Skip to main content

Advertisement

Log in

Can Anything Good Ever Come From Bearing Migraine Attacks? Suggestions for a Comprehensive Concept of Gain in Migraine

  • Episodic Migraine (S Nasas, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to summarise the current state of knowledge concerning known types of gain, the reasons why patients might seek it, as well as implications for headache disorders.

Recent Findings

Even though the subject has been studied in the past, it received less attention in recent years.

Summary

There is no doubt that migraine is a highly disabling disorder. However, attacks sometimes may be beneficial for the migraine brain as a time-out from the daily routine. On the other hand, patients are often stigmatised as trying to satisfy other needs through their disease. These “other needs” may be the exaggerated seeking for attention and affection or an undue official sickness certificate and were named secondary gain. Striving for secondary gain denotes a behaviour that aims at benefiting from a disease in a way that is seen as inappropriate by others. The fact that the term has persisted in doctors’ vocabulary for decades probably indicates that it designates a concept considered relevant by many. However, its usage is complicated by its usually imprecise definition. We found in a literature search that the strive for secondary gain is not limited to neurosis, might both occur consciously and unconsciously, sometimes may aim at financial gain and sometimes at social gain, and can either be potentially expected or readily obtained. This behaviour mainly seems to aim at shaping one’s interactions with the environment. Its causes have not been elucidated completely, though, but “unrequited demands for love, attention and affection” have been postulated. The desire for social gain can be influenced by approaches based upon behavioural psychology. Broaching the issue of secondary gain may be beneficial in the daily clinical routine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CH:

Cluster headache

cM:

Chronic migraine

CPSP:

Central post stroke pain

eM:

Episodic migraine

LBP:

Lower back pain

n/a:

Not applicable

SFN:

Small fibre neuropathy

TN :

Trigeminal neuralgia

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 2018. 38(1): p. 1-211.

  2. Dodick DW. Migraine. Lancet. 2018;391(10127):1315–30.

    PubMed  Google Scholar 

  3. Stovner LJ, et al. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954–76.

    Google Scholar 

  4. Young WB, et al. The stigma of migraine. PLoS One. 2013;8(1):e54074.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Lampl C, et al. Interictal burden attributable to episodic headache: findings from the Eurolight project. J Headache Pain. 2016;17:9.

    PubMed  PubMed Central  Google Scholar 

  6. Caspermeyer JJ, et al. Evaluation of stigmatizing language and medical errors in neurology coverage by US newspapers. Mayo Clin Proc. 2006;81(3):300–6.

    PubMed  Google Scholar 

  7. Parikh SK, Young WB. Migraine: stigma in society. Curr Pain Headache Rep. 2019;23(1):8.

    PubMed  Google Scholar 

  8. Katz J. On primary gain and secondary gain. Psychoanal Study Child. 1963;18:9–50.

    CAS  PubMed  Google Scholar 

  9. Vorlesungen zur Einführung in die Psychoanalyse. 4th ed. Frankfurt am Main: S. Fischer Verlag; 2009

  10. •• Loder E. What is the evolutionary advantage of migraine? Cephalalgia. 2002;22(8):624–32. Very interesting article in which possible positive aspects of suffering from migraine attacks are discussed from an evolutionist standpoint.

    CAS  PubMed  Google Scholar 

  11. Stout MA. A cognitive-behavioral study of self-reported stress factors in migraine headache. Psychopathology. 1984;17:290–296. https://doi.org/10.1159/000284064

    CAS  PubMed  Google Scholar 

  12. Aubuchon P, Haber JD, Adams HE. Can migraine headaches be modified by operant pain techniques? J Behav Ther Exp Psychiatry. 1985;16(3):261–3.

    CAS  PubMed  Google Scholar 

  13. Haber, J.D., Psychophysiological correlates of secondary gain factors in migraine. 1985. 5(3_suppl): p. 230-231.

  14. van Egmond JJ. The multiple meanings of secondary gain. Am J Psychoanal. 2003;63(2):137–47.

    PubMed  Google Scholar 

  15. Fishbain DA. Secondary gain concept. APS J. 1994;3(4):264–73.

    Google Scholar 

  16. Raskin M. Diagnosis of conversion reactions. Jama. 1966;197(7):530.

    CAS  PubMed  Google Scholar 

  17. WOLFF HG. Personality features and reactions of subjects with migraine. Arch Neurol Psychiatr. 1937;37(4):895–921.

    Google Scholar 

  18. Davis RE, Smitherman TA, Baskin SM. Personality traits, personality disorders, and migraine: a review. Neurol Sci. 2013;34(Suppl 1):S7–10.

    PubMed  Google Scholar 

  19. Barlow DH, et al. The origins of neuroticism. Perspect Psychol Sci. 2014;9(5):481–96.

    PubMed  Google Scholar 

  20. •• Borsook D, et al. Understanding migraine through the lens of maladaptive stress responses: a model disease of allostatic load. Neuron. 2012;73(2):219–34. The authors of that very interesting article hypothesise that migraine attacks might be the result of a dysfunctional attempt to maintain physiological stability in the face of psychological or physiological stressors.

    CAS  PubMed  Google Scholar 

  21. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27(5):394–402.

    CAS  PubMed  Google Scholar 

  22. Peroutka SJ. What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep. 2014;18(10):454.

    PubMed  Google Scholar 

  23. Hougaard A, et al. Provocation of migraine with aura using natural trigger factors. Neurology. 2013;80(5):428–31.

    PubMed  Google Scholar 

  24. de Tommaso M, et al. Altered processing of sensory stimuli in patients with migraine. Nat Rev Neurol. 2014;10(3):144–55.

    PubMed  Google Scholar 

  25. Chen WT, et al. Peri-ictal normalization of visual cortex excitability in migraine: an MEG study. Cephalalgia. 2009;29(11):1202–11.

    PubMed  Google Scholar 

  26. Judit A, Sandor PS, Schoenen J. Habituation of visual and intensity dependence of auditory evoked cortical potentials tends to normalize just before and during the migraine attack. Cephalalgia. 2000;20(8):714–9.

    CAS  PubMed  Google Scholar 

  27. Hellstrom C, Carlsson SG. Busy with pain: disorganization in subjective time in experimental pain. Eur J Pain. 1997;1(2):133–9.

    CAS  PubMed  Google Scholar 

  28. Giffin NJ, et al. Premonitory symptoms in migraine: an electronic diary study. Neurology. 2003;60(6):935–40.

    CAS  PubMed  Google Scholar 

  29. Rains JC, et al. Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache. 2005;45(Suppl 2):S92–109.

    PubMed  Google Scholar 

  30. Sarwer-Foner GJ, Dancy TE. The psychodynamic basis of compensation: a contribution to the study of ego defences. Can Psychiatr Assoc J. 1959;4(2):125–32.

    CAS  PubMed  Google Scholar 

  31. King SA. Concept of secondary gain. APS J. 1994;3(4):279–81.

    Google Scholar 

  32. Miller H. Accident neurosis. Br Med J. 1961;1(5230):919–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Fishbain DA. Response to Drs. Gallagher, King, and Large. APS J. 1994:3(4).

    Google Scholar 

  34. Ciccone DS, Just N, Bandilla EB. A comparison of economic and social reward in patients with chronic nonmalignant back pain. Psychosom Med. 1999;61(4):552–63.

    CAS  PubMed  Google Scholar 

  35. Flor H, Kerns RD, Turk DC. The role of spouse reinforcement, perceived pain, and activity levels of chronic pain patients. J Psychosom Res. 1987;31(2):251–9.

    CAS  PubMed  Google Scholar 

  36. International statistical classification of diseases and related health problems. - 10th revision. Fifth edition ed. 2016: World Health Organization.

  37. Weighill VE. ‘Compensation neurosis’: a review of the literature. J Psychosom Res. 1983;27(2):97–104.

    CAS  PubMed  Google Scholar 

  38. Winckler P. The concept of “compensation neurosis” in psychiatric expertise. Versicherungsmedizin. 1998;50(6):219–25.

    CAS  PubMed  Google Scholar 

  39. Hall RC, Hall RC. Compensation neurosis: a too quickly forgotten concept? J Am Acad Psychiatry Law. 2012;40(3):390–8.

    PubMed  Google Scholar 

  40. Fordyce WE, et al. Pain measurement and pain behavior. Pain. 1984;18(1):53–69.

    CAS  PubMed  Google Scholar 

  41. Finkel AG, et al. Headache in military service members with a history of mild traumatic brain injury: a cohort study of diagnosis and classification. Cephalalgia. 2017;37(6):548–59.

    PubMed  Google Scholar 

  42. Gladstone J. From psychoneurosis to ICHD-2: an overview of the state of the art in post-traumatic headache. Headache. 2009;49(7):1097–111.

    PubMed  Google Scholar 

  43. Saper JR. Posttraumatic headache: a neurobehavioral disorder. Arch Neurol. 2000;57(12):1776–8 discussion 1780-1.

    CAS  PubMed  Google Scholar 

  44. Evans RW. Posttraumatic headaches in civilians, soldiers, and athletes. Neurol Clin. 2014;32(2):283–303.

    PubMed  Google Scholar 

  45. Sterling M, et al. Prognosis after whiplash injury: where to from here? Discussion paper 4. Spine (Phila Pa 1976). 2011;36(25 Suppl):S330–4.

    Google Scholar 

  46. Schrader H, et al. Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet. 1996;347(9010):1207–11.

    CAS  PubMed  Google Scholar 

  47. Miller H. Accident neurosis. Br Med J. 1961;1(5231):992–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Young JN, et al. Lumbar disc surgery in a fixed compensation population: a model for influence of secondary gain on surgical outcome. Surg Neurol. 1997;48(6):552–8 discussion 558-9.

    CAS  PubMed  Google Scholar 

  49. Gotten N. Survey of one hundred cases of whiplash injury after settlement of litigation. J Am Med Assoc. 1956;162(9).

    CAS  PubMed  Google Scholar 

  50. Rohling ML, Binder LM, Langhinrichsen-Rohling J. Money matters: a meta-analytic review of the association between financial compensation and the experience and treatment of chronic pain. Health Psychol. 1995;14(6):537–47.

    CAS  PubMed  Google Scholar 

  51. Mendelson G. Follow-up studies of personal injury litigants. Int J Law Psychiatry. 1984;7(2):179–88.

    CAS  PubMed  Google Scholar 

  52. Mendelson G. ‘Compensation neurosis’ revisited: outcome studies of the effects of litigation. J Psychosom Res. 1995;39(6):695–706.

    CAS  PubMed  Google Scholar 

  53. van Egmond JJ. Beyond secondary gain. Am J Psychoanal. 2005;65(2):167–77.

    PubMed  Google Scholar 

  54. Fordyce WE, Fowler RS, DeLateur B. An application of behavior modification technique to a problem of chronic pain. Behav Res Ther. 1968;6(1):105–7.

    CAS  PubMed  Google Scholar 

  55. Block AR, Kremer EF, Gaylor M. Behavioral treatment of chronic pain: the spouse as a discriminative cue for pain behavior. Pain. 1980;9(2):243–52.

    CAS  PubMed  Google Scholar 

  56. Montagna P, Pierangeli G, Cortelli P. The primary headaches as a reflection of genetic darwinian adaptive behavioral responses. Headache. 2010;50(2):273–89.

    PubMed  Google Scholar 

  57. Fordyce WE, et al. Some implications of learning in problems of chronic pain. J Chronic Dis. 1968;21(3):179–90.

    CAS  PubMed  Google Scholar 

  58. Fordyce W, et al. Pain complaint--exercise performance relationship in chronic pain. Pain. 1981;10(3):311–21.

    CAS  PubMed  Google Scholar 

  59. Fordyce WE, Roberts AH, Sternbach RA. The behavioral management of chronic pain: a response to critics. Pain. 1985;22(2):113–25.

    CAS  PubMed  Google Scholar 

  60. Kwon M, et al. The role of descending inhibitory pathways on chronic pain modulation and clinical implications. Pain Pract. 2014;14(7):656–67.

    PubMed  Google Scholar 

  61. Cornell Law School. Jacobellis v. Ohio. [cited 2019 13.03.2019]; Available from: https://www.law.cornell.edu/supremecourt/text/378/184.

  62. Gallagher RM. Secondary gain in pain medicine. APS J. 1994;3(4):274–8.

    Google Scholar 

Download references

Funding

The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: HP was funded by the Werner Dessauer Stiftung.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Heiko Pohl.

Ethics declarations

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Episodic Migraine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pohl, H., Schubring-Giese, M. & Gantenbein, A.R. Can Anything Good Ever Come From Bearing Migraine Attacks? Suggestions for a Comprehensive Concept of Gain in Migraine. Curr Pain Headache Rep 23, 90 (2019). https://doi.org/10.1007/s11916-019-0829-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-019-0829-2

Keywords

Navigation