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.

A: To begin with, the regular use of niacin can be preceded by either diphenhydramine (Benadryl) or aspirin that will prevent the flushing aspect that is so difficult for patients to deal with. However, I strongly urge you to speak with your primary care physician before putting this into play because of an anti-coagulant issue that could present problems for some individuals.

Inositol hexanicotinate is used for a variety of conditions to include hypertension, insomnia, atherosclerosis, restless legs syndrome, poor circulation, Raynaud’s disease, high cholesterol levels, and more. It is a compound of niacin (vitamin B3) and inositol. This form of niacin is purported to reduce or prevent flushing, simply because it breaks down at a slower rate. Inositol hexanicotinate appears safe for most individuals, works to reduce cholesterol levels in some people but the results of tests are contradictory. It does not release the active form of niacin and can cause unwanted side effects in others, to include nausea, stomach upset, headache, hiccups, and indigestion. There appears to be some reports of possible liver damage in some patients and questions remain if it actually helps lower cholesterol levels.

Some patients are warned not to take the product if they have a history of kidney disorders, angina, diabetes, allergies, gout, hypotension, gallbladder disorders and more. The chronic use of inositol hexanicotinate might increase blood sugar levels and thus, decrease the effectiveness of diabetic medications. Therefore, individuals who choose to take it should have their sugar levels closely monitored. Further, it may also slow blood clotting so taking it with prescription medications to slow the clotting process could result in easy bruising and bleeding.

Because the product works to lower cholesterol levels in some individuals and not in others, I might opt for other methods to lower your readings such as a trial of the prescription Niaspan which is regulated and considered both safe and effective. Consider avoiding saturated fats in your daily diet. Substitute what you are using with olive or canola oil. Reduce your consumption of marbled or fatty beef and fill in with broiled fish or chicken. Fish is an excellent means of lowering cholesterol levels because of the omega 3 oils. Increase your dietary fiber by eating more whole grains, fresh fruits and vegetables. Sprinkle flax seed on your toast or cereal in the morning and nibble on walnuts or almonds when you get hungry. If these methods fail to work after a period of time, ask your physician what he or she would recommend as a natural remedy first prior to getting into a prescription medication.

Readers who would like related information can order Dr. Gott’s Health Report “Cholesterol” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention thew title or print an order form from www.AskDrGottMD.com.

I have been to the emergency room no less than four times with chest burning and the doctors there can’t seem to give me an answer. Being a veteran, I have been to VA doctors several times to no avail. I’ve been to a gastroenterologist, physical therapist and a back doctor. Each one I see refers me to someone else. The tests I have had done should have revealed something by now. I have had a stress test, MRI, CT scan, several EKGs, X-rays, a colonoscopy, upper endoscopy and they even sent me to a mental doctor at the VA. I had seven sessions of blood work.

On a daily basis I take Metoprolol tartrate, Levothyroxine, Lisinopril, Simvastatin and hydrochlorthiazide. I’m really getting concerned about all of this. I am a retired 62-year-old male. Other than all the issues I’m having, I seem to be pretty healthy and everyone I have visited doesn’t seem to be concerned.

A: Initially, I’m going to take the easy way out on your symptoms and indicate they may all or in part be directly related to the medications you are taking. For example, while all of the drugs you have been prescribed are well-tolerated by most individuals, Metoprolol can cause chest pain, nausea and headaches. Levothyroxine is associated with headaches, fever and hot flashes. Lisinopril can cause headaches, tingling and fever. Simvastatin can cause muscle pain, nausea and fever. Lastly, hydrochlorothiazide can cause nausea and numbness. I cannot indicate which may be the culprit and, indeed, two or more could cause adverse side effects when taken together. The only way to determine this is with the assistance of the prescribing physician(s) who may be able – based on your medical history – to temporarily or permanently discontinue one at a time to see if any of your symptoms disappear or become less intense. If there is no change with the first (or any medication you currently take), for example, it can either be substituted for another drug in its class or begun with the second being temporarily or permanently discontinued, and so on. Not every drug will affect every person in the same way. We are all different and drug reactions will vary.

Gastroesophageal reflux disease (GERD), cardiac issues, irritable bowel syndrome and other issues appear to have been ruled out; however, has your doctor considered food allergies, kidney stones, Crohn’s disease, ulcers, or gallbladder disease? The latter commonly occurs just after a meal and can present with nausea, vomiting, abdominal or back pain. Perhaps a pheochromocytoma (a rare adrenal gland tumor) or carcinoid syndrome (due to carcinoid tumors) is to blame?

You have already had numerous tests which should have detected abnormalities, but didn’t. As a result, I recommend you request a second opinion from a top notch diagnostician who can categorize your many symptoms and hone in on the most likely causes. Take a copy of your lab work and testing results for his or her review. If deemed necessary, you may have to repeat some of the testing that has already been done.

I am unaware of your insurance coverage, based on the fact that you have been seen by the VA. If you end up back at your nearest VA facility, bring them a copy of my response and ask if you can be seen by someone who can sort things out and get you back on track. Good luck.

Readers who would like related information can request Dr. Gott’s Health Report “Medical Specialists” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Peter H. Gott, M.D. Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

Recently, I consulted with my primary-care physician regarding flushing and the redness on my cheeks and nose. I was diagnosed with rosacea and prescribed metronidazole gel to be applied twice a day. I was advised that it would only help reduce the redness and not the pain. However, after three days of using the gel, my facial pain was reduced by half and after 10 days, it was all but gone. I missed using it one day, and the pain returned. Just a couple of days after restarting, the pain went away again.

Because I haven’t made any other changes, I believe the gel is responsible but don’t know why since my doctor clearly stated that it was not a pain reliever. Can you tell me why this happened?

DEAR READER: Rosacea is a disorder of the skin that causes redness, inflammation, swelling, small pus-filled bumps and a host of other symptoms. It most commonly occurs on the face, but may develop on other areas of the body.

According to the National Rosacea Society, many sufferers report burning, stinging, itching or a feeling of tightness across the affected areas. I could not find documentation of facial pain or pressure as known symptoms. However, this is not to say that it is unrelated because inflammation and swelling can cause pain.
It is my theory that your facial pain was probably due to inflammation caused by the rosacea and by using the metronidazole gel, you effectively reduced or eliminated this source of the pain.

Because you do not mention having seen a dermatologist, I recommend that you make an appointment with one to confirm the diagnosis and undergo regular monitoring. Rosacea rarely gets better on its own and often worsens over time if not treated. While I do not doubt your primary-care physician’s diagnosis, I do believe you should get a second opinion from a specialist to ensure that you do, in fact, have rosacea and are being correctly treated. He or she will also be able to offer other treatment suggestions and helpful home-care tips.

In the meantime, stick with the prescription gel. You should also be gentle when washing your face and avoid or sparingly use lotions, creams and cosmetics because they may aggravate your symptoms. Avoid touching your face. Use sunscreen and oil-free moisturizers and cosmetics once the topical medication has dried. Extreme temperature changes, alcohol, sun exposure, stress and spicy foods may trigger symptoms.

To provide related information, I am sending you a copy of my Health Report “Dermatitis, Eczema and Psoriasis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.