Q: My daughter is 53 and has suffered terribly with migraines since she was 16. She experiences these episodes from one to three times per week. She is taking on Zomig. If she takes the medication at the onset, it reduces the pain and duration quite effectively, but it does nothing to reduce frequency. She is aware of the side effects, including stroke, but since she is incapacitated for days per episode, she is willing to take the risk. Is there any research on why she suffers so badly? Do these episodes typically get better or worse at menopause?


There are two separate types of treatment for migraines.

Acute treatment, the kind your daughter is getting, is designed to stop a migraine once it occurs. As you point out, the faster the medicine is taken, 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 migraine.


People who still have significant symptoms despite acute treatment should be treated with preventive therapy. This is often medication but also can include supplements, acupuncture and other treatments.


It sounds to me like your daughter needs preventive treatment.

Migraines can worsen temporarily around menopause, but most women find that the migraines are better, often dramatically better, after menopause — which is a process, not an event.

Q: For many years, I have had episodes in which I am shocked, like an electric shock. It wakes me from sleep. I jump out of bed, then my legs and feet tremble rapidly, and I need to sit down or I will fall. I have been diagnosed as having “night terrors,” but it is not that. I had a normal MRI. These shocking episodes used to happen twice a week, then dwindled to monthly. Lately, I have it pretty much under control. Is there a diagnosis for me.

A: I think you are having a severe case of nocturnal myoclonus, a fancy name for muscle jerks at nighttime. These are very common and usually are normal, but are sometimes associated with epilepsy. Since yours aren’t getting worse over time and you haven’t had seizures, you are almost certain to have the “physiologic” type. Occasionally, there is a family history. I don’t think you will need any treatment.

Q: My mother was diagnosed with Alzheimer’s disease in 2009, and she is taking Namenda and Aricept to help slow its advancement. She complains of being cold all the time. She and my father keep the temperature in their house at 80 degrees, and my mother wears winter clothes, a coat and a blanket in the house. She sometimes sweats through the clothes, but we can’t persuade her to remove any layers. The house is uncomfortably hot for anyone else, and yet she says she is cold. Her general practitioner has said that this is part of her disease. Is there anything else that could explain this?

A: I have seen a lot of people with dementia of all kinds, but I haven’t personally seen this degree of intolerance to cold. Your mother’s doctor may have more experience than I do, but I didn’t find much about it written in the medical literature. Every person is different, and it’s possible this is just part of how the dementia is affecting her.

However, cold intolerance to this degree suggests some alternate possibilities. The most important and likely is low thyroid levels, which also can cause a condition that looks like dementia and would certainly make dementia worse. I bet her doctor has checked for it. If her thyroid level has not been checked recently, she should have that done.

Other, less-common causes include Addison’s disease (inability to make appropriate amounts of steroid hormones), iron deficiency, anemia from any cause and severe malnutrition.

Q: I am a 70-year-old man. I take enalapril, HCTZ, clopidogrel, oxybutynin, Zocor and Aleve every day. I do not have much of a problem getting an erection, but I do not have ejaculation. This started about a year ago, with less semen each time I had intercourse until I finally stopped having any ejaculation at all. Is this due to my age, or could it be due to medication?

A: Disorders of ejaculation are much more common than once believed, but many men are reluctant to discuss it with their doctors. Unfortunately, there are many possible causes. Of the medications you mentioned, oxybutynin might be the most likely to be the cause. It would be worthwhile to visit a urologist to evaluate for any medical cause.

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