The purpose of this study was to explore the physical and psychosocial effects of migraines on female adults and their experience of chiropractic treatment in the management of pain. The objectives of this study were to explore the physical symptoms with which female patients with migraines presented, to understand how migraines affected female adults psychologically and socially, to understand how chiropractic treatment enabled their management of migraines, and to explore which other complementary and alternative treatments were used by patients for their migraines. This study used a qualitative descriptive design which explored the experiences of female chiropractic patients, between the ages of 18-65 who presented to chiropractic practices for migraine treatment in eThekwini, KwaZulu-Natal. Purposive, convenience and snowball sampling were used to recruit participants for this study. The data was collected through 12 semi-structured interviews and subsequently analysed using thematic analysis. From the study, six main themes emerged. Theme one focused on the physical effects of migraines. The sub-themes that emerged were the symptoms of migraines, and the impact on physical functioning and daily life. Theme two related to the psychological and cognitive effects experienced by the participants. The sub-themes that emerged were depression, anxiety, feelings of hopelessness and withdrawal, fear-avoidance behaviour and lifestyle changes, and acceptance of migraines. Theme three focused on the effects migraines had on relationships. The subthemes that emerged were the impact on family and social networks, which included both strained and supportive relationships, and the impact on work life. Theme four explored the factors that contributed to migraines. The sub-themes that emerged were hormonal factors, oral contraceptives, dietary factors, weatherrelated factors and lighting, musculoskeletal factors, and sleep deprivation. Theme five focused on chiropractic treatment for migraines. The sub-themes that emerged were the experiences of chiropractic treatment for migraine pain management, and perceptions of chiropractic treatment approaches to migraine management. Theme six discussed the self-management of migraines. The sub-themes that emerged were resistance to medication, factors that alleviated migraines and alternative therapies. This is one of the first qualitative studies in South Africa to highlight the severe burden of this disease and the psychosocial impact of migraines on female chiropractic patients. Chiropractic treatment improved the quality of life, and reduced the duration, severity and frequency of migraines, and the need for pharmacological therapy. All participants had favourable experiences with chiropractors for migraine management, with some patients expressing that chiropractic treatment was the only effective treatment for their migraines. This was despite their experience with different alternative therapies. Furthermore, alternative and holistic therapies were sought wherever possible as an alternative to pharmacological therapy. This study builds on the body of knowledge for migraine management and supports the use of chiropractic treatment for migraine management. Future studies should include more qualitative research studies on the psychosocial impact of migraines amongst the female population. The impact of menstruation, pregnancy and menopause on migraines should be further investigated in other qualitative studies. A more detailed study should be undertaken to ascertain the impact and efficacy of chiropractic treatment for migraines.

Background Migraines are one of the leading causes of disability globally and in South Africa. There is a paucity of local empirical literature regarding the psychosocial impact of migraines on women. Although there are a variety of treatment approaches, many women prefer alternative and holistic treatment for their migraines. Aim The aim of this study was to explore the psychosocial impact of migraines on women and their use of complementary and alternative therapies for migraine pain management. Setting The study was conducted in the eThekwini region of KwaZulu-Natal, South Africa. Methods The study adopted a qualitative descriptive design. Purposive sampling was used to recruit participants for the study. Data were collected through 12 semi-structured interviews and subsequently analysed using thematic analysis. Results Theme 1 related to the psychological and cognitive effects experienced by the participants. Theme 2 focused on the effects migraines had on personal, family and social relationships. Theme 3 discussed the self-management of migraines. Conclusion The pertinent psychological effects of migraines were depression, anxiety, feelings of hopelessness and withdrawal, fear-avoidance behaviour, lifestyle changes, and acceptance of migraines. The participants experienced a lack of understanding about their migraine severity from co-workers, family and social networks. The alternative therapies that were sought to alleviate migraine symptoms included chiropractic, massage, meditation, reflexology, yoga, cupping and acupuncture. Contribution The awareness of the effectiveness of complementary and alternative therapies for women may be beneficial for healthcare providers seeking a multidisciplinary approach to migraine management.

Peer review declarationThe publisher (AOSIS) endorses the South African 'National Scholarly Book Publishers Forum Best Practice for Peer Review of Scholarly Books'. The manuscript underwent an evaluation to compare the level of originality with other published works and was subjected to rigorous two-step peer review before publication, with the identities of the reviewers not revealed to the editor(s) or author(s). The reviewers were independent of the publisher, editor(s), and author(s). The publisher shared feedback on the similarity report and the reviewers' inputs with the manuscript's editor(s) or author(s) to improve the manuscript. Where the reviewers recommended revision and improvements, the editor(s) or author(s) responded adequately to such recommendations. The reviewers commented positively on the scholarly merits of the manuscript and recommended that the book be published.