Q: I’ve never written to ask for help before but I have used several of your suggestions and got good results. My husband is 90 years old. I’m 95. He used to have horrible migraines on the left side of his face but they aren’t as bad as they used to be. But,on the same side of his face he now has heat and has to use a small fan to keep his face cool. Any help will be greatly appreciated. He also has vertigo and we don’t get help from the doctors here.

A: Migraines can cause extreme pain for hours or days without relief. Some are preceded by an aura or warning sign such as tingling of an extremity, light flashes, blind spots, or a particular smell. They can be preceded by irritability, a stiff neck, depression, constipation or diarrhea and even a craving for a specific food. Once an attack occurs, the individual may suffer from blurred vision, pain on one side of the head, light-headedness, and light sensitivity.

Triggers may include specific foods such as MSG, beer, chocolate, aged cheeses, and more. Then there’s the bright lights, stress, specific medications, pending menstruation in women and weather pattern changes. Sadly, an appreciable amount of time and number of migraines can occur prior to a person recognizing what triggers an attack and takes steps to avoid the occurrence.

Diagnosis is commonly made by a physician taking a medical history, physical examination, or specific X-rays to include a CT or MRI. Treatment is provided in the form of pain-relieving drugs when a migraine is in process or daily preventive drugs to hopefully reduce the intensity and frequency. There are numerous methods of treatment, to include a combination acetaminophen, caffeine and aspirin, triptans such as Imitrex, Zomig, Maxalt and others, an ergotamine and caffeine combination, Botox, opiates, over-the-counters such as feverfew, butterbur, and others.

Without knowing what, if anything, your husband is on for migraine-control, I cannot determine if that remedy may be causing the “heat” on the side of his face. Thinking beyond that, other possibilities that comes to mind include a thyroid abnormality (typically not unilateral); Frey’s syndrome, a rare neurological disorder characterized by redness or sweating on one side of the face when specific foods are consumed or literally salivated over; Horner syndrome caused by damage to the sympathetic nerves of the face includes a drooping eyelid but would unlikely be intermittent; or even Harlequin syndrome caused by neurovascular compression of the sympathetic chain characterized by sweating and flushing on one side of the face, chest and neck;

I don’t know how debilitating or downright annoying your husband’s facial heat is but it appears neurological in nature. Therefore, I recommend you visit a neurologist who might be able to shed some light on the subject. If you don’t currently have a neurologist, ask your primary care physician or local hospital for a referral. You might even keep a log between now and his appointment to determine if one stable thread precedes each episodes. For example, does he drink a specific cup of herbal tea, use a moisturizing lotion, or use an after-shave product? By all means, bring a list of his medications so the specialist can determine if facial flushing is the unwanted side effect culprit.

Because I mentioned a thyroid abnormality as one possible cause, other readers who are interested in learning more can order Dr. Gott’s Health Report “Thyroid Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.