DEAR DR. DONOHUE: What makes a headache a migraine headache? I have some real doozies that make work impossible. The headaches are more frequent and intense than they were. I can’t afford to lose more work time. Friends insist I have migraines. How are they treated? I usually take aspirin for my headaches. — C.J.

ANSWER: Migraine headaches are second on the list of headache types. Tension headaches, a feeling that a band is constricting the head, are the No. 1 cause. Tension headaches are not as severe as migraines. A migraine frequently begins slowly and reaches a peak in an hour or more. In 60 percent to 70 percent of migraines, they are one-sided — felt on one side of the head. People describe them as pulsatile, “a beat, beat, beat” or as being deep in the head with no respite from the pain. Around 25 percent of migraineurs see flashing lights, zigzag lines or a blind spot in their visual field before the onset of head pain. That’s called the migraine aura. Nausea and vomiting often accompany the headache. Light and sound exacerbate the headache, so the affected person seeks out a quiet, dark place to lie down. A typical migraine lasts from four hours to three days. Skipping a meal, alcohol (red wine in particular), sausages and similar processed meats, monosodium glutamate (a seasoning), caffeine, aged cheeses, the artificial sweetener aspartame, chocolate, cigarette smoke, nuts, menstrual periods and both too much and too little sleep all can give rise to a migraine.

Doctors now have a large assortment of medicines for migraine treatment. If the headache isn’t incapacitating, then nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen and indomethacin) often can relieve pain. For severe pain, drugs called triptans are a breakthrough that makes control of migraines more successful than in the past. Some names are sumatriptan (Imitrex) and zolmitriptan (Zomig).

For recurring migraines, medicines that act as preventatives, such as propranolol and verapamil, are prescribed.

Your family doctor can diagnose migraine headaches for you and provide treatment for them.

DEAR DR. DONOHUE: I have been diagnosed with kyphoscoliosis. Will you enlighten me as to the cause and treatment, and prospects for the future? I am 86 years old. — L.K.

ANSWER: Kyphosis is an outward protrusion of the upper back. It’s the kind of back that the hunchback of Notre Dame had. If it makes its appearance in younger years, it’s often a deformity the person is born with. In older years, it frequently results from osteoporosis with collapse of the backbones. Is also called a dowager’s hump.

Scoliosis is a bend of the back to the right or the left. If the upper back bends to the right, the lower back might curve to the left, or vice versa. Scoliosis often is a congenital problem. What to do for it depends on the degree of curvature. A brace is sometimes used. For more severe curvatures, surgery has to be performed. At older ages, osteoporosis can be the factor that’s causing the curvature.

If you do have osteoporosis, you should be on treatment with calcium and vitamin D. Your doctor will judge whether other medicines are indicated. Your back curvatures are not likely to increase much more at your age unless you have severe osteoporosis.

DEAR DR. DONOHUE: I suffer from depression and anxiety disorder. For me, they’re mostly due to genetics. I’m worried that I might get postpartum depression after delivering my baby and not want to take care of him. I want to breastfeed. Is there any medication I can take to prevent a relapse? — K.M.

ANSWER: You must work closely with your gynecologist and your psychiatrist. The amount of antidepressants that pass into a woman’s milk generally is low and doesn’t adversely affect the baby. Exceptions do exist. Two antidepressants that appear to be safe are Zoloft (sertraline) and Paxil (paroxetine). You should consult your psychiatrist well before your due date. Call the doctor today. Talk therapy might be the only treatment needed to keep you free from depression and anxiety.

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.

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