DEAR READER: I’m glad I could help. I will definitely provide an update as new developments unravel.

To provide related information, I am sending you a copy of my Health Report “Headaches.” 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 4409-20167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

After smoking for 15 years, I finally quit when my mother passed away from lung cancer. Almost immediately after quitting smoking, my migraines came back and were so bad that I couldn’t function. With three active children, this was not an option for me, so I started smoking again, and the headaches went away.

I am scared of what my future holds if I continue to smoke, and I truly want to quit. I went to my family doctor and a neurologist. I have tried several different medications, such as antidepressants, antiseizures and migraine-specific drugs, which didn’t work. I was on a blood-pressure medication briefly that worked well for the headaches, but after a while it caused my blood pressure to drop too much, and I ended up in the hospital being monitored.

I don’t know what the connection is with smoking and migraines, but I’m guessing it involves stress. Can you offer any suggestions on what to do so that my children don’t grow up without a mother? I don’t take any medicines except an occasional over-the-counter ibuprofen or naproxen for minor aches and pains.

DEAR READER: I am not aware of any connection between smoking and migraines. However, in your instance, this is clearly the case. I cannot recommend you continue smoking in order to control the headaches. I can, however, try to offer you some advice and recommendations that you may not have tried.

First, migraines are a type of headache that can be disabling when they occur. They typically cause severe one-sided head pain, may present with a visual aura (flashing lights, blind spots, etc.) and cause sensitivity to light and/or sound. Vomiting and nausea are also common symptoms. They can run in families, and those with a family history are at higher risk of developing migraines.

Each sufferer usually has specific triggers that, when a person is exposed to them, can result in a migraine. Triggers can include hunger, fatigue, hormonal changes, certain medications, stress, head trauma, changes in environment, sensory stimuli (such as bright lights or unusual smells) and certain foods, especially those with preservatives (nitrates), MSG or aged cheeses and wines.

If possible, retreat to a quiet, comfortable place at the first sign of a migraine. Turn off the lights, apply heat or ice to your head and neck, and gently massage the painful areas. For some, taking an aspirin or other OTC pain reliever with a caffeinated beverage such as a soda or coffee can boost the pain-relieving effects of the medication. Too much caffeine, however, may worsen the pain or lead to a withdrawal headache when the caffeine intake is stopped.

Typical prescription medications include antidepressants, antiseizure drugs and migraine-specific medications such as those you have tried. For some people, certain blood-pressure medications and other cardiovascular drugs may also be beneficial. However, because you have tried this without success, I recommend one of the following alternative treatments. Be sure that you have physician approval first because not all these treatments may be appropriate for your case.

Acupuncture may provide positive results, even though it is not routinely recommended because scientific studies have failed to show strong beneficial evidence. Because you have taken the conservative, modern-medicine route, now may be the time to try this ancient therapy.

Biofeedback is a relaxation technique that utilizes special equipment to monitor and control certain physical responses. By understanding the body’s response to certain stimuli such as tension, a person may be able to learn how to control and alter those responses.

The herbs feverfew and butterbur have shown some positive results in preventing or reducing the severity of migraines. High doses of vitamin B2 may also act as a preventive. Still others have had success with coenzyme Q10.

Finally, some migraine sufferers have had success with cervical manipulation; however, there is no scientific proof that chiropractic or spinal manipulation will help migraines. This treatment also carries the risk of arterial damage that may result in stroke or death. When performed by a qualified professional with experience, this is very rare.

I suggest you return to your primary-care physician or neurologist to discuss these options.

In the meantime, you should quit smoking. Substitute over-the-counter nicotine patches or gum to reduce the severity of your migraine symptoms during this stressful period.

To provide related information, I am sending you a copy of my Health Report “Headaches.” 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.

She is a very active 44-year-old who lives and works in an office as an attorney. She takes the Excedrin whenever she has her menstrual cycle which cures her of the accompanying headaches. Is there an alternative solution?

DEAR READER:
Acetaminophen and salicylates combine to relieve pain and reduce fever. Several reports have indicated the duo may cause kidney damage or cancer of the kidneys or bladder. The side effects can occur if large doses are taken for a very long time. Taken according to recommended dosing and for short periods, these unwanted side effects are unlikely.

If your daughter takes Excedrin Migraine once a month during her menstrual cycle, she may not be overdoing at all. However, if she has headaches on a regular basis and pops a pill or two regularly, that is another story.

Migraines appear, in part, to be caused by changes in serotonin levels in the brain and intestines. When levels are high, blood vessels shrink. When levels fall, blood vessels swell, causing pain and other problems. Reasons for variations in serotonin include estrogen and blood sugar levels and certain foods. MSG, soy sauce, aspartame, excessive caffeine and beverages that contain alcohol are common migraine triggers for some individuals.

Your daughter might consider keeping a journal to determine what precedes each migraine. Stress, food and family history will come in to play here. Other than her regular cycle, she might be able to avoid situations that trigger attacks. Once the culprit is identified, she might be able to avoid it and have fewer headaches.

Pure lavender oil or clove oil has been found effective. Place a drop or two of either oil on the ends of a wet washcloth. Place the cloth in the microwave for 15-20 seconds. Remove and wrap the cloth around your neck. Aromatherapy will lessen the tension, easing a headache.

Migralief is an over-the-counter drug available in most pharmacies. The riboflavin in the product will change the color of your urine to fluorescent yellow, but this causes no physical harm.

Alternative options are available. Try suggesting them to your daughter.

I was wondering if there is a possibility that the headaches were caused by head trauma? During a previous marriage my husband was abusive and beat my head against concrete. I was also in a car accident a few years later where my head went through the windshield. I was never tested with an MRI or CT scan following these injuries. I don’t recall if the headaches started after one of the events but I do know that they have been increasing in severity over time.

I am so tired of being in pain because of my headaches. Do you have any suggestions?

DEAR READER:
Chronic headaches can be very difficult to treat. Nearly all people experience a headache at some point in their lifetimes, often because of stress. There are some individuals, however, who have headaches on a regular basis for a variety of reasons or no reason at all. Migraine sufferers know all too well what it is like to feel perfectly fine and then all of a sudden have the beginnings of a headache which can escalate to a debilitating state rapidly.

There are several types of headaches including tension (caused by stress), cluster (caused by blood vessel abnormalities) and migraine (caused by abnormal levels of serotonin and blood vessel abnormalities). Migraines can cause blurred vision, stiff neck, lightheadedness, sensitivity to light or noise, and more. Tension headaches can cause neck and shoulder stiffness or soreness and head pain. Cluster headaches generally cause only head pain but occur in clusters over several days, weeks or even months. Because you do not say what symptoms you have other than pain, I cannot be sure what type of headache you have. However, you have been repeatedly diagnosed with migraines by several different doctors, so I must assume that the doctors are correct.

Because you have had headaches on a regular basis you should see a neurologist who can order thorough testing to include a CT scan or MRI of your brain to determine if your previous head trauma has caused permanent brain damage which may have led your headaches. If the testing is normal, the neurologist will also be up to date on the latest treatment options or if he or she feels the headaches are not coming from the brain, can refer to you an appropriate specialist.

In the meantime, you need to take steps to prevent the headaches as much as possible by reducing your amount of daily stress and relaxing whenever possible. Let me know what happens.

To give you related information, I am sending you a copy of my Health Report “Headaches”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092.