS patient doesn’t need to know what the repressed anger is about or where it comes from, the patient just needs to acknowledge he has some sort of repressed anger. On page 113 he writes, in relation to his Migraine attacks, “I didn’t know what I was unconsciously angry about, but I was willing to accept that something psychological was responsible for my headache. That alone prevented the migraine permanently.”

Which leads to my fourth problem with the book, where Sarno, by saying his Migraines were prevented permanently, is claiming migraine is a curable disorder. The fact that he still experiences the “dancing lights” (“Nor have I ever had another migraine headache, thought I have continued to have the ‘dancing lights’ to this day,” page 111), indicates he still has Migraine disorder, but with aura only and no headache pain. Migraine is the disease; headache is but one symptom of that disease.

From the MAGNUM web site again: “After a century of society and the medical community blaming Migraines on their sufferers, advanced technology and the age of information gave us the knowledge to begin to understand this debilitating disease. However, dangerous and outdated myths surrounding the Migraine disease have not yet been dispelled on a widespread basis. Not only are such myths believed by many loved ones and co-workers of those with Migraines, but by those with Migraines themselves (Migraineurs). Furthermore, such myths continue to be unwittingly reported in the media. The Migraine disease is a serious health and disability problem that affects approximately 11 to 18 million Americans, most of whom are women, with up to 38 million Americans having Migraine genetic propensity. There is no known cure for the Migraine disease, only treatments for the symptoms.”

I have no doubt that, in some cases, our emotional state can exacerbate body pain. However, I think Sarno does the medical community and Migraineurs a disservice when he claims the majority of body pain and other maladies can be traced to our emotional state.

Migraineurs have heard too much, too often how our Migraines are all “in our heads;” we don’t need this book or this doctor erroneously saying this as well.




The Mindbody Prescription: Healing The Body, Healing The Pain by John E. Sarno, MD, Warner Books, Inc., 1998

M.A.G.N.U.M., Migraines: Myth vs. Reality, An Understanding of Migraine Disease & Tips for Migraine Management by Michael John Coleman and Terri Miller Burchfield

* Deborah Wirtel is a freelance writer and a forum host on About Headaches/Migraine.