Family therapy approach to incapacitating migraine

A nine-year-old boy who suffered from intractable migraine was referred for psychiatric consultation and treatment after failing to respond to congeries of medications and diets, notwithstanding thorough investigations by neurologists, pediatricians, and other specialists. The decision for a family systems treatment approach resulted in the following defined objectives: (1) to investigate triggers for the headaches and to see if these could be reduced and/or eliminated, (2) to see if therapy would help the boy stay in school, (3) to examine, and if possible, change family rules of interaction and transaction, (4) to allow for more “fun within the family” (5) to allow for ventilation without retribution, and (6) to clarify the mother's role as a significant contributor to the family's interactions, shifting the focus from the father as the sole generator of family tension. The principal therapeutic tools which proved efficacious involved the following: (1) scrutiny of the maternal and paternal histories, and (2) analysis of triangulations within the family system, leading to (3) the formulation of therapeutic strategies, and (4) specific task assignments. A major intervention by the therapist was the specific strategy to have the family examine the rules of transaction which were in the metapsychological sense unarticulated.