• migraine;
  • stress;
  • multiple personality disorder;
  • thunderclap headache

Objective.—To report a patient with multiple personality disorder who experienced severe acute headaches without warnings, solely during the transition between her host personality and her pain-prone personality.

Background.—The initial detailed description of headache in multiple personality disorder was made by Packard and Brown and published in this journal 15 years ago.

Methods.—Clinical history, neurologic examination, electroencephalogram, and brain magnetic resonance imaging.

Results.—A 54-year-old Holocaust survivor with an established diagnosis of multiple personality disorder had recurrent, excruciating, acute (“thunderclap”) headaches only when switching between her domineering personality and her pain-prone personality, who suffered from chronic back pain. None of her personalities otherwise suffer from headaches. Electroencephalogram and brain magnetic resonance imaging were normal.

Conclusion.—This is an independent and current confirmation of the existence of transitional headaches in a patient with multiple personality disorder. They may occur as an isolated event during the switch process and have features of benign thunderclap headache.