THE DOCTOR WILL SEE YOU NOW

Dr Sarah Jarvis answers your questions and rounds up the latest health news this month

Dr Sarah Jarvis answers your health questions

Help for migraine misery

QI’ve had occasional migraines for years but recently, they have become more frequent due to stress. I’m worried about my ability to function and my painkiller intake, too. What can I do? A Migraines are very common, affecting three times more women than men; one in every seven or eight women are sufferers (including me). Every day in England alone, almost 200,000 people have a migraine. It’s so much more than a bad head – in fact, the severe pain of migraine can be completely incapacitating and last from four hours to three days. It’s often accompanied by nausea, vomiting, profound tiredness and extreme sensitivity to light and/or sound or smell. Stress is a common trigger, not least because it can disrupt sleep and being overtired can bring on migraines in susceptible people (as can computer use, caffeine, alcohol and more). But it can be a vicious cycle – if you can’t function because of migraine, it can affect your mood, and a recent survey suggested almost half of people with migraine felt depressed and one in four women felt guilty about needing time out. Seven in 10 said migraines stopped them leaving the house and one in three said migraines had affected their children’s happiness.

Paracetamol, ibuprofen and aspirin work for some, but triptan medication may be more effective for acute attacks. However, try to avoid painkillers containing codeine as these are more likely to result in ‘medication-overuse’ headaches if taken regularly (at least twice a week), for three months or more.

Keeping a migraine diary is an important first step in working out your triggers. It can also help guide your GP’S suggestions for treatment: for example, more than half of women report a link between their menstrual cycle and their migraines and, if this is so, hormone treatment may help.

If you have more than two severe migraines a month, or simple painkillers don’t help, talk to your GP about preventive medication. There are several options, all with different possible side-effects, so discuss the pros and cons with your doctor.

Chest concern

Q

My son’s breastbone has always been slightly indented but in the last six months, this has become much more obvious. He’s a self-conscious teenager but I saw it when I went into his bedroom unannounced. He won’t talk about it – what should I do? A

It sounds as if he has a condition called pectus excavatum or sunken chest syndrome, which is more common in boys than girls and often gets worse around puberty. In severe cases, the breastbone can press on the heart and lungs, leading to recurrent chest infections, dizziness, chest pains, palpitations and decreased exercise tolerance. But for many, it doesn’t cause physical symptoms, although it can lead to severe self-confidence issues.

It’s worth trying to persuade your son to speak to his GP, who can ask about symptoms. Often, no cause is found, although it can run in families and is sometimes linked to other conditions affecting the skeleton, such as Marfan and Ehlers-danlos syndrome. In mild cases, physiotherapy can help. Surgery does correct the problem in severe cases, but (very unfairly in my view) has been basically banned on the NHS in England.

Sudden hair loss

Q

I am losing my hair very quickly – it’s very fine and the centre parting has gone. Is there a medical cause? A

We tend to think of hair loss as a man’s domain, but women are almost as likely to complain of thinning hair.

Certain medical conditions can cause hair loss. Alopecia areata is an autoimmune disease (where your body’s own immune system turns on itself), that leads to one or more patches of complete hair loss (usually circular), with normal thickness of surrounding hair.

I would also consider lack of iron (even if not enough to cause anaemia) or underactive thyroid, both of which can lead to diffuse thinning hair rather than patchy hair loss. Not having enough ‘first-class protein’ in your diet can also affect your hair – vegetarians can get enough from eggs, dairy products and quorn or tofu, but it can be more difficult for vegans.

About half of women develop ‘androgenic alopecia’ – most start to notice it in their 50s or 60s, but it can happen at any age. Male-pattern balding usually starts at the temples and crown. Women are more likely to see thinning on the top of the head. It’s partly down to thinner hairs replacing hairs naturally lost as part of the hair growth cycle.

While this process can’t be reversed, avoiding chemicals (such as ammonia or peroxide in permanent hair dyes) will help. Volumising products can also help, as long as they are paraffin-free. The good news is that, unlike in men, you are highly unlikely to lose your hair completely.