DEAR DR. DONOHUE: I have awful headaches. I sometimes see spots in front of my eyes and have a sick feeling in the pit of my stomach when I get the headaches. Everyone says they are migraines. Could you write something on this subject? – B.T.

ANSWER: Migraine headaches are almost always one-sided headaches with a pulsating beat to the pain that’s often in synchrony with the heartbeat. Along with the migraine, people are frequently nauseated. The headache makes them sensitive to light and sound, and they look for a quiet, dark place to lie down. Activity worsens the headache. It lasts anywhere from four to 72 hours.

Some migraine sufferers experience what’s called an aura before the headache begins. The aura can be flashing lights, a blind spot in the field of vision or a numbness of the face.

Caffeine and some other foods and drinks can trigger a migraine. So can missing a meal. Menstrual periods can bring on headaches for some women.

There are effective migraine medicines called triptans that have made life bearable for migraineurs. There are also medicines that can prevent frequent recurrences of these headaches.

Tension headaches, the most common kind of headache, feel like a band of tightness that squeezes both sides of the head as though it were in a vise. They can last from 30 minutes to a full week. Usually there are no visual symptoms with the headache.

I’m not convinced that you have true migraine headaches. See the family doctor. A few more pertinent questions can settle the issue. You might not have tension headaches, either. Yours could be one of the more uncommon types that need further investigation.

The headache booklet deals with this common complaint in depth. Readers can order a copy by writing: Dr. Donohue – No. 901, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I just found out that two of my sisters have Paget’s disease of bone. Do you think it might run in the family? – M.C.

ANSWER: Bones undergo constant remodeling. With Paget’s bone disease, the process goes awry. The breakdown phase of the remodeling lasts longer than normal. To catch up, the buildup phase hastily lays down new bone of poor quality in a disorganized pattern that often makes the bone misshapen and easily broken. Paget bone can also cause pain.

When the process is limited to a small bone section, people rarely have symptoms. The process is discovered incidentally via a blood test or an X-ray taken for some other reason.

In some cases, Paget’s does run in families. Between 5 percent and 25 percent of Paget’s patients have other family members with it. At your next examination, tell the doctor about your sisters. The doctor can order an alkaline-phosphatase blood test. Alkaline phosphatase is elevated in Paget’s disease.

There are medicines that can often control this condition.

Your sisters and all Paget’s patients should take advantage of the many services provided by the Paget Foundation. Its toll-free number is 1-800-23-PAGET, and its Web site is www.paget.org.

DEAR DR. DONOHUE: My husband had an ECG at his HMO. The tech said it showed atrial fibrillation. He discussed it with the doctor, and they took another ECG, which showed the same reading. They decided the machine was not acting right. Is this something we need to be concerned about? – Anon.

ANSWER: Yes, it’s something to be concerned about. Atrial fibrillation is an erratic heartbeat that gives rise to clots in the atria, the upper heart chambers. Those clots can be carried by the blood to the brain, where they can block a brain artery and cause a stroke.

People with atrial fibrillation are usually placed on blood thinners to prevent this.

Call the doctor’s office for a clarification right away.

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. Readers may also order health newsletters from www.rbmamall.com.