Reflexology and the Whole Person – Chronic Headache/Migraine

Foot massageChronic headache and migraine are distressing and often debilitating conditions.  To achieve a medical diagnosis of chronic headache or migraine clients need to report pain across 15 days a month.  Most clients are prescribed a cocktail of topical analgesia and prophylactic (preventative) medication.

Chronic migraine can present as a stand alone condition, or can display in conjunction with either cluster headaches and/or ice pick headaches.   Additionally clients can often describe feeling a foggy, or fuzzy painful head.  Some clients experience less common types of headache, similar to the one presented in Sarah’s case study (below).

Over Use of Analgesia

Medication-induced headaches are caused by overuse of painkillers or triptan medication (triptans are a class of drugs used to treat migraine or cluster headaches).  These type of headaches can be defined as headaches occurring daily, or on most days.  Medication-induced headache is the third most common cause of headache after migraine and tension-type headache.  The Migraine Trust states:

“The extent to which frequent usage of analgesics or triptans causes problems seems to vary from one drug to another, and in all likelihood varies considerably from one patient to another.  Our experience is that over-usage of ergotamine, triptans and opiate based medications (from codeine-based products up to morphine) tend to cause problems most frequently, with paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen less likely to do so.  The International Headache Society criteria for medication overuse reflects this, with opiate or triptan over-usage defined as ten days or more per month, whereas over-usage of paracetamol or NSAID is deemed to be present when these drugs are used 15 or more days per month.”

Pressure placed upon the liver due to excessive medication consumption can impact blood quality.  In essence the liver is a large chemical processing factory.  When the liver becomes ‘overworked’ as a result of repeatedly encountering the chemical components of many medications, wider knock on effects can present in associated parts and organs of the body.

The Occipital Nerve 

Most of the feeling in the back and top of the head is transmitted to the brain by the two greater occipital nerves.  The nerves emerge from the cervical vertebrae in the upper neck.  The two occipital nerves extend up and across the back of the head and into the scalp, sometimes reaching as far forward as the forehead.

Irritation of one or both of the nerves can cause a shooting, electric, or tingling pain located on one side of the scalp. Sometimes the pain can radiate toward the eye.  Problems can sometimes occur spontaneously, or as the result of a pinched nerve root, caused by tight neck muscles or arthritis, for example.  Additionally, injury or surgery to the scalp or skull can result in irritation of the occipital nerve(s).

Many types of headache, including migraine, predominately involve the back of one side of the head.  Patients with headaches of this type are often diagnosed with chronic headache or migraines involving the greater occipital nerve, rather than occipital neuralgia, which is much less common.

Chronic Headache/Migraine and Traditional Chinese Medicine 

“Chronic headaches more often accompany internal disharmonies.  Severe headaches are usually signs of excess, while slight, annoying headaches are usually signs of deficiency.  The organ most associated with headaches is the liver, because liver qi often rises when the liver is in disharmony.” (Kaptchuk, 2000)

Chronic headache and migraine within TCM tend to be viewed in essence as excessive conditions.  However, there are three differentiations of headaches according to TCM:

  • headache due to invasion of pathogenic wind in the meridians
  • imageheadache due to upsurge of liver yang
  • headache due to deficiency of Qi and blood

The liver meridian runs into the feet and big toes.  Stimulation of the feet according to TCM promotes the movement of blood and Qi around the body.  The Ancient Chinese described the feet as the roots of the body.  According to TCM the liver meridian is associated with:

  • the blood
  • the free flow of Qi around the body
  • the muscles
  • the eyes
  • the emotions: anger and irritation

The Psychology

Whilst reflexologists are not counsellors, practitioners do often find themselves listening to their clients.  Empathy can help practitioners to remain within the unique framework of our clients experience, thus helping to reduce the possibility of unfounded assumptions occurring.

Dealing with chronic pain can be utterly exhausting, both physiologically and psychologically.  As a result conditions such as chronic headache and migraine can impact across many areas of the individuals life.  The International Institute for the Study of Pain (Traue, et al) have defined pain as:

“An unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage.”

Going on to state:

“Pain is often accompanied by strong emotions.  It is perceived not only as a sensation described with words such as burning, pressing stabbing or cutting, but also as an emotional experience (feeling) with words such as agonising, cruel, terrible and excruciating.”

Owning Illness

I have personally yet to meet a long term chronic headache or migraine client at consultation who hasn’t come to believe they are physiologically broken.  Perhaps this stance is adopted when an individual reaches the point of believing ‘if the highest qualified expert in the land (the neurologist) isn’t able to fix it … then surely nothing can?’  Perhaps this is the point at which one gives up hope?

The practice of owning a health condition and accepting it as part of ones being is not uncommon.  For example, many practitioners will have heard phrases such as; My headaches mean it’s difficult for me to …..” or, “It’s because of my chronic fatigue I can’t …” ?  Undoubtedly these deeply distressing and painful conditions are entirely real and wholly experienced.  However, if a client comes to truly believe their illness has become a natural part of who they are, then it can become more challenging to visualise a real existence without the presence of the condition.

The nature of the therapeutic relationship in reflexology can provide an appropriate context for practitioners to provide a listening ear and emotional support.  The therapeutic relationship can also be used to provide appropriate information able to promote existential change in clients.

Sarah – The Client

Sarah came to see me some two years after a clinical diagnosis of chronic cluster headaches affecting only the left eye.  Typically, Sarah could be woken up to ten times a night by an excruciating, burning pain in her eyeball.  Sarah was under the care of a consultant neurologist, and had been prescribed both daily prophylactic and topical analgesic medication.

Some nights were better than others, but Sarah reported in over two years she had only experienced a handful of nights without an attack.  During our initial consultation the impact of Sarah’s condition became clear.  Her left pupil was noticeably dilated, and her eye generally bloodshot.  Sarah looked tired, rundown and underweight.

Sarah reported to be a happy and fairly contented lady otherwise.  Apart from her headaches she felt all was well in her world, and considered her job in social work to be ‘sometimes stressful, but very rewarding.’

During the consultation Sarah mentioned she had been following a vegan diet for several years.

Sarah reported some neck pain and general stiffness.

The Initial Consultation Session

Sarah is a sweet, thoughtful, slightly timid, nervous lady, in her mid thirties.  Her hands have the tendency to fidget, she smiles a lot and offers compliments freely.  Liver energy rising according to TCM is associated with repressed anger and states of agitation and irritation; these were not emotions I was readily picking up from Sarah’s language, descriptions or body language.  Instead I felt more drawn to focusing on Sarah’s diet, and an associated potential deficiency in the blood and Qi because of her vegan diet.

Protein influences blood quality (protein is required by the body for cell renewal).  Sarah and I discussed her vegan diet, specifically focusing on her protein intake.  We also explored a potential link connected to a sleep related drop in blood pressure, and Sarah’s general energy levels.  Sarah agreed to do some of her own research and report back her findings. (It can often be helpful to encourage clients to take more responsibility for their body and wider health care.  Client research can promote autonomy and self directed change).

The Sessions

imageAt the next session Sarah was able to report she estimated her protein intake was less than 40% of the recommended daily requirement, and she was able to explain how she planned to rectify the situation.  I worked on Sarah using reflexology for six weeks initially, performing a full and firm treatment.  I gave extra attention to the head/brain, neck, cervical vertebrae, shoulder, liver and adrenals.  Additionally, Sarah was asked to steep her feet in hot water daily – a practice often performed prior to reflexology in the East, in order to promote stimulation of the blood and to open the pores.  Sarah also agreed to use a heated beanbag on her neck daily.

Sarah was additionally able to use the space and confines of the therapeutic relationship to talk about her experience; her pain, her fears regarding her condition, and her levels of exhaustion.

Across this six week period Sarah began to report a lessening in the frequency, duration and intensity of the attacks, resulting in a reduction in her use of topical analgesia.  During week seven, for the first time, Sarah’s pain spontaneously moved from the left to right eye, where it lingered for an additional three weeks.  By week twelve Sarah reported only one attack across the entire week.

Sarah is now free from prescribed medication, and has been discharged by neurology.  The attacks are now consistently limited to one or two occcurances, at or around the time of menstruation.  Sarah continues to attend every six weeks for reflexology.  She upholds her dietary requirements, endeavouring to consume a more balanced diet.

Summary

The information presented towards the top of this blog is a summarised representation of my present personal knowledge regarding chronic headache and migraine.  It is from this bank of knowledge I am able drawn upon and educate each individual client.  Through presenting relevant information, and allowing the client to choose a meaning which seem appropriate for them, we are able to promote client autonomy.  Education and reflective information gathering and exchanges promote self-directed client change.  From a psychological perspective this can be viewed as a highly beneficial stance; related to clients potentially regaining some element of control.

Sarah was able to benefit not only from the physical application of reflexology and the support of an empathic practitioner, but also from appropriate education regarding her body and its functions.  Sarah was able then to choose a meaning which resonated with her own experience, and act upon the information she gathered.

A different client may find a different meaning, and perhaps recognise that neck tension and pain presents the biggest challenge.  This client may require referral to a osteopath, chiropractor or masseur for more direct manipulation, to run alongside reflexology.  Another client may identify alcohol, or perhaps a toxic diet, compounded by medication, as potential contributing factors, and again can benefit from the choice to make changes.

Within my private practice my ethical responsibility requires I work with my clients best interests in mind.  As a professional reflexologist I choose to approach my work entirely holistically.  I provide the setting, intervention and appropriate relevant information for each individual client.  I engage therapeutically with the whole unique person.

That is mind, body, spirit.

References:

Lake, A. E. (2006), Medication Overuse Headache: Biobehavioral Issues and Solutions. Headache: The Journal of Head and Face Pain

Kaptchuk T, J. (2000), The Web That Has No Weaver. Chicago: Contemporary Books

The Migraine Trust.  www.migrainetrust.org

Traue, C. H,  Bretzke, J. L,  Pfingsten, M,  Hrabal, V. Chapter Four: Psychological Factors in Pain Management.  IASP

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6 thoughts on “Reflexology and the Whole Person – Chronic Headache/Migraine

  1. Very interesting, especially the idea of “owning” the disease condition rather than seeing it as separate, an intruder, unwelcome & not invited to stay, thank you very much; how lovingly you’ve given Sarah options along with tender care and utmost respect.

    Like

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