A Real Headache

To discern how wellbeing can be compromised by bottling up anger, Nicholson and his colleagues surveyed 422 people, then screened and eliminated anyone with anxiety or depression, both of which can trigger headache. Central to Nicholson's survey were questions that addressed how angry a person was, how much they internalized anger and how severe and their headaches were. 171 people who held anger in complained of frequent headache while 251 claimed to be almost headache free.

After examining how they dealt with anger, Nicholson found that chronic headache sufferers—those who experience upwards of four headaches a month—employed "anger-in" or the tendency to suppress rage. Anger-in topped other forms of anger as the number one cause of chronic headache.

But anger itself wasn't as important in triggering headache as the way people dealt with it. "People who hold their anger in…are the least likely to respond positively to interventions and they're more likely to experience pain that's more intense as a result," Nicholson says.

Van Burger happily working

What happens in the body to trigger such extreme responses to anger? Nicholson says one theory is that when the brain talks to itself it uses pathways. Some researchers theorize that emotions cross the same pathways that are related to pain response. Where they overlap, chemicals signal change in the body. "You're going to have an increase in your heart rate, blood pressure's going to get increased," Nicholson says. "Your breathing's going to get shallow. You're going to sweat more. And we know those things are going to happen whenever your body becomes stressed in general, and particularly when the body becomes angry."

But Nicholson also believes that learned behavior plays a role in anger and headache. "You don't just suddenly decide, 'You know what I think today? I'm just going to decide to hold my anger in,'" Nicholson says. "Maybe you were told, 'If you can't say anything nice don't say anything at all.' So, you chose not to say anything at all. While that can be good in some situations, in other situations it's not so good."

Instead of living with the hulking presence of anger, Nicholson suggests change. "There are times in your life when things are going to make you angry," he says. "Recognizing that may help because it makes you realize that life isn't always fair."

Subscribing to that belief takes some doing. "I still have my days," Van Burger says. "When you have scars from the past there's only so much you can move on."

Patience may be the key to sorting through a lifetime of pent up anger. "Rome wasn't built in a day, and to make those changes it's not going to be taken down in a day either," Nicholson says.

With three years of therapy behind him, Van Burger says he knows he still has a long way to go to learn how to cope with anger. But he points to one positive change: His headaches have lessened from everyday to about two a month. That, he believes, is directly related to understanding how to let the little things slide.

This research appeared in the June, 2003 issue of the journal Headache and was funded by the St. Louis University School of Medicine.