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A Study of the Effects of Reflexology on Migraine Headaches
By Gail W. Testa
History & Background of Reflexology
Chapter 1 – Nature of the Problem
History of Migraine Headaches
Description of the Problem
Costs of the Problem
Traditional Treatment
Chapter 2 – Literature Review
JAMA Reports
Vitamin Therapy Reports
Reflexology Therapy Reports
Chapter 3 – Methodology
Chapter 4 – Results
Research Questionnaire Data
Chapter 5 – Implications and Recommendations
Sample Questionnaire
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 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.)
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.
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?
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:
Frequency of headaches?
How long do they usually last?
Any medications taken (prescribed or over-the-counter).
Number of workdays missed due to a headache.
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:
How often do you have reflexology?
Have you been able to reduce or eliminate your need for medication?
Have you found the same triggers affect you in the same way?
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.
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.
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
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
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
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 ½ hr Amerge
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
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.
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.
(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, Acupressure's 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.


text:
Hollywood Movie to be Shot in Georgia
Artists Recreate Georgian Medival Poem Knight in the Panther's Skin as a Comic Book
Unprecedented warranty offer from HUAWEI
Georgian Opera Singers Feature in Woody Allen Play
Alexandre Zazarashvili Wins The Voice Kids of Ukraine
Art of Brush Writing – Sighnaghi Hosts Japanese Artist's Exhibition Echo
BBC World Service Records in Tbilisi
Picnic Festival with Band Soft Eject
Georgian Cinematographer Becomes Member of American Film Academy
Georgian Wine Presented in US Cities
The Hollywood Reporter: Advantages to Filming in Georgia
BERLIN - The Hollywood Reporter has published an article about the progress of Georgian film production in the last few years.
The Film office and other representatives of several countries were in Berlin over the past week to tout their new production incentives at the European Film Market amid the increasing competition for Hollywood and other international shoots.
Foreign film makers are being encouraged to use the unique Georgian landscape and architecture to shoot their films.
THR reported that Georgia was the first former Soviet republic outside the Baltic area to develop an incentive scheme. Last year it announced plans for a 20% plus cash rebate and has been promoting its "Film in Georgia" initiative in Berlin.
Film in Georgia formally launched last month and currently an additional 5% on top of the standard rebate is available for those films that signal that they have been shot in Georgia, for example by showing the flag or well-known buildings.
The Georgian Film Commission's David Vashadze told THR that there is a request that any films shot in Georgia should cast the country in a positive light.
"The application process is fully online and you can apply with a script and a treatment. Funds are released within 90 days of presenting audited accounts of in-country spend," he said.
Georgia also offers architecture that reflects a jumble of European Asian and Soviet style and has landscapes ranging from snow-covered mountains to desert and seaside within a few hours' drive of each other.
According to THR, the scheme has already attracted two projects – a Bollywood movie and a pilot designed to appeal to a US network show.
Photo: Giorgi Mrevlishvili

redpajama_set_name: RedPajamaCommonCrawl


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Travel and tours company-Globetrotter Agency Limited has become the second firm to join the Nairobi Security Exchange (NSE)'s incubation and acceleration programme, as it targets to list on the East Africa leading bourse.
Dubbed 'Ibuka', which is a Swahili translation for 'emerging', the programme seeks to unlock the potential of small and medium sized companies.
The programme intends to enhance the firms' financial, technical, operational, commercial and strategic aspects of their businesses.
It also enables companies to raise capital through debt and equity market as they track valuation as well as produce specialized documents such as capital raising and equity raising reports.
The admission comes following a rigorous evaluation and vetting process that resulted in Globetrotter becoming the second among a group of enterprises expected to join the program.
Globetrotter is a leading travel and tours Company with enhanced domestic and international travel solutions. Established in 2015, Globetrotter offers a wide variety of services including Medical Tourism, Airline and Hotel Reservations to tourist from various markets across the globe.
Mombasa based tea exporter APT Commodities Limited became the first to be admitted on the programme, having joined on January 31.
"This enrollment is a key milestone for Globetrotter and underscores the company's potential for growth as companies on the program are evaluated by a team of highly qualified consultants and financial advisors with high levels of experience in capital markets," said NSE CEO Geoffrey Odundo.
According to Odundo, Ibuka is aimed at growing visibility whilst enhancing brand recognition and business opportunities among hostee companies.
Additionally, the program will assist companies improve a variety of spheres of their business including corporate governance, strategy formulation and business modelling while educating them on the various opportunities in the capital markets and preparing them for their next phase of growth.
Globetrotter Agency Limited was established in 2015. It acts as a link between the client and the tourism sector by identifying the tourist destination fitting the client's budget, schedule and expectation in terms of availability, reliability, transport and other hospitality services.
Its main destinations include Kenya, Rwanda, Seychelles, South Africa, Tanzania and Uganda.
The management says the company is keen to go public to gain more visibility for faster growth, while raising capital for expansion of the family-owned business.
The NSE is the principal securities exchange of Kenya. Besides equity securities, the NSE offers a platform for the issuance and trading of debt securities.
It is a member of the African Securities Exchanges Association (ASEA) and the East African Securities Exchanges Association (EASEA).
It is also a full member of the Association of Futures Markets (AFM) and the World Federation of Exchanges (WFE), and a partner Exchange in the United Nations Sustainable Stock Exchanges Initiative (SSE).


Last December, when the Defence White Paper was published, I wrote to you to explain how we were developing the future structure of the RAF. That work is now largely complete. As you read this Briefing Note, the Secretary of State for Defence will have made his announcement to Parliament about the outcome of the 2004 Spending Review and the changes necessary in Defence to give effect to the broad policy set out in the White Paper. These follow a hard look across the board at all three Services and the civilian element of the Department to see how we need to adapt if we are to meet the various challenges ahead of us. We in the RAF have been planning and pursuing many of the changes for some time. These will make us a more effective fighting Service. Others, inevitably, are driven by the hard realities of an increased but finite budget that faces continued pressure from rising costs. I, my colleagues on the Defence Management Board, and the Commanders-in-Chief have been fully engaged in this work, and our aim throughout has been to secure the best overall outcome for Defence in general and, within that the RAF. Unsurprisingly, the result is not good news in every area, but I believe that we have an agreed programme that will underpin our ability to win in the future. We now need to give it effect.
You already know the broad thrust of my intent: an agile, adaptable Air Force based on good people trained to the highest standards, and on modern multi-role aircraft and systems that can exploit Network Enabled Capability to achieve the desired effect swiftly. In all of this we must focus on overall capability, not just on numbers of systems or people. During Operation Telic a much smaller RAF employed only about 70% of the number of fast jets used in Operation Granby, but to much greater overall effect. We need to maintain this trend of increasing capability.
To do this we are of course introducing new systems such as Typhoon and Joint Combat Aircraft; we will continue to invest in collective and individual training; and we will seek to enhance the standing of and support for our people. But such a programme does not come cheaply, and we have had to make some very hard decisions about priorities.
Our task is to provide the key air power element of the UK's military capability. So the size and shape of the RAF depends on the scale and nature of the forces we need to commit to operations. The increasing capabilities of our individual systems and our growing ability to switch them from one role to another as the situation demands mean that we are able to reduce the size of the overall deployed force. This will provide us with the necessary resilience to meet the demands of the more likely multiple concurrent and enduring small and medium scale operations. But at the upper end of the scale, we will have the capacity to deploy a force larger than that which we contributed to Operation Telic, and which, platform for platform, will be increasingly more capable. The changes that we are making to our day-to-day structure are all consistent with delivering this level of air power on operations.
Your commanders will brief you on the changes that impact on your unit, but I would highlight a few of the key decisions. We will bring forward the retirement of the Jaguar fleet by some 2 years to 2007. We will reduce the number of Nimrod MR2 aircraft from 21 to 16, reflecting a lower submarine threat to the UK at least, but acknowledging the Nimrod force's wider capabilities. The requirement could in future be met by around 12 of the more capable Nimrod MRA4 although much work will be required with industry before a decision is reached. We will disband one F3 squadron early, reflecting a slightly reduced need for deployed air defence capability. The Department has also concluded that we can reduce our investment in Ground Based Air Defence, and as a consequence we will be phasing out the RAF's Rapier squadrons over the next few years (and at the same time halving the number of High Velocity Missiles in the Army).
We have long planned to reduce our overall requirement for manpower. Through existing equipment modernisation programmes, HQ and estate rationalisation, and initiatives such as End-to-End logistics and the Joint Personnel Administration System, we have sought to maintain or improve our capability with fewer uniformed people. These developments, together with the force structure changes I have already outlined, mean that we can reduce our trained strength from its current level of around 48,500 to around 41,000 by 1 April 2008. We will, though, continue to address the pinch point trades that currently have insufficient numbers to meet deployment commitments. We have already started planning the reductions. Indeed, we have reduced our intake over the last 6 months in anticipation of these changes. But to maintain the required balance of skills and experience across the rank structure, and to secure good promotion prospects into the future - a key requirement - we will need a targeted redundancy scheme. The details, once agreed with Ministers and the Treasury, will be announced towards the end of the year.
Looking to the future, our major equipment and personnel programmes remain in place. We are fully committed to Typhoon and JCA. They will provide a true multi-role capability, and along with the Tornado GR4 and Harrier GR9 will form the core of our future air combat force. In parallel, we will network our combat systems, commanders and surveillance assets, such as ASTOR and MRA4, to bring about the level of accuracy and speed of response we need. But no matter how good our systems, our Servicemen and women and the civilians who support us will remain the key to our capability. We will continue to need high quality people capable of meeting the demands of an uncertain future and of driving the necessary changes. People remain my top priority, and we need to do better at providing appropriate infrastructure and accommodation for them. We will never succeed in this if we continue to spread ourselves over an unnecessarily high number of bases. So we intend to move towards fewer larger and better-equipped main bases. We intend to announce details of the associated rationalisations in 2005.
A variety of other changes that will affect the RAF are detailed in the briefing note that accompanies this message. There are, of course, many other measures that affect our sister Services and the civilian strength of the Ministry of Defence. Taken together, they will allow us all to move forward within the Defence budget announced by the Chancellor of the Exchequer on 12 July.
The RAF has a proud tradition and an enviable record of operational success. We will not compromise these. But while the past remains an inspiration and guide to us, we must look forward. Because of, rather than despite, the hard choices we have had to make, we have a programme that will improve our ability to meet the challenges of the future and to sustain a Royal Air Force that continues to offer rewarding careers.


One bedroom, one bathroom apartments at Summerfield Gardens. Upstairs and downstairs units available. Includes water and sewer with rent for $350/month. Pets over age two welcome with fee. Section 8 approved.


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class CosineCoverage : public UnaryMathRasterAndNumber
{
public:
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class TangentCoverage : public UnaryMathRasterAndNumber
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class ArcsineCoverage : public UnaryMathRasterAndNumber
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public:
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class ArccosineCoverage : public UnaryMathRasterAndNumber
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public:
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public:
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public:
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public:
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public:
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public:
    AbsCoverage() {}
    AbsCoverage(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(AbsCoverage);
};

class CeilCoverage : public UnaryMathRasterAndNumber
{
public:
    CeilCoverage() {}
    CeilCoverage(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(CeilCoverage);
};

class FloorCoverage : public UnaryMathRasterAndNumber
{
public:
    FloorCoverage() {}
    FloorCoverage(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(FloorCoverage);
};

class SignCoverage : public UnaryMathRasterAndNumber
{
public:
    SignCoverage() {}
    SignCoverage(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(SignCoverage);
};

class CosineHCoverage : public UnaryMathRasterAndNumber
{
public:
    CosineHCoverage() {}
    CosineHCoverage(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(CosineHCoverage);
};

class SineHCoverage : public UnaryMathRasterAndNumber
{
public:
    SineHCoverage() {}
    SineHCoverage(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(SineHCoverage);
};

class SineTable : public UnaryMathTable
{
public:
    SineTable() {}
    SineTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(SineTable);
};

class CosineTable : public UnaryMathTable
{
public:
    CosineTable() {}
    CosineTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(CosineTable);
};

class TangentTable : public UnaryMathTable
{
public:
    TangentTable() {}
    TangentTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(TangentTable);
};

class ArcsineTable : public UnaryMathTable
{
public:
    ArcsineTable() {}
    ArcsineTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(ArcsineTable);
};

class ArccosineTable : public UnaryMathTable
{
public:
    ArccosineTable() {}
    ArccosineTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(ArccosineTable);
};

class ArcTangentTable : public UnaryMathTable
{
public:
    ArcTangentTable() {}
    ArcTangentTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(ArcTangentTable);
};

class Log10Table : public UnaryMathTable
{
public:
    Log10Table() {}
    Log10Table(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(Log10Table);
};

class SqrtTable : public UnaryMathTable
{
public:
    SqrtTable() {}
    SqrtTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(SqrtTable);
};

class NaturalLogarithmTable : public UnaryMathTable
{
public:
    NaturalLogarithmTable() {}
    NaturalLogarithmTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(NaturalLogarithmTable);
};

class AbsTable : public UnaryMathTable
{
public:
    AbsTable() {}
    AbsTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(AbsTable);
};

class CeilTable : public UnaryMathTable
{
public:
    CeilTable() {}
    CeilTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(CeilTable);
};

class FloorTable : public UnaryMathTable
{
public:
    FloorTable() {}
    FloorTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(FloorTable);
};

class SignTable : public UnaryMathTable
{
public:
    SignTable() {}
    SignTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(SignTable);
};

class CosineHTable : public UnaryMathTable
{
public:
    CosineHTable() {}
    CosineHTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(CosineHTable);
};

class SineHTable : public UnaryMathTable
{
public:
    SineHTable() {}
    SineHTable(quint64 metaid, const Ilwis::OperationExpression &expr);
    static Ilwis::OperationImplementation *create(quint64 metaid,const Ilwis::OperationExpression& expr);
    static quint64 createMetadata();

    NEW_OPERATION(SineHTable);
};
}
}

#endif // UnaryMathTableOPERATIONS_H

redpajama_set_name: RedPajamaGithub


text:
Q: ssh fails to start due to missing host keys While trying to start an ssh server daemon I get an error about missing hostkeys, however, looking at /etc/ssh I see the host keys are there and I believe the permissions are correct.
This is with OpenSSH 8.3p1 on an embedded Linux system.
Any ideas on what is wrong with my OpenSSH configuration?
~> ls -l /etc/ssh
total 529
-rw-r--r--    1 root     root        525809 Mar 30 15:16 moduli
-rw-r--r--    1 root     root          1484 Mar 30 15:16 ssh_config
-rw-------    1 root     root          1369 Mar 30 19:02 ssh_host_dsa_key
-rw-r--r--    1 root     root           600 Mar 30 19:02 ssh_host_dsa_key.pub
-rw-------    1 root     root           505 Mar 30 19:02 ssh_host_ecdsa_key
-rw-r--r--    1 root     root           172 Mar 30 19:02 ssh_host_ecdsa_key.pub
-rw-------    1 root     root           399 Mar 30 19:02 ssh_host_ed25519_key
-rw-r--r--    1 root     root            92 Mar 30 19:02 ssh_host_ed25519_key.pub
-rw-------    1 root     root          2590 Mar 30 19:02 ssh_host_rsa_key
-rw-r--r--    1 root     root           564 Mar 30 19:02 ssh_host_rsa_key.pub
-rw-r--r--    1 root     root          2333 Mar 30 17:29 sshd_config
~> systemctl status sshd
● sshd.service - OpenSSH server daemon
     Loaded: loaded (/usr/lib/systemd/system/sshd.service; enabled; vendor preset: enabled)
     Active: failed (Result: exit-code) since Tue 2021-03-30 19:02:43 UTC; 8s ago
    Process: 338 ExecStartPre=/usr/bin/ssh-keygen -A (code=exited, status=0/SUCCESS)
    Process: 465 ExecStart=/usr/sbin/sshd -D -e (code=exited, status=1/FAILURE)
   Main PID: 465 (code=exited, status=1/FAILURE)

Mar 30 19:02:41 cm1sd ssh-keygen[338]: ssh-keygen: generating new host keys: RSA DSA ECDSA ED25519
Mar 30 19:02:41 cm1sd systemd[1]: Started OpenSSH server daemon.
Mar 30 19:02:43 cm1sd sshd[465]: sshd: no hostkeys available -- exiting.
Mar 30 19:02:43 cm1sd systemd[1]: sshd.service: Main process exited, code=exited, status=1/FAILURE
Mar 30 19:02:43 cm1sd systemd[1]: sshd.service: Failed with result 'exit-code'.

Edit:
The config does include the HostKey
HostKey /etc/ssh/ssh_host_rsa_key

Edit 2:
I've updated to OpenSSH 8.5p1 and ran with debugging enabled and get some additional info:
~> sshd -D -e -ddd
debug2: load_server_config: filename /etc/ssh/sshd_config
debug2: load_server_config: done config len = 374
debug2: parse_server_config_depth: config /etc/ssh/sshd_config len 374
debug3: /etc/ssh/sshd_config:14 setting Port 10505
debug3: /etc/ssh/sshd_config:19 setting HostKey /etc/ssh/ssh_host_rsa_key
debug3: /etc/ssh/sshd_config:35 setting MaxAuthTries 6
debug3: /etc/ssh/sshd_config:36 setting MaxSessions 2
debug3: /etc/ssh/sshd_config:38 setting PubkeyAuthentication yes
debug3: /etc/ssh/sshd_config:42 setting AuthorizedKeysFile .ssh/authorized_keys
debug3: /etc/ssh/sshd_config:55 setting IgnoreRhosts yes
debug3: /etc/ssh/sshd_config:58 setting PasswordAuthentication no
debug3: /etc/ssh/sshd_config:59 setting PermitEmptyPasswords no
debug3: /etc/ssh/sshd_config:67 setting X11Forwarding no
debug3: /etc/ssh/sshd_config:89 setting Subsystem sftp  /usr/libexec/sftp-server
debug1: sshd version OpenSSH_8.5, OpenSSL 1.1.1k  25 Mar 2021
Unable to load host key "/etc/ssh/ssh_host_rsa_key": error in libcrypto
Unable to load host key: /etc/ssh/ssh_host_rsa_key
sshd: no hostkeys available -- exiting.

Looks like the issue is with OpenSSL's libcrypto. I have OpenSSL version 1.1.1k installed.

A: On WSL, this worked:
sudo ssh-keygen -A
sudo service ssh --full-restart

redpajama_set_name: RedPajamaStackExchange


text:
Imperial Ends
The Decay, Collapse, and Revival of Empires
Alexander J. Motyl
Despite their historical importance, empires have received scant attention from social scientists. Now, Alexander J. Motyl examines the structure, dynamics, and continuing relevance of empire—and asks, "Why do empires decline? Why do some empires collapse? And why do some collapsed empires revive?"
Rejecting choice-centered theories of imperial decline, Motyl maintains that the very structure of empires promotes decay and that decay in turn facilitates the progressive loss of territory. Although most major empires have in fact declined in this manner, some, such as the Soviet Union, have collapsed suddenly and comprehensively. Motyl explains how and why collapse occurs, why such an outcome is hard to foresee, and why some collapsed empires revive. While broad-ranging historically and empirically, Imperial Ends focuses on five modern empires: the Soviet, Romanov, Ottoman, Habsburg, and Wilhelmine.
Examining the possibility of a revival of the Soviet empire, Motyl points out that the expansion of NATO and the European Union, along with increasing globalization, will isolate Russia and its neighbors, promoting their dependence upon one another and perhaps facilitating the rise of the former core.
With boldly stated conclusions and concise analytical interpretations, Imperial Ends cohesively illustrates to policymakers and social scientists alike the importance of possible imperial revivals and the rise of future empires.
Offers a refreshingly explicit explaination of his preferences. Journal of Early Modern History
Introduction: Finding Empire
Imperial Beginnings
Imperial Decay
Imperial Collapse
Imperial Revival
Conclusion: Losing Empire
Alexander J. Motyl is associate professor of political science at Rutgers University, Newark, where he also serves as Deputy Director of the Center for Global Change and Governance. The editor-in-chief of the Encyclopedia of Nationalism, he is also the author of Revolutions, Nations, Empires (Columbia, 1999); Post-Soviet Nations (Columbia, 1995); Thinking Theoretically About Soviet Nationalities (Columbia, 1995); and Sovietology, Rationality, Nationality (Columbia 1990)..
Philosophy: Political Theory
Political Science: Political Theory