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Introduction
Migraine headaches are a major source of
concern for many Americans. Approximately 28
million Americans or 13% of the population of
the country suffer from migraine headaches.
Because of the debilitating effects that
migraine headaches have on many people, these
headaches are the cause of much lost work time
for many sufferers. All of these people report
either a significant reduction in their daily
activity or a complete inability to function
altogether. This translates to an estimated
$5,617.2 billion a year in missed work and
physician visits as well as poor job
performance.
This paper examines the effects of one
alternative treatment for migraine headaches,
reflexology, and evaluates whether reflexology
can relieve the severity of headaches or
eliminate them altogether by studying the
effects of reflexology on a sample group of
people. There are currently no conclusive
studies showing the effects of reflexology on
migraine headaches.
Reflexology is an ancient method of using the
thumb and fingers to apply pressure to reflex
points on the feet and hands that correspond to
all organs and glands of the body. Stimulating
these reflexes improves circulation and many
health conditions. Reflexology has been
practiced for thousands of years. The earliest
known origins of reflexology date back to over
5,000 years ago in Egypt where illustrations of
a practitioner performing reflexology on a
patient were found carved on the wall of a tomb.
Other evidence of reflexology has been seen in
India, approximately 5,000 years ago. A carving
of "The Feet of Vishnu" shows symbols on the
bottom of the feet. Although the actual meaning
of these symbols is unknown, the placement of
the symbols corresponds too closely with what is
known today as many of the reflex areas for
specific organs and glands of the body to be
merely a coincidence.
Reflexology has been practiced over the years
in various forms. In the 19th century it was
examined seriously by doctors and scientists.
Over the next 100 years, reflexology developed
into an accepted practice around the world.
Eunice Ingham, working with Dr. William
Fitzgerald in the 1930s, is credited with
developing the modern practice of reflexology in
the United States. In the 1950s reflexology
faced opposition by the American Medical
Association (AMA), who tried to make it illegal
by claiming practitioners were practicing
medicine without a license.
Although reflexology stills finds opposition
today from the medical community, it has
continued to thrive as an alternative or
complementary treatment to traditional medicine.
Since 80% of all migraine sufferers are
women, the researcher chose to focus this study
on women. Women who currently suffer or have in
the past suffered from migraine headaches and
who have used reflexology as one method of
treating these headaches were polled. In all,
over 100 questionnaires were distributed through
a network of reflexologists and through the
researcher’s website. The questionnaires asked a
series of questions applying to "before
reflexology" and "after reflexology." Responses
were received and evaluated.
If this study supports the theory that
reflexology is effective in treating migraine
headaches, the theoretical implications could
point to a new way of treating migraines that
would significantly improve the quality of life
for many people. Using reflexology instead of
traditional medicine would offer many people the
opportunity to stop using drugs and improve
their ability to function in everyday life. If
the study shows that reflexology has no effect
in treating migraine headaches, it could help
establish reasons for focusing on other types of
alternative therapies such as acupressure,
stress management, biofeedback, or nutritional
therapies, or on expanding and improving
traditional treatments.
No research project can be done under perfect
conditions and this study is no exception.
Controversy may arise over the way the research
was conducted. Outside of selecting women as a
group to participate in the study, there were no
other parameters of participation. Women of
varied economic, age, and ethnic groups were
polled, as were women who may have been
suffering from various other health problems or
from no other health problems. Questions
requesting extremely detailed information were
not included. Specifically, questions were not
included that related to outside influences (air
quality, time of year, type of work the
participant does, etc.); ethnic background of
the participant; and any emotional and mental
problems or stress the participant may be
experiencing. An analysis of how other therapies
that the volunteer has used or may be using
could have on the effectiveness of the
reflexology was not included in this study.
There can also always be some concern as to how
much of the improvement seen in a participant is
due to the participant’s belief that reflexology
would improve her condition. The researcher
tried to eliminate this factor by including some
women in the group who agreed to participate in
the study even though they were extremely
skeptical and did not believe that it would
improve their conditions. This would support the
belief that a positive response to reflexology
would not be due to a placebo effect since the
participant had actually been expecting it not
to be effective. (One of these women is
discussed in more detail in Chapters 1 and 4.)
Chapter 1
Nature of the Problem
First recorded during the Mesopotamian Era in
3,000 B.C. , migraine headaches are one of the
oldest medical conditions affecting humans, of
which there is currently no recognized cure.
Migraine is a neurologic disorder characterized
by recurrent attacks of headache. They may occur
when blood vessels of the head and neck spasm or
constrict. This decreases blood flow and may
cause symptoms other than headache. These
symptoms are what is known as the "aura" that
approximately 15% to 20% of sufferers
experience. These symptoms can include visual
disturbances such as flashing lights or bright
spots or a tingling in the hand, tongue, or side
of the face. Minutes to hours after experiencing
the "aura," the blood vessels in the head dilate
or enlarge, resulting in a severe headache.
The pain is often on one side of the head and
is accompanied by various combinations of
symptoms such as intense throbbing (usually on
one side of the head), sensitivity to light and
sound, blurred vision, nausea, chills, sweating,
extreme fatigue, irritability, and vomiting.
They can occur at any time of the day or night,
but are most common first thing in the morning.
They can last from several hours to several days
and are often intense and disabling. During a
migraine, pain may migrate from one part of the
head to another or radiate down the neck into
the shoulder. Many patients report scalp
tenderness during or after an attack. Most
headaches are not life threatening, but they may
seriously influence one’s quality of life and
coping abilities. They strain family life,
disrupt leisure activity, and diminish career
opportunities.
They can be caused by a variety of triggers,
such as anxiety, fatigue or tiredness, weather
changes, odors or fumes, pollution or smoke,
motion or travel, lifestyle change, stress,
disrupted sleep patterns, smoking cigarettes,
and hormonal changes such as pregnancy,
menopause, or birth control pills. Many foods
can also contribute to the onset of migraine
headaches, including red wine, beer, chocolate,
fermented or marinated foods, caffeine, dried
fish, broad beans, fermented cheese, nuts,
citrus fruits, dairy products, and food
additives such as nitrates, MSG, and aspartame.
Surveys have been done on the number of
people in the United States that suffer from
migraine headaches. These studies report that
between 24 to 28 million people suffer from
migraine headaches. That translates to
approximately 13% of the population of the
country. Headaches usually begin between the
ages of 10 and 46. Eighty percent of the people
suffering from migraines rate their headaches as
being severe or extremely severe and 25% of them
have sought emergency room treatment for their
headaches. Surveys indicate that women suffer
from migraine headaches 2 to 3 times more than
men do, or as many as 80% of migraine sufferers
are women. Women also report having more pain,
headaches of a longer duration, and a greater
number of accompanying symptoms than men report.
Migraine headaches are diagnosed by a doctor
or other health care provider based on the
pattern of symptoms, the history of migraines in
the family, and the person’s response to
treatment. No abnormalities are detected during
a physical examination that can point to the
diagnosis of migraine headache. There is no
known cure for migraines, only treatment to
control symptoms and prevent further attacks.
The cost of migraine headaches to the
American public is staggering. It is estimated
that approximately $5,617.2 billion a year is
lost in missed work, physician visits, and poor
job performance. The corresponding cost to
industry and the healthcare system is between $5
and $17 billion a year. Although most migraine
sufferers continue to work despite their
condition, they have reported a downward trend
in their income and productivity over time due
to the headaches. One study on the economic cost
of migraines found that the unemployment rate in
individuals with severe migraines is 10% to 20%,
significantly higher than the general public.
One reason for this is that people often think
that migraine sufferers just can’t handle life’s
stresses or that they are drug addicts or
alcoholics. This perception is formed when, for
example, coworkers or employers see the migraine
sufferer wear sunglasses indoors due to their
sensitivity to light. Or, the sufferer may be
seen lying down in the restroom, or make
frequent trips to the restroom due to nausea,
leave work early, slur her speech, or engage in
otherwise erratic behavior.
There is also the unrecordable cost of stress
put on the friends and family of someone
suffering from migraines. Dr. Randy Levin,
medical officer for the Food and Drug
Administration’s division of
neuropharmacological drug products, noted in the
FDA Consumer Magazine that, "Migraines are
unlike tension headaches in that they often
interfere with people’s activities to the extent
of forcing them to stop what they’re doing and
lie down." This often causes problems because of
family members who have difficulty understanding
and coping with the disease.
Examples of how migraine headaches can affect
every aspect of a sufferers’ personal life was
illustrated clearly in case studies of two of
the researcher’s clients, "Sandra, and
"Maryanne.*" Maryanne, a 34 year-old married
woman with no children, reported that when she
has a migraine, "everything anyone does or says
is extremely annoying." Maryanne did find that
she could manage her headaches if she could be
sure to get a minimum of seven hours of sleep a
night. This sometimes meant that if she and her
husband had company over for an evening, she
might have to excuse herself and go to bed. She
said that people often didn’t understand why she
did this when she didn’t have a headache.
However, Maryanne said that any problems
excusing herself early might cause were small in
comparison to the headache that she was sure to
get if she did not leave her company and go to
bed. Maryanne also stated that there was a point
in her life when the migraines had "taken over"
her life. She felt that she was always either
getting over a headache, anticipating the next
one, thinking about what could have caused it,
or about what she was going to do about it.
Sandra is a 31-year-old married woman and
mother of two who has averaged one migraine a
week since she was 15 years old. These headaches
would last anywhere from three hours to three
days. When Sandra had a headache, she said she
could do nothing.
"I wasn’t able to make dinner, bathe the
kids, I wasn’t able to do anything. I would just
take medication and go to bed." Although Sandra
was fortunate to have a supportive and
understanding husband, it still put a strain on
their relationship at times. Sandra felt like
she missed a lot of time with her children due
to her headaches. Her children had to learn at a
very young age "not to disturb Mommy," or that
"Mommy can’t play because she has a headache."
This left her feeling "worthless" and
"depressed." Sandra even questioned her sanity
and overall health. She said that she got to the
point of feeling that there was something
seriously wrong with her. "How could someone
have so much pain for so many days without
something being seriously wrong with them," she
would ask herself.
Historically, migraines have been treated
using a trial and error approach based on
medical information available at the time or
with primitive methods based upon superstitions.
Early physicians such as Galen and Hippocrates
had prescribed treatments such as drilling a
hole in the skull to free "evil spirits," purges
and bloodletting, applying a hot iron to the
site of the pain, and inserting a clove of
garlic through an incision in the temple.
More traditional treatments for migraines
have revolved mostly around drug therapy, both
over-the-counter and prescription drugs.
Over-the-counter acute migraine therapies such
as Excedrin are recommended first for acute
treatment of migraines. If these drugs don’t
work, other drugs may then be recommended. The
most common drug is Imitrex (Sumatriptan), which
became available in the early 1990s. This drug
is self-administered as an injection under the
skin or can be taken in the form of an oral
tablet. It works by constricting the dilated
blood vessels, relieving the pain and associated
symptoms.
Other treatments include the use of a patch
worn on the skin that allows medicine to be
absorbed through the skin, oxygen inhalation,
laser therapy to the maxillary nerve, and
estrogen treatments. Although some of these
treatments have helped to relieve symptoms for
some people, for others these same treatments
can trigger migraines. Still others may
experience "rebound headaches." These headaches
can be particularly depressing and frustrating
for a migraine sufferer because the drug seems
to be having an effect on the migraine and the
patient may begin to feel relief, but then the
headache returns, sometimes even more severe
than before they took the drug. For all
sufferers, these treatments can be extremely
costly (for example, Imitrex costs about $35 a
dose) and they all only treat the symptoms and
do not resolve the cause of the problem.
In more recent times, other alternative or
complementary therapies have been used to
relieve migraine headaches. These have included
classes in stress management, herbal remedies,
acupressure, acupuncture, massage therapy,
biofeedback, and reflexology. These alternative
therapies have been found to be helpful in
alleviating the pain of migraine and in either
reducing or eliminating migraine headaches
altogether for some sufferers. For example, 70%
of patients in a study performed by the London
Migraine Clinic reported fewer and less painful
attacks of migraines using the herb Feverfew
Leaf. Researchers believe that this herb
prevents the spasms of blood vessels in the head
that trigger migraines.
Biofeedback is a technique used to train
people with migraines to reduce muscle tension
by attaching devices to their body that provide
"feedback" information about changes in their
physical state by means of visual or sound
signals. Using this feedback, one learns to
control previously involuntary body processes.
Biofeedback training has been used successfully
to improve many types of headaches. It is
especially useful for children and pregnant
women where medications may need to be limited
or restricted.
Another way of using these non-drug therapies
is to use them in conjunction with known
triggers of the migraine. By targeting the
trigger, patients have been able to reduce or
eliminate migraine attacks by changing their
diets or sleep patterns, or by reducing stress
and anxiety in their lives. For example, if a
migraine sufferer has identified that a specific
food such as caffeine triggers a migraine, he or
she would eliminate that food from their diet.
If a sufferer has noticed that he or she
experiences migraines after going to bed
especially late (as in the case of Maryanne
previously mentioned), the patient would be
encouraged to be consistent in his or her sleep
patterns. By maintaining a regular bedtime and
waking up at the same time each morning, he or
she could experience a dramatic improvement.
Since success has been seen in treating
migraine headaches with some types of
alternative treatments, there is a need to
examine the validity of all these treatments to
improve the health and quality of life for the
migraine sufferer. This study asks the question,
what research currently exists that examines the
use of reflexology to prevent and/or relieve
migraine headaches in women.
Chapter 2
Literature Review
Most research done on the treatment of
migraine headaches has revolved around drug
therapy. The Journal of American Medical
Association (JAMA) has reported on many studies
that have examined the causes and treatments for
migraine headaches. Although these studies do
not rule out the ability of certain types of
alternative treatments to have a positive effect
on the treatment of migraine, they also do not
go as far as crediting these treatments with the
prevention or cure of migraines. They continue
to look to drug therapy for the main answers.
JAMA reported a double-blind study conducted
by Dr. Richard Lipton of the Albert Einstein
College of Medicine in New York City on 273
patients with disabling migraines treated with
either the drug Sumatriptan (Imitrex) or with a
placebo. The results of this study showed that
68% of migraine headaches responded favorably to
this drug. This percentage of success has earned
the drug praise and many physicians promote its
use.
Most research showed results such as these.
There is no doubt that modern drugs can help to
prevent or relieve migraine headaches, but what
if an individual wishes to avoid drugs? What
other methods have been studied and found to be
effective in treating or preventing the disease?
Some research has been done examining the use
of herbs or vitamins to treat the condition. A
study was conducted of 55 patients in Belgium
and Luxembourg who normally had two to eight
migraines a month. It was found that after
taking 400 milligrams of Vitamin B2 daily, those
patients taking the B2 had about one-third fewer
headaches than those patients taking a placebo.
Examining studies that deal with the effects
of reflexology on headaches, one European study
conducted a blind random trial to determine
whether reflexology is an effective treatment
for headaches. This study examined 32 patients
between the ages of 15 and 57. There were 25
women and 7 men randomly assigned to two groups.
One group was given a placebo and received
reflexology treatments two times a week for two
to three months. The other group received
Flunarizin treatment (a selective calcium entry
blocker with calmodulin binding properties and
histamine blocking activity that has been
effective in preventing migraines) and massages
of a non-specific area twice a week for 12
sessions. Patients were evaluated at the end of
the study and again three months after the end
of the study. It was concluded that the
reflexology treatment was at least as effective
as the Flunarizin treatment and may be classed
as an alternative non-pharmacological
therapeutic technique that would be particularly
appropriate to those patients that were unable
to follow pharmacological treatment.
A Chinese study of 26 patients, 9 men and 17
women, from 19 to 43 years of age showed that
after one session of foot reflexology, 13 of the
participants considered themselves symptom free,
and 1 reported symptoms relieved. After two
sessions, 6 considered themselves to be cured
and 1 reported to be symptom free. After three
sessions, 2 participants said they were cured
and 3 stated their symptoms were unchanged. The
conclusion of this study was that reflexology is
a safe, economic therapy.
An unpublished Danish study looked at 20
migraine headache sufferers who received 240
reflexology treatments, an average of 12
sessions per patient. Nine of the participants
reported no longer having headaches, 6 reported
considerable improvement in their conditions, 2
stated they felt a little better, and 3 reported
no improvement.
Another Danish study is probably one of the
most extensive studies done to date on the
effects of reflexology on headache sufferers.
Since 1988, reflexology has been the alternative
treatment most often used to treat headaches in
Denmark. (This study was appropriate because a
researcher found in 1994 that Denmark
experienced a loss of 729,000 workdays each year
due to migraines and thus warranted research for
ways to reduce migraines.) The largest share of
the population of Denmark suffering from
headaches are people in the 25 to 44 age range.
This study followed 220 people suffering from
migraine and tension headaches over a six-month
period who received a maximum of 78 reflexology
treatments. The study was conducted from 1993 to
1994 and examined why patients sought
reflexology, what their previous experience had
been with medication, and the outcome of the
reflexology treatments.
The largest age group making up this study
were people in the 25- to 44-age range.
Sixty-one percent of the participants reported
taking over-the-counter drugs for their
headaches and 9% reported taking prescription
medications. Eighty-one percent were women.
At three months into the reflexology
sessions, patients were polled on their
progress. Eighty-one percent reported they were
helped or "cured" (their term) by reflexology.
Nineteen percent of the participants who had
been taking drugs for their headaches were able
to stop taking the drugs.
At the end of the six-month study, 23% of the
participants reported they were cured.
Fifty-five percent reported relief. Three months
after the end of the study, participants were
polled again. Sixteen percent reported being
cured, 65% experienced relief, and 18% stated
their condition was unchanged compared to the
beginning of the treatment.
Those participants who continued with
reflexology sessions after the six-month period
reported the greatest probability for cure.
Those who reported having had headaches for the
shortest period of time prior to the study
reported the greatest relief after the study.
The authors’ conclusions of this study were
that reflexology "seems to improve patients’
general well-being, energy level, ability to
interpret their own body signals, and ability to
understand the reasons for headache. However,
these relationships may be due to other factors
in the treatment environment. Additional studies
are necessary to determine the proximate cause
of reflexology’s therapeutic benefits."
One thing the researchers noticed that could
have affected the study was that once receiving
reflexology, many of the participants seemed to
make lifestyle changes that reflected how they
looked at their headaches. Prior to receiving
reflexology, patients looked at their headaches
as something separate from themselves over which
they had no control. After working with a
reflexologist, they seemed to understand the
mind-body connection to their headache and how
it could be controlled through the integration
of the mind and body. It appeared that the
reflexology practitioner became a catalyst for
initiating the learning process and inspiring
personal development in the patient.
In conclusion, these studies demonstrate
interesting results pointing to hope in
providing non-drug treatments for the relief of
pain and improvement of life for migraine
sufferers. This last study mentions a total of
81% of the participants reporting either being
cured or experiencing relief for as long as six
months after the study’s conclusion. The JAMA
study conducted by Dr. Lipton of the Albert
Einstein College of Medicine mentioned at the
beginning of this chapter found that the most
popular migraine drug on the market, Imitrex,
resulted in 68% of participants experiencing
relief. If this drug can receive such attention
and praise with a record of 68% patient relief,
shouldn’t a therapy that has no side effects and
has an 81% success rate among migraine sufferers
receive at least as much attention and at least
be offered as another option to those
individuals who suffer from migraine headaches?
Chapter 3
Methodology
This research examines the alternative
treatment of reflexology on women suffering from
recurring and often debilitating migraine
headaches and its effectiveness in reducing the
severity of these headaches or eliminating such
headaches altogether.
Many women suffer from migraine headaches,
which can interfere with her ability to work
and/or be an effective parent. Migraines can
also put a strain on marriages and other
relationships because of a lack of understanding
on the part of others as to the disease.
Treatment for these headaches is limited to
traditional drug therapy, with some alternative
methods still considered at best experimental,
to at worst quackery. This study has focused on
one alternative therapy, reflexology,
considering similar research and conducting
additional research to confirm or refute
previous research.
The researcher developed a questionnaire
asking each volunteer questions related to their
migraine headaches before they began reflexology
and after using reflexology. The "before
reflexology" questions included the following:
1. Frequency of headaches?
2. How long do they usually last?
3. Any medications taken (prescribed or
over-the-counter).
4. Number of workdays missed due to a headache.
5. Other triggers (i.e., food, stress, etc.).
Participants were also asked to rate the
severity of their headache on a scale of 1 to 10
with 1 being painful, but still able to
function; 5 meaning she may miss work and other
activities but still has some ability to
function; and 10 meaning she is bedridden,
cannot tolerate light or noise, and experiences
nausea.
The second part of the questionnaire then
asked questions relating to participants’
condition after receiving reflexology. The
"after reflexology" questions included the
following:
1. How often do you have reflexology?
2. Frequency of headaches?
3. How long do they usually last?
4. Have you been able to reduce or eliminate
your need for medication?
5. Have you found the same triggers affect you
in the same way?
6. If you have reflexology during a headache,
does it shorten the duration of it, reduce the
severity of it, eliminate it altogether, or no
change?
Participants were also asked once again to
rate the severity of their headaches after
having reflexology using the same scale as
above.
The questionnaire was distributed to
volunteers through a network of reflexologists
and from a website where volunteers could
download a copy of the questionnaire.
Reflexologists who received the questionnaire
were asked to distribute it to any of their
clients who suffered from migraine headaches.
The questionnaire was worded carefully so as not
to assume that reflexology had helped a
sufferer’s condition. Volunteers were assured
that their names would not be used in the study
and that any personal information would not be
distributed. The forms were sent directly to the
researcher and not returned to the reflexologist
who had distributed the questionnaire and who
may have performed reflexology on the volunteer.
This ensured that the volunteer could be
comfortable in answering the questions
completely and honestly without fear of
offending her practitioner.
No timeframe was set or number of reflexology
sessions designated. Participants were asked in
the questionnaire, however, to specify the
length of time they had been receiving
reflexology.
As a certified reflexologist, the researcher
also contributed to gathering clinical
information through two clients who volunteered
to be part of the research. Each of these
individuals had been clinically diagnosed with
migraine headaches and had not received
reflexology before beginning the study for their
migraines or for any other reason. One of the
participants, Maryanne,* had used other
alternative treatments and was open to the
possibility of reflexology helping to improve
her condition. The other volunteer, Sandra,* was
completely skeptical and only agreed to
participate because, as she said, she "had tried
everything else." In addition to completing the
standard questionnaire, these two volunteers
were also asked to provide additional
information on themselves, their history, and
their feelings about the headaches.
As detailed in Chapter 2, other research has
been conducted that examines the effects
reflexology may have on migraine headaches.
Other research has concentrated on simply
evaluating whether or not reflexology 1) gave
the volunteers relief, or 2) cured their
headaches. This study asks additional questions
of the volunteers to determine whether or not
those people who did still experience headaches
found their headaches to be less frequent or
shorter in duration. Information has also been
gathered on what, if any, other medications or
therapies were being used in conjunction with
the reflexology.
This study was done while volunteers were
still receiving reflexology. At the time of this
writing, there is no way to include input from
volunteers on their conditions three or six
months after stopping reflexology as most of the
participants have chosen to continue with
reflexology. Except for Maryanne and Sandra,
whom the researcher saw on a weekly basis, there
was no set number of sessions the volunteers had
to have before completing the questionnaire.
Volunteers completed questionnaires after what
they believed would be enough time to notice a
change in their condition. All participants
filled out their questionnaires without help,
oversight, or follow-up from the researcher or
from the practitioner that provided the
reflexology treatments.
Chapter 4
Results
Introduction
What effect does the research show
reflexology to have on migraine headaches? Does
reflexology have a positive effect on migraine
headaches? Does it contribute to migraines? Do
migraine sufferers who undergo reflexology
treatment experience any change at all in the
frequency, duration, or severity of their
migraine headaches?
This chapter compiles the findings of the
researcher beginning with case studies of two
clients who agreed to participate in the study
and supply information in addition to what was
requested in the research questionnaire. The
participants, Sandra and Maryanne*, both
suffered from clinically diagnosed migraine
headaches and were followed over a period of 6
months. Both received a full reflexology session
once a week, and both were asked to keep a diary
of any changes they noticed in their condition
over that time period. The researcher also noted
of any changes in their condition or attitude
over this time period.
Case Study - Sandra
Sandra stood at my doorway. "OK" she said. "I
have a headache coming on and I can tell it’s
going to be a bad one. I don’t have anything to
lose, so go ahead."
Sandra is a 31-year-old married woman with
two boys ages 7 and 9. She has suffered from
migraine headaches since age 15, having had one
or two migraine headaches a week lasting
anywhere from three hours to three days. At the
beginning of our sessions, Sandra on average
missed 3 workdays a month due to her headaches.
She has been to her family doctor, her
gynecologist, and to a neurologist to treat her
migraines. She has been hospitalized for her
migraines and has used several drugs, including
Maxalt, Inderal, and Pamelor. She reports that,
at best, these drugs give minimal relief from
the headaches, and at worst make her feel
drugged and dopey.
Sandra is quite familiar with the symptoms of
her headaches, including how they start, if it
will be a minor headache causing her slight
inconvenience, or if it will be a major
headache, sending her to bed. This day she knew
from the symptoms she was experiencing that the
headache was going to be a major one that could
mean she would be bedridden for a day or more.
When I first started working with Sandra she
was completely skeptical. She was aware of my
research, but had decided that reflexology, like
everything else she had tried, would be useless
in helping to relieve her headaches. The idea of
"rubbing someone’s feet" to relieve clinically
diagnosed migraine headaches was "silly" to her.
She admitted to me later that she only came to
me that first time because she didn’t have
anything to lose and she thought she could prove
that reflexology, like so many other things she
had tried, would have no effect on her.
I led Sandra to the chair I use for my
clients and after taking a few minutes to
briefly explain the concept of reflexology and
how it works, I did a few relaxation techniques
to help her relax. I then started working on the
reflexes to the head and sinuses. Within 10 to
15 minutes, Sandra opened her eyes, looked at me
and said, "I just felt that pressure in my head
release."
I continued to work on Sandra’s feet for a
full 45-minute session, paying particular
attention to the reflexes that should be worked
for migraine headaches. These include the
reflexes for the entire spine, the diaphragm,
the pituitary, and the head. I continued on to
the other reflexes on her feet and as I got to
the reflexes for the ovaries and uterus, she
indicated that these areas were particularly
sensitive. I asked her if she had noticed any
correlation to her migraine headaches and her
menstrual cycle and she said she did. I then
spent extra time working the areas relating to
the reproductive system, as well as the reflexes
relating to migraine headaches.
At the end of her first session, Sandra felt
relaxed and said that her headache was gone. She
was still somewhat skeptical, and left my office
fully expecting her headache to return before
the end of the day. She came back in the next
day, however, and informed me that her headache
did not return and she felt fine. She made
another appointment to see me and agreed to
become part of my research.
Sandra has continued to come for weekly
reflexology treatments since that first session.
Since then, she has had only 2 headaches, each
of which she reports being "not bad," lasting
much less time than the headaches of the past
and being relieved with medication.
As we worked together in our weekly sessions,
Sandra expressed a great deal of frustration and
anger in the way doctors had treated her over
the years. She recalled her first visit to her
family doctor when she was 16 years old and how
she felt patronized when the doctor decided her
headaches were caused by "stress over her
relationship with her boyfriend." More recently,
she reported frustration with her neurologist,
who, she says, "spends ten minutes with me and
only prescribes more drugs."
As Sandra continued to receive reflexology
treatments, we would talk. As with the
participants in the Danish study reported in
Chapter 2, Sandra seemed to also look to her
reflexology practitioner as a "catalyst for
initiating the learning process and inspiring
personal development." She became interested in
finding out more information on the drugs that
had been prescribed for her. She searched the
Internet to discover what side effects these
drugs may produce and what the long-term effects
might be. She wanted to find out more about any
effects her menstrual cycle may have on her
headaches and started searching the Internet for
information on doctors and hormone therapy for
migraine headaches. She also became interested
in how her diet could be causing her headaches
and became more conscientious about her diet and
eating habits. Although I answered her questions
and helped her find the information she
requested, I did not initiate any of this. As in
the Danish study, once Sandra realized that she
might be able to take control over her
headaches, she took an active interest in
finding ways to do just that. She definitely had
a change of attitude and, where she seemed in
the beginning of this study to be resigned to
suffering with headaches and being on drugs for
the rest of her life, she now seems hopeful that
she can live drug-free and headache-free and
motivated to achieve this.
Case Study – Maryanne
At the beginning of this study, Maryanne was
a 34-year-old married woman with no children.
She has had clinically diagnosed migraine
headaches since she was 25 years of age.
Maryanne had approximately two to three
headaches a month that would last between four
to eight hours and would cause her to miss
approximately one day a month from work. She
takes Imitrex for a headache when she has one.
Maryanne has found that her menstrual cycle,
improper eating habits, too much sunlight,
stress, and irregular sleep patterns are some of
the triggers to her headaches.
Maryanne also found that with a regular
practice of yoga along with certain other
lifestyle changes, such as better regulating her
sleep patterns, she was able to keep her
migraines more or less under control. Although
she had never undergone a reflexology session,
she did believe alternative therapies could be
helpful and was open to trying reflexology and
to the possibility that it could also help her
migraines. Maryanne agreed to take part in the
research and began regular weekly reflexology
treatments.
Although Maryanne’s headaches were not as
severe as they had been before she began yoga
and before she identified other triggers to the
migraines, she still suffered from migraine
headaches fairly regularly. She attributed these
headaches mostly to stress. Once weekly sessions
began, Maryanne noticed a marked decrease in the
frequency and severity of these headaches.
At one time while she was having a headache,
she came to my office and I was able to work on
her at that time. After a full 45-minute session
in which I worked the reflexes of the entire
foot and concentrated on the reflexes associated
with headache, she relaxed for a few minutes and
then returned to work. I checked on her about 4
hours later and she reported, "I feel great."
She said that the headache had left and did not
return. Another time she came to me at the
beginning of a headache and I worked on her.
Although this time the reflexology session did
not totally eliminate the headache, she did say
that the headache was greatly relieved and she
was able to function in her job the rest of the
day when she normally would have had to go home
and go to bed.
Although Maryanne did not have any migraine
headaches after beginning the regular
reflexology treatments, she did continue to have
occasional headaches; however, she reported that
they were much less severe than migraines, did
not last as long, and were easier to manage.
Since beginning reflexology, Maryanne has not
had to take Imitrex to control a headache and
found that if she has a headache and is unable
to schedule a reflexology session to help
relieve it, taking one Tylenol is all that is
necessary to relieve the headache.
During our sessions, Maryanne quit smoking
and went on a diet to lose weight. Although she
had tried unsuccessfully to quit smoking several
times in the past, this time Maryanne seems to
have been successful. She lost about 20 pounds
on her diet --- a good weight for her. She also
decided to become pregnant while receiving
reflexology sessions, so this was probably a
major motivation in her decision to quit
smoking. She continued to receive reflexology
treatments throughout her pregnancy. She
believes that regular reflexology treatments
helped her to avoid taking any drugs for her
migraines while she was pregnant as well as
helped her to control stress in her very busy,
high-pressure job, and any stress she was
experiencing from the withdrawal of cigarettes.
Maryanne recently delivered a healthy 8-pound,
4-ounce baby boy and has indicated that she
would like to begin reflexology treatments on
her new son because she believes it to be
helpful in maintaining balance in one’s body.
Research Questionnaires
Over 100 questionnaires were distributed to
reflexologists across the country, who were
asked to distribute these questionnaires to any
clients they had that suffered from migraine
headaches. The questionnaire was also posted on
the researcher's website explaining what it was
for and requesting that any migraine sufferer
who used reflexology to help with her headaches
to complete and return the questionnaire.
Of the 100 questionnaires that were sent out,
16 were returned. Of the 16, all but one
participant had had her migraine headaches
clinically diagnosed by a medical doctor. The
average age of the women who responded was 38,
with the oldest participant 56 years of age and
the youngest 12 years of age. The average age of
the women when they first reported getting
migraine headaches was 21. This included 3 women
who got their first headache at age 12 or
younger. The women who responded had been having
migraine headaches for an average of 16 1⁄2
years. All but three of the women participants
received reflexology sessions once a week. Two
received sessions twice a month and one received
monthly sessions. Of the 16 women, 7 of them
added other alternative therapies along with
reflexology. One woman added chiropractic, one
woman practiced yoga, two women received massage
therapy, two women received acupressure
treatments, and one woman received water therapy
and exercised.
Before reflexology treatments, 12 of the 16
women reported losing an average of 2.1 workdays
a month due to their migraines, 3 of the women
had been on disability due to their migraines,
and 1 woman had missed an entire school year of
teaching due to her headaches.
The most common prescription medication the
women reported using was Imitrex. The most
common over-the-counter medication used was
Advil. The most common migraine trigger reported
by the women was their menstrual cycle with 7 of
the women, or 43.75%, citing this as the main
cause of their migraines.
Most women reported the number of headaches
to be at least one-half of what they had
previously experienced with the duration of
headaches decreasing from one-half to
three-quarters of the time it lasted before
regular reflexology sessions.
The women were asked to rate their most
common headaches on a scale of one to ten both
before and after regular reflexology sessions.
One was considered to be painful, but still able
to function. Five meant the participant may miss
work and other activities, but still have some
ability to function. Ten indicated she was
bedridden and was unable to tolerate light or
noise and experienced nausea. Using this scale,
the women rated their headaches at an average of
8.1 before reflexology and 4.43 after
reflexology for an average decrease in pain of
3.68 or 45.43%. As a result, 14 of the 16 women,
or 87.5% reported that they were able to reduce
or eliminate their need for medication after
having regular reflexology sessions.
This study shows that all but two of the
women (or 87.5%) reported a considerable
decrease in the frequency, duration, and
intensity of her headaches. (This corresponds
with the studies previously mentioned in Chapter
2 where 88% of the participants of the Chinese
study reported experiencing relief, 85% of the
participants of the unpublished Danish study
reported relief, and 81% of the larger Danish
study reported experiencing relief through the
use of reflexology.)
Current Age Age at Onset Years with Migraine
Clinically Diagnosed Frequency of Reflexology
Sessions Frequency of Headache Before Frequency
of Headache After Duration Before Duration After
Meds Before Reduce or eliminate meds? Scale 1 –
10 Before Scale 1 – 10 After # of Points Reduced
After # Lost WorkDays Triggers Eliminate, or
Shorten? Other Therapies Used
46 25 21 Y 1/wk 2-3/wk 1/mo 12 hr 4 hr Advil
Aleve Y 9 4 5 N/A Chocolate
Coffee Y N/A
32 16 16 Y 1/wk 1/wk 0 4-6 hr N/A Advil Y 7 3 4
1 Sweets Y N/A
56 20 36 Y 1/wk 2-3/mo 2/yr 24 hr 4 hr Imitrex Y
10 3 7 3 N/A Y N/A
42 20 22 Y 1/wk 1/day 1/wk 2-6 hr 2 hr Advil Y 5
3 2 2-4 Citrus Y Chiropractic
31 15 16 Y 1/wk 1-2/wk 1/mo 24 hr 4 hr Maxalt
Inderal
Pamelor Y 8 4 4 3 Menstrual Cycle; Alcohol;
Bananas; Nuts Y N/A
34 25 9 Y 1/wk 2-3/mo 1/mo 3-72 hr 2-4 hr
Imitrex Y 8 6 2 1 Menstrual Cycle; Diet; Sun;
Sleep; Stress Y Yoga
40 14 26 Y 2/mo 2-3/mo 2-3 mo 24 hr 24 hr
Imitrex N 10 10 0 2 Menstrual Cycle Y
Acupressure
20 19 1 Y 1/mo 2/mo 1 mo 8-10 hr 8-10 hr Toridol
Excedrin Y 10 6 4 1 Menstrual Cycle; Sleep;
Stress Y N/A
12 7 5 N 1/wk 2-3/wk 1/mo 24 hr 2-3 hr Homeo-
pathic
only N/A 10 6 4 4 Chocolate; Dairy; Sweets Y
Acupressure Aromather. Homeopathy
42 30 12 Y 2/mo 1/wk 2/mo 6-12 hr 6-12 hr
Butabital
Caffeine Y 10 8 2 4 Menstrual Cycle Y Massage
55 18 37 Y 1/wk 1/mo 1/mo 36 hr 18 hr Advil Y 4
2 2 1 Menstrual Cycle Y N/A
50 43 7 Y 1/mo 1/wk 1/mo 1-3 da 1-2 da Fioscet
Ultram
Soma Y 6 4 2 N/A N/A Y Massage
46 40 6 Y 1/wk 1-2 da 1/da 2-3 da 1⁄2 hr Amerge
DHE
Celebrex
Ultram N 7 5 2 1 yr Heat; Stress; Menstrual
Cycle Y Water therapy, exercise
28 12 16 Y 1/wk 2/mo 1 qtr 2-4 hr 2 hr. Tylenol
Advil Y 8 3 5 1 N/A Y N/A
24 12 12 Y 1/wk 1 wk none 6 hr N/A Advil Y 8 N/A
8 3 Stress Y N/A
53 30 23 Y 1/wk 1-2/wk 1/mo 2-3 da 1 hr Imitrex
Toridol Y 10 4 6 N/A Onions; Red Wine Y N/A
Chapter 5
Implications and Recommendations
The pain of migraine headaches is very
misunderstood. All of the women participating in
this research reported years of pain and
suffering. They reported depression and
frustration as a result of not being able to
find any relief from the pain. They also
reported frustration and discouragement when
dealing with their physicians and friends who
didn’t understand their disease. Women told
stories of doctors who brushed off their pain
and contributed it to premenstrual syndrome
(PMS) or to an inability to deal with the
stresses of everyday life. Some women told of
friendships or marriages that were damaged
because people didn’t know how to deal with a
friend or mate who was "always sick," or who
always required support and understanding due to
her illness.
The pain of a migraine headache is a very
real and intense pain. Many women could describe
their pain in intricate detail. For example,
Maryanne explained that when suffering from a
migraine she found that all of her senses were
highly attuned, increasing the pain she
experienced. As she described it, "the bedsheet
wrinkling is so loud it hurts my ears, the light
of the half-moon is too bright, I can feel my
blood going through my veins, especially the
ones in my head."
This pain causes depression, added stress,
and can cost a migraine sufferer an enormous
amount of money. Even for those women fortunate
enough to have a good health insurance plan,
most migraine sufferers will still have to pay,
at a minimum, a co-payment for every doctor’s
visit or a visit to a specialist. Then there is
the time and expense involved in driving to
these doctors’ offices; the inconvenience of
finding someone to drive her there because she
is usually too sick to drive herself; the cost
to her spouse or friend who may lose work time
in order to drive her to an appointment; the
scheduling and making of arrangements to get to
the hospital or labs for any special tests or
bloodwork required; the visits to pharmacies to
pick up medicines; the actual cost of the
medication; and the cost to the sufferer of any
work time lost. Most sufferers report using up
all of their sick time and having to take either
additional time off without pay due to the pain,
or using vacation time to take time off because
of a headache, or both.
Four of the 16 women that responded reported
having been on long-term disability because
their migraine headaches made it impossible for
them to continue to work. This takes a personal
toll on the individual through loss of
self-esteem, work experience, and job
advancement. These are all things that cannot
have a dollar amount put on them. Being on
long-term disability also contributes
significantly to increased costs to other
consumers through higher insurance premiums and,
in turn, mark-up in goods.
In addition, all participants cited the costs
of a "normal life." This included things such as
short tempers, missed opportunities with family
and friends,inability to spend time with others,
damaged relationships, missed time with their
children, etc. When asked to comment on this
subject, Sandra said, "As a parent, I have felt
worthless over the 9 years that I have had
children because most of that time I’ve had a
migraine and I spent time sleeping or in a dark
room, undisturbed. I missed a lot and generally
felt worthless and depressed. How can you place
a cost on that?"
Many women reported a great deal of
frustration in how traditional medicine treated
the problem and reported this as one reason they
decided to try alternative therapies to treat or
prevent their headaches. Traditional allopathic
medicine usually only treats the symptoms of a
migraine. All participants reported either being
told to take over-the-counter drugs to treat
their headaches, or they were given
progressively stronger medications to relieve
the pain and symptoms of their migraines. One
woman reported becoming dependent on her
medications. Fortunately, she recognized this
dependency on her own, stopped taking the
medication, and found another doctor. Many women
reported that when they told their doctor that
the medication was not working as effectively as
it had in the beginning to relieve their pain,
the doctor only prescribed another, stronger
medication.
Until recently, most traditional doctors
didn’t suggest or even consider any other type
of treatment. It is now possible to find more
doctors that will suggest alternative therapies
either because they truly believe them to be
helpful, or because they find it "fashionable"
to do so. Some doctors may suggest massage
therapy, changes in diet, or acupuncture to
handle the pain. Acupuncture is becoming one
alternative treatment that has realized an
increase in consideration from the medical
community, mainly because the AMA recently
recognized it as a legitimate treatment.
This researcher believes that the findings
reported in Chapter 4 confirm the hypothesis
that one alternative therapy, reflexology, does
have a positive effect on the frequency,
duration, and intensity of migraine headaches.
As a result, I believe that physicians need to
become more educated in the research that
currently exists showing that alternative
methods such as reflexology can and do make a
difference in controlling and preventing the
pain of migraine headaches, and they should
encourage their patients to use reflexology as a
form of treatment for this debilitating disease.
Conclusion
As a result of the research that I have
conducted for this dissertation, I have a new
understanding and appreciation of the pain and
frustration women suffering from migraine
headaches experience. Those of us that have
never experienced a "full-blown" migraine
headache can only imagine how it feels. Most
people have had a headache at one time or
another in their lives and think that a migraine
is only a more severe version of such a
headache. The only way someone can truly
understand the debilitating effects of a
migraine headache is to experience it.
Fortunately for doctors, but unfortunately for
migraine sufferers, the majority of doctors
treating migraine patients have never
experienced a migraine headache.
More research needs to be done on the actual
causes of migraine headaches. Although drugs can
alleviate the pain of a migraine for many people
so they are able to function, these drugs do not
address the cause of the migraine. Although
sufferers appreciate the relief they get while
taking the drug, most sufferers would prefer not
having to the take the drug in the first place.
A lot of money and research is spent on
finding new drugs to treat this disease. An
equal amount of money and research needs to be
spent on preventing the disease.
The beginning of Chapter 2 (page 13) reviews
a study in the Journal of the American Medical
Association (JAMA) that was conducted by Dr.
Richard Lipton of the Albert Einstein College of
Medicine. This study followed the effects of a
new drug on 273 patients with migraines. In the
same chapter, I reviewed a Danish study (page
15) that followed a comparable number of
migraine sufferers (220) whose migraines were
treated with regular reflexology treatments.
Dr. Lipton’s study resulted in 68% of
migraine sufferers experiencing relief while
taking the drug. The Danish study resulted in
81% of the participants reporting either being
cured or experiencing relief as long as six
months after the end of the study.
With only a 68% success rate, this drug,
Imitrex, has become one of the best known and
most prescribed drugs on the market to treat
migraines. And yet, a comparable study showing
an 81% success rate in the use of reflexology
for migraine headaches is virtually unheard of.
Why?
Is it because reflexology cannot be patented
and sold at high costs, making money for the
drug companies? Is it because if enough migraine
sufferers were to use reflexology to treat their
headaches, drug companies may notice a decrease
in the profits of their migraine medication? Is
it because recognizing reflexology to be a
viable alternative treatment for migraine
headaches would mean that it might be necessary
to recognize other forms of alternative
therapies as viable treatments for treating
other diseases?
These and other questions need to be
seriously considered and investigated through
continued research on the effects of reflexology
on migraine headaches and by making public these
findings. Finding answers to these questions
could be the first step to a more productive and
pain-free life for more than 28 million
Americans.
Appendices
Sample Questionnaire
Completed Participant Questionnaires
(Not included in this version)
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