DEAR DR. DONOHUE: My migraine headaches are so bad that I miss many workdays. I am afraid that I am going to lose my job. I take Imitrex. It worked well for me at first, but it doesn’t do anything for me now. Is there any alternative? – C.P.

Migraine headaches can be incapacitating and can make a migraine sufferer retreat to a dark, quiet room and a bed until the headache goes away.

Imitrex, a very good drug, is not the only drug for migraines. It was the first “triptan” drug, and it revolutionized migraine treatment. Now there are six additional triptan drugs – Maxalt, Frova, Relpax, Amerge, Axert and Zomig. People who do not obtain relief with one triptan can switch to another and often find their problem solved.

Then, too, there are migraine medicines other than triptans. Migranal, for instance, has been around for a long time and has benefited many migraineurs.

Have you ever taken so-called prophylactic medicines? Those are medicines taken when you don’t have a migraine in order to prevent one from occurring. Inderal is such a medicine. Two classes of blood pressure medicines, ACE inhibitors and angiotensin-receptor blockers, have had good results in keeping people free from migraines.

There is a trap that many headache suffers fall into – taking too much headache medicine. Keep a tally of how much Imitrex you use. Overuse is counterproductive. Show the list to your doctor, who might solve your problem by having you take less medicine.

Keep another tally of what you have done or eaten prior to the appearance of a migraine. Over- or undersleeping, more than two cups of coffee a day, alcohol and erratic mealtimes can spark a headache. You might find that the answer to migraine prevention is exercise. It does work.

The headache pamphlet goes into detail on the kinds of and treatments for headaches. Readers can obtain a copy by writing: Dr. Donohue – No. 901, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a woman, and I have a hernia. I thought only men got them. My doctor is trying to talk me into having surgery. Why? It doesn’t bother me. – O.F.

Hernias are more common in men, but women can get them, too, especially the kind called femoral hernias. Those hernias pop out below the crease that the thigh makes with the abdomen, and little more to the side than the usual groin hernia. It arises in an enlarged opening in the abdominal wall that permits the passage of the femoral artery into the leg.

Childbearing and aging, both of which cause tissue laxity, are blamed for women having these hernias.

There is no law that says you have to have your hernia surgically repaired, but it is a good idea. There is a large membrane that drapes over abdominal organs. Hernias are protrusions of that membrane through defects in the abdominal wall. In the case of a femoral hernia, the place where it bulges is an enlarged femoral canal. Not only can the covering push through the defect, but so can the intestines. If the hernia cannot be easily pushed back (reduced), it is called an incarcerated hernia, and it can cause grief. An even worse complication is a strangulated hernia. That’s one whose blood supply has been cut off. It requires emergency treatment, for the hernia contents can become gangrenous without a blood supply. You won’t find hernia repair a formidable process.

DEAR DR. DONOHUE: When does a woman ovulate? And can a woman’s fertility be affected by taking birth control pills for many years? – P.G.

Ovulation occurs on the 14th day of the cycle, day No. 1 being the first day of bleeding. In the real world, it can happen between day 12 and day 17.

Pill use does not affect fertility. It can take a few month for normal periods to resume after discontinuing the pill.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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