To Your Health: Relief from migraines often follows menopause

Q: My daughter is 53 and has suffered terribly with migraines since she was 16. She experiences the episodes anywhere from once a week to three times a week.

She is on Zomig. If she takes the medication at the onset of a migraine, it reduces the pain and duration effectively, but the frequency hasn’t improved. She is aware of the Zomig side effects, including strokes, but, because she is incapacitated for days with each episode, she is willing to take the risk.

Do the episodes typically get better or worse at menopause?

A: Migraine headaches are common, affecting 17 percent of women and 6 percent of men. Nobody knows why migraines occur.

Two types of treatment are available.

Acute treatment, the type that your daughter is getting, is designed to stop a migraine when it occurs. As you point out, the faster the medicine is given, the more likely it is to work.

Zomig (zolmitriptan) works on serotonin receptors in the brain, and it is one of the most effective drugs at stopping a migraine. Strokes have been reported with such medications; however, the increase in stroke risk is low or none.

Still, such medicines probably shouldn’t be given to people with a history of strokes.

People who still have significant symptoms despite acute treatment should be treated with preventive therapy, which most often involves medication but also includes supplements and acupuncture. Many classes of medications — including blood-pressure medicines, anti-epilepsy medicines and antidepressants — are effective.

It seems as if your daughter needs preventive treatment.

Migraines can worsen temporarily around menopause, but most women find that migraines are milder, often dramatically so, after menopause (which is a process, not an event).

Q: A dear friend of mine has polymyalgia rheumatica and is being treated with prednisone. Can you tell me about the illness?

A: Polymyalgia rheumatica is a common illness, almost always found in people older than 50. It causes pain and stiffness, especially in the arms and shoulders, and especially in the morning. It responds well to low to moderate doses (10 to 20 milligrams) of prednisone. The prednisone is usually continued for one to two years.

The illness is often associated with a more serious condition — temporal (or giant cell) arteritis. Any symptoms of vision loss need to be evaluated immediately because permanent blindness can result.

Q: I am a 70-year-old man. I take enalapril, hydrochlorothiazide, clopidogrel, oxybutynin, Zocor and Aleve every day. I don’t produce any semen. Is that because of my age or because of a medication?

A: Unfortunately, many causes are possible. Of the medications you mentioned, oxybutynin is the most likely cause.

It would be worthwhile to have a urologist evaluate a possible medical cause.
