A Study of the Effects of Reflexology on Migraine Headaches
By Gail W. Testa
Table of Contents
History & Background of Reflexology
Chapter 1 Nature of the Problem
History of Migraine Headaches
Description of the Problem
Costs of the Problem
Chapter 2 Literature Review
Vitamin Therapy Reports
Reflexology Therapy Reports
Chapter 3 Methodology
Chapter 4 Results
Research Questionnaire Data
Chapter 5 Implications and Recommendations
Completed Participant Questionnaires
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 researchers 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 participants 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.)
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 ones 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 persons 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 cant handle lifes 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 Administrations division of neuropharmacological drug products, noted in the FDA Consumer Magazine that, "Migraines are unlike tension headaches in that they often interfere with peoples activities to the extent of forcing them to stop what theyre 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 researchers 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 didnt understand why she did this when she didnt 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 wasnt able to make dinner, bathe the kids, I wasnt 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 cant 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 dont 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.
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 reflexologys 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 studys 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, shouldnt 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?
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:
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:
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 sufferers 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.
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 its going to be a bad one. I dont 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 someones 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 didnt 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 Sandras 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 Maryannes 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 ones body.
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 ½ 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 Work Days||Triggers||Eliminate, or Shorten?||Other Therapies Used|
|46||25||21||Y||1/wk||2-3/wk||1/mo||12 hr||4 hr||Advil
|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
|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
|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-
|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
|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
|46||40||6||Y||1/wk||1-2 da||1/da||2-3 da||½ hr||Amerge
|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
|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
|Y||10||4||6||N/A||Onions; Red Wine||Y||N/A|
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 didnt 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 didnt 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 doctors 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 Ive 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 didnt 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.
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. Liptons 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.
Completed Participant Questionnaires
(Not included in this version)
Byers, Dwight, Better Health with Reflexology, Ingham Publishing, Inc., St. Petersburg, FL, 1983.
Crane, Beryl, Reflexology: A Basic Guide, Barnes & Noble Books, New York, NY, 1998.
Gach, Michael Reed, Acupressures Potent Points, Bantam Books, New York, NY, 1990.
Ingham, Eunice, Stories the Feet Can Tell, Ingham Publishing, Inc., St. Petersburg, FL, 1938.
Ingham, Eunice, Zone Therapy & Gland Reflexes, Ingham Publishing, Inc., St. Petersburg, FL, 1945.
Issel, Christine, Reflexology: Art Science & History, New Frontier Publishing, Sacramento, CA, 1990.
Turgeon, Madeline, Right-Brain, Left-Brain Reflexology, Healing Arts Press, Rochester, VT, 1988.
Wills, Pauline, Reflexology and Color Therapy, Element, Shaftesburg, Dorset, 1992.
Kunz, Kevin and B. Kunz, "The Golf Ball Technique," Reflexions, Fall, 1991.
Lafuente, A., M. Nouera, C. Puy, A. Moins, F. Titus, F. Sanze, Dr. A. Kesselring, Effects of Treatment with Stimulation of the Reflex Zones of the Foot with Regard to the Prophylactic Flunarizin Treatment of Patients Suffering From Cephalaea headaches, SBK Institut fur Pflegeforschung, Bern.
Launso, L., E. Brendstrup, and S. Amberg. "An Exploratory Study of Reflexological Treatment for Headache." Alternative Therapies, May 1999, Vol.5, No. 3.
Qui Jian, Foot Reflex Zone Massage in Treating Agioneurotic headache (ANH): Report of 26 Cases, School Hospital of Wuhan University Hubei, China.
Rasmussen, BK, Epidemiology of Headache, Copenhagen, Denmark: Copenhagen University, 1994.
Stewart, Lipton, et al., "The American Migraine Study I," conducted by Strategic Insights, Inc. in 1989 and reported in the Journal of American Medical Association, JAMA, 1992, Vol. 267, No. 1, pages 63-69.
Unpublished report available from FDZ Research Committee, Denmark, Reflexology and Migraine Headaches.
http://lifematters.com/headache/fact.html, "Headache Facts." May 8, 2000.
http://womenshealth.about.com/health/womenshealth/library/weekly/ aa022400a.htm, "Migraine Headaches." May 8, 2000.http://www.vitamins.com/news/newsletter/volumes/v2e2/migraine.html "Research Report: Migraine Headaches, May 8, 2000. http://www.migraines.org/disability/impawork.htm, MAGNUM Migraine Awareness Group, "Disability & Impairement," June 27, 2000. http://www.migraines.org/treatment/treatalt.htm, MAGNUM, "Treatment & Management, Alternative Measures," June 27, 2000. http:///www.ama-assn.org/special/migraine/newsline/conferen/aan99/0422suma.htm, "Sumatriptan Treats Full Range of Headaches in Migraineurs," June 27, 2000.
The American Migraine Study II, conducted for the National Headache Foundation, 1999, by Strategic Insights, Inc., and reported at the 13th Annual Conference of the Diamond Headache Clinic & Education Foundation, Palm Springs, CA, February 22, 2000.