ASK THE DOC

Surgeon and lecturer Dr Sarah Rayne on whether spicy foods could cause migraines, the difference between a wheat allergy and coeliac disease and how to treat a torus fracture.

Q: I have started experiencing excruciating headaches that tend to develop after I eat spicy food. Are the two related?

A: Migraines are the most common cause of severe recurring headaches and can last for hours or even days. Their cause isn’t known but it is thought to be a combination of changes in brain activity, nerve stimulation and blood vessels. For one in 10 people suffering from migraines, food can be a trigger.

The most common triggers are cheeses, alcohol and caffeine (so wine and chocolate are out!), but spicy foods are not usually suspected. This is because spice tends to improve blood supply – in fact, chilli and ginger are both thought to help migraines.

So if it’s not chilli, then what else is your spicy food hiding? Monosodium glutamate (MSG), meat tenderisers, salt, nuts and onions may all be implicated in migraines and can be hidden in processed foods such as curries. Make your own curries (avoiding these triggers) to see if your headaches improve. If not, you’ll have to embrace the bland!

Q: I love bread, but it makes me feel sick. My children suspect that I am gluten intolerant but, as I understand it, it could also be a wheat allergy or coeliac disease. What’s the difference?

A: Growing and eating cereal crops like wheat and barley have been an important part of the evolution of humankind, transforming us from hunter-gatherers to farmers with time to build cultures and communities. But over the last half-century we have recognised that not everyone gets along with cereals in the same way.

Coeliac disease is an autoimmune condition triggered by gluten that causes damage to the gut; a wheat allergy is an allergic reaction to various parts of the wheat grain. It doesn’t cause digestive problems; instead, it commonly affects the lungs (known as ‘baker’s asthma’) or causes rashes or swelling. Both can be diagnosed through a series of clinical tests.

What is harder to diagnose is non-coeliac gluten sensitivity (NCGS), which can affect up to 13 percent of the population, or even double that in people with irritable bowel syndrome. Symptoms include pain, alternating diarrhoea and constipation, and bloating along with headaches, tiredness and rashes. Excluding wheat or other gluten-containing foods may help with symptoms. Wheat-containing products can often be highly processed, so cutting down on these can also be good for your health in general.

Q: My teenage son recently sustained a wrist injury during a tennis match. Yet two weeks later he’s still complaining about the pain and a lump has developed on his hand. Could he have fractured a bone or is he overreacting?

A: It is so important for children to be active, but it comes at a cost: 10 percent of children (of which two-thirds are boys) will sustain a sports-related injury every year. In the teen years, bones are vulnerable to sudden increases in strength and flexibility as hormones change, and this can lead to broken bones. So it sounds like your son has fractured a bone – right where that big lump is!

In young people, bones can bend and buckle but not break clean; this is called a torus fracture. The bone heals itself starting with a ‘big lump’ of callus: fresh, fragile pre-bone, which matures into new strong bone. The good news is that most of these fractures heal by themselves – but your son should still see a doctor, have an X-ray to confirm and get treatment.

Many childhood accidents don’t necessitate a doctor’s visit, but when pain from any injury doesn’t improve or gets worse, it should be checked out. ✤