I recently mentioned ‘hypnotic hangovers’ (headaches which happen during, immediately after and/or because of hypnosis) on a hypnotherapist’s discussion group and got a surprisingly wide variety of responses, from those who hadn’t come across the idea at all, to those who had only heard of them to those who had had some experience with them. So, I thought, it would be a good topic to talk about this month.
The problems with talking about hypnotic headaches
Unwanted side effects of hypnosis are under-researched and, even where they are considered, there is usually no distinction made between headaches and other unwanted effects.
Add to that, there is also often no distinction made between hypnosis being used in therapeutic settings, laboratory studies and stage acts, so getting accurate facts and figures about this topic specifically for therapists is pretty much impossible.
Finally, there is no comparison of the frequency of the side effects mentioned following hypnosis with the frequency they’re experienced after other, comparable activities such as psychotherapy. So, it’s arguable that we might have a correlation and not a causative effect.
Having said that, post-hypnotic headaches are reported commonly enough to assume that there is at least some level of causation, and I feel justified in writing from that point of view.
Unwanted side effects of hypnosis
Gruzelier (2000) [1] suggests that adverse effects of hypnosis are ‘common, … [but] mostly short lived’.
Gruzelier (2000) and Gates (2011) both mention headaches as a possible side effect of hypnosis and so does Healthline.com (2019) and the Mayo Clinic. Gruzelier, in fact, has quite a long list of potential issues, including some pretty scary ones: ‘chronic headache and depression, morbid anxiety reactions, seizure and stupor, resurrecting memories of previous trauma, recurrent spontaneous dissociative episodes, and triggering psychiatric illnesses or producing decompensation’ [2] but looking at all of them would take much more space than I have here, so we’ll stick to the headaches for now.
I couldn’t find any independently verified statistics for the frequency of headaches in hypnotherapy, but Thom Bush, a hypnotherapist from Singapore, estimates around six cases in his 16,000+ hours of clinical work. [3]
What causes hypnotic hangovers?
A number of risk factors have been identified, but remember that some of these refer to ALL possible unwanted side effects of hypnosis and not just headaches.
External factors – Gruzelier says that elements such as anxiety and context (for example, what he calls ‘potential prolonged stress’ caused by participating in stage shows which cause ‘embarrassment’ and ‘humiliation’). [4]
Context - Schultz, (1954) and MacHovec, (1987 & 1988) [5] suggest that participants in stage acts are more likely to experience unwanted symptoms than other users of hypnosis. Jon Chase, a well-known stage hypnotist, says in an online discussion that he has ‘Only seen [trance hangovers] on stage’. Chase goes on to say this is because the stage is ‘where more people actually get hypnotised - most clinical hypnosis is just relaxation …’. [6] Whatever your take on that one, a Google search for ‘will hypnosis give me headaches?’ or similar will reveal a number of online discussions in which people are reporting headaches following the use of therapeutic or self-hypnosis, so even if it is more common on the stage, it's still something that therapists might come across.
Expectation - in the discussion on trance-induced headaches mentioned above, setting aside the issue of whether therapists actually use trance at all, Jon Chase suggests that people develop trance hangovers because they expect it to happen, and the trance termination doesn’t undermine that expectation. This explanation is also supported by Larry Elman (son of David) in another online discussion on self-hypnosis [7] and in a video discussing this topic he suggested that the hypnotic hangover was more prevalent in the past because media coverage led people to believe they would experience headaches and grogginess on coming out of trance. [8]
Inadequate reorientation – several contributors, including Larry Elman again, point to incomplete or too-rapid reorientation from trance as a factor in developing hypnotic headaches, or a kind of ‘brain fog’ or disorientation similar to that experienced on waking suddenly from a deep sleep. [9 & 10]
Susceptibility to trance – various studies have shown that although anyone can get adverse effects from hypnosis, highly hypnotisable people tend to be more likely to encounter them. That might fit with the idea that stage show participants are more at risk, because stage hypnotists tend to choose highly susceptible individuals for their shows.
Childhood reactions to anaesthetics - Hilgard et al (1961) [11] reported that 8.5% of their subjects had adverse reactions following hypnosis including headaches and dreams connected with the hypnotic experience. They said that ‘childhood adverse reaction to chemical anaesthesia’ were ‘frequently’ associated with these, and this was also supported by another, later study (Orne, 1965). [12]
Pre-existing mental health issues - having a mental illness or some kind of psychological impairment makes it more likely you’ll encounter problems of any kind with hypnosis.
Physical changes during hypnosis - headaches, in particular, might be due to changes in levels of ‘arousal’, i.e. in blood pressure, the autonomic nervous system, heart rate etc. Gruzelier (2000) says ‘Headaches commonly occur with adjustment to shifts in arousal ...’ [13] and he links trance hangovers to a large number of studies showing that hypnosis (especially if relaxation inductions are used) alters brain rhythms to lower frequencies and shifts autonomic activity from the sympathetic to the parasympathetic nervous system. In my experience, this is the reason most cited by therapists in informal discussions and it’s certainly what I was taught in my original training. It’s nice to know there is plenty of evidence to support it.
Bad posture during trance – I haven’t found anyone who has included this factor in a study of hypnosis, but the NHS website suggests that bad posture or sitting in one position for long periods can cause muscle tension and lead to headaches. If the client is not moving around in trance, especially if their head flops into an uncomfortable position, this could arguably have the same effect. [14]
How to prevent headaches associated with hypnosis
Gruzelier (2002) reminds us that ‘It must be kept firmly in mind that most subjects have reported positive effects of hypnosis’ [15] but that nonetheless ‘education about unwanted effects and safeguards should be a requirement for all practitioners’. [16]. Quite right too.
He also highlights another issue, which is that clients who might benefit from the use of hypnotherapy or self-hypnosis might be discouraged from using it if they experience headaches, so being proactive in protecting our clients from this is important to therapists. We cannot bury our heads in the sand and simply assume that unwanted side effects won’t occur.
The possible explanations for hypnotic hangovers can help us guard against them, although not all are under our control.
- Take a thorough case history, checking thoroughly for contraindications and/or any history of psychological issues before working with clients. I don’t routinely ask if the client has ever had an adverse reaction to anaesthetics even after reading these studies, though I suppose you could.
- Manage clients’ expectations, ask if they have any worries or concerns about trance work. If they mention headaches, it’s not ethical to guarantee it won’t happen but you can reassure them and address it during the re-orientation (counting out). I don’t mention headaches as a potential side effect unless clients do so first, because of the risk of creating the expectation.
- Ensure the client is physically comfortable throughout the trance part of your session. Clients deeply in trance don’t always think to adjust their position or notice slight levels of discomfort. If your client’s posture looks awkward, suggest they can adjust it at any time, and that doing so will take them even deeper into trance.
- Make sure your reorientation is complete, and at a reasonable speed for the client. As a general rule, the deeper they go the slower you should count them back, to enable arousal levels to change gradually and comfortably. Calibrate to what you observe as they are coming out and slow down if they seem to need more time.
- Always include positive suggestions about feeling well and clear-headed as you count them out. I use a quick suggestion to this effect on each number as I count, something like ‘coming back with your head clear, coming back with your body warm and comfortable, ‘open your eyes, feeling better than you have in a long time’, and so on. David Elman apparently favoured, ‘feeling better than you have all day’. [17]
- Ask your client to see a doctor, especially if these steps don't help or if the headaches are severe or persistent.
Should your client report any level of grogginess, headache etc, after trance, the simplest option is to put them back into trance with a rapid induction, then count them out much more slowly with positive suggestions for improved wellbeing.
In this case (and this case only!) I would suggest specifically that their head is clear and pain-free when they open their eyes. In other circumstances, I don’t want to use words like ‘pain-free’ in case that sets up the expectation that it might not be.
However, prevention being better than cure, if you follow the tips above, you should find that you rarely, if ever, encounter a problem.
Citations
[1] Gruzelier, J., 2000. 'Unwanted effects of hypnosis: a review of the evidence and its implications', Contemporary Hypnosis, vol. 17, no. 4, pp. 163-193. (p 163)
[2] ibid. (p167)
[3] www.quora.com. (2018). Does hypnosis give you serious headaches? - Quora. [online] Available at: https://www.quora.com/Does-hypnosis-give-you-serious-headaches [Accessed 19 Mar. 2021].
[4] Gruzelier, J., 2000. 'Unwanted effects of hypnosis: a review of the evidence and its implications', Contemporary Hypnosis, vol. 17, no. 4, pp. 163-193. (p165)
[5] cited in Gruzelier, J. ibid, (p174)
[6] www.quora.com. (2018). Does hypnosis give you serious headaches? - Quora. [online] Available at: https://www.quora.com/Does-hypnosis-give-you-serious-headaches. [Accessed 19 Mar. 2021].
[7] www.quora.com. (2017). During practicing self-hypnosis, why do I get headaches? - Quora. [online] Available at: https://www.quora.com/During-practicing-self-hypnosis-why-do-I-get-headaches [Accessed 19 Mar. 2021].
[8] Dave Elman Hypnosis Institute. (2010). Hypnotic Hangover. [online] Available at: https://www.youtube.com/watch?v=_ytX8DEl9GI [Accessed 19 Mar. 2021].
[9] www.quora.com. (2017). During practicing self-hypnosis, why do I get headaches? - Quora. [online] Available at: https://www.quora.com/During-practicing-self-hypnosis-why-do-I-get-headaches [Accessed 19 Mar. 2021].
[10] www.quora.com. (2016). Is it normal that I feel a small headache and dizzy after hypnosis? - Quora. [online] Available at: https://www.quora.com/Is-it-normal-that-I-feel-a-small-headache-and-dizzy-after-hypnosis [Accessed 19 Mar. 2021].
[11] cited in Gruzelier, J., 2000. 'Unwanted effects of hypnosis: a review of the evidence and its implications', Contemporary Hypnosis, vol. 17, no. 4, pp. 163-193. (p166)
[12] cited in Gruzelier, J., ibid. (p166)
[13] ibid. (p178)
[14] nhs.uk. (2018). 10 headache triggers. [online] Available at: https://www.nhs.uk/conditions/headaches/10-headache-triggers/.[Accessed 19 Mar. 2021].
[15] Gruzelier, J., 2000. 'Unwanted effects of hypnosis: a review of the evidence and its implications', Contemporary Hypnosis, vol. 17, no. 4, pp. 163-193. (p176)
[16] Gruzelier, J., 2000. 'Unwanted effects of hypnosis: a review of the evidence and its implications', Contemporary Hypnosis, vol. 17, no. 4, pp. 163-193. (p188)
[17] Dave Elman Hypnosis Institute. (2010). Hypnotic Hangover. [online] Available at: https://www.youtube.com/watch?v=_ytX8DEl9GI [Accessed 19 Mar. 2021].
Other References
Gates, C.M. (2011). UNWANTED EFFECTS OF HYPNOSIS: A REVIEW OF THE EVIDENCE AND ITS IMPLICATIONS. [online] www.semanticscholar.org. Available at: https://www.semanticscholar.org/paper/UNWANTED-EFFECTS-OF-HYPNOSIS%3A-A-REVIEW-OF-THE-AND-Gates/d05e1c440e0072b44f429c4129e403489eaae002 [Accessed 19 Mar. 2021].
www.mayoclinic.org. (n.d.). Hypnosis - Mayo Clinic. [online] Available at: https://www.mayoclinic.org/tests-procedures/hypnosis/about/pac-20394405#:~:text=Adverse%20reactions%20to%20hypnosis%20are [Accessed 19 Mar. 2021].
Watt, A. (2013). Hypnotherapy. [online] Healthline. Available at: https://www.healthline.com/health/depression/hypnotherapy#how-it-works.
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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of The Hypnotherapist's Companion and Their Worlds, Your Words and a co-writer of the Hypnotherapy Handbook, all of which are available from Amazon.
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