Higher frequency of migraines calls for meds

DEAR DR. ROACH >> I’m an 82-yearold woman in good health. Last May, I began having migraine headaches preceded by an aura two to three times a week. They’re not as severe as they were when I was younger, but I hadn’t been having more than one or two a year since I was in my 40s. I had a scan of my brain in August, but it was normal. I can’t tolerate anti-inflammatory drugs, as they upset my stomach. Any suggestions as to whether I should be concerned and/or what to do about the headaches?

— J.R.

New headaches in older people

DEAR READER >>

should raise the concern of different types of headaches from migraine, especially temporal arteritis. However, the presence of an aura, and the fact that you have had these before, makes migraine the most likely cause for you. In people who are having more than 10 headaches a month, I usually recommend medication to prevent headaches, in addition to medication to stop the headache from happening. Medications like sumatriptan are among the most effective for acute treatment, while there are many options for preventive therapy, including over-the-counter options such as magnesium or the vitamin B2, riboflavin.

Given your age and the frequency of these headaches, getting a scan is wise.

I was recently diagnosed with prostate cancer for the third time, and my radiation oncologist stated, “We can’t radiate a third time, as I don’t want to compromise your colon.”

He has suggested hormone therapy with Orgovyx, and my urologist is in agreement. My concern is the side effects; they are frightening. What are your thoughts, or other suggestions?

DEAR DR. ROACH >>

DEAR READER >> Recurrent prostate cancer after treatment is always a frightening issue, and there are no easy choices. I don’t have enough information, such as the size and location of the prostate cancer, to give you definitive advice the way your urologist and radiation oncologist have. But when definitive therapy with surgery isn’t possible (in your case, two rounds of radiation may already make surgery impossible, or there may be other anatomical concerns), then the standard treatment is to prevent your body from being able to make testosterone. Most prostate cancers grow more with testosterone, and a low testosterone level (ensured with surgery or with medications like Orgovyx) usually keeps prostate cancer from growing.