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SYNOPSIS

Occasionally patients with headache present with the complaint of “a really good one. ” This paper examines three cases of patients with migraine who often referred to their headaches as “good.”

When the patients were asked what made the headaches good, they immediately tried to clarify their terminology as “just a figure of speech” that really meant bad. Further exploration usually revealed the headache symptoms had indeed been “good” in a relative sense, in that it had somehow served to help the patient avoid a more unpleasant emotional situation. The headache may have allowed a “time out” or a forced period of rest in a hectic schedule, resolved a conflict for the patient in an acceptable way by becoming sick, or represented a suppressed or repressed affect, usually anger.

When headaches are described as good, there may very well be something in the patient's life that is worse.