An Intriguing Chronic Headache

An Intriguing Chronic Headache.

Tim was in his first year at university and he was a resident at one of its halls, with a room to himself. His pastor referred him after he blacked out at one of his care group gatherings. During the initial sessions of history taking and diagnostic tests, Tim revealed that he had been to see a neurologist at one of the general hospitals months ago, and they were unable to pin down a diagnosis; it was not a migraine and he had no pre-existing medical conditions. The specialist had prescribed strong painkillers, but he was adverse to resort to them as they only minimally reduced his suffering. When the headaches began, he described them as persistent, unrelenting, and he felt as though his head was going to split open! He was particularly worried that these headaches may eventually affect his studies, as he was a straight A’s student.

Immediately, I began investing in a series of psychological manuals and books on undifferentiated pain disorders, focusing on headaches, and was on overdrive, catching up on the most recent research in this area in the relevant medical and psychological journals. Further tests were done with Tim, and we began to establish a pattern when these headaches were surfacing, and worked initially toward some cognitive-behavioural treatment strategy. After a few sessions, I began to sense that Tim was keeping back information that could possibly explain further his headaches. I probed but Tim refused to divulge. Four months into our counselling, Tim decided to open up. It was a peculiar session, filled with lengthy silences and a seeming frozen inability to coherently describe the issue he had been battling. When he eventually articulated it all, I empathised with his own shame-based difficulty.

Tim showed me a clip of his motorcycle helmet collection on his mobile phone. They were quality collector’s items in presentation cases, brightly coloured and beautifully crafted safety helmets. There were six of them. What lay behind his fascination for these helmets when he did not have a license for a motorcycle? Each helmet symbolised a female classmate whom he had taken a fancy toward, and when he felt lonely, he would put on a specific helmet, and began to phantasise being close to her. These helmets became his fetish. His headaches would come on as his guilt level rises with each phantasy episode, thinking about his young ladies. His headaches were most pronounced when he was in a lecture theatre, the canteen and in the hostel, almost always in the university compound. In fact, the six helmets were not the only ones he possessed; other helmets at home represented other girls he had a crush on during his teen years. How did his fetish develop?

When he was a very young boy, his favourite aunt used to have him pillion-ride with her wherever she went, and he enjoyed these excursions. When he was younger, she would have him sit in front of her as they rode around the small town, and as he grew up, he sat behind her; but always with the closest physical contact. His bond with his aunt was much stronger than those with his parents. He had a rather stormy relationship particularly with his father.