Dr. Keith Roach
Dear Dr. Roach: I would like to know what you think about brain supplements and whether you would recommend any. My age is 84 and I am in good health, but my memory is getting bad. B.S.
Dear B.S.: A careful review of the published data (where there is any) reveals no consistent evidence that supplements are effective in the treatment or progression of Alzheimer’s disease. There may be one exception: vitamin E. Patients who want to try that in reasonable doses, such as 2,000 IU daily, may have a modest benefit. These benefits are likely to be smaller than with the approved prescription treatments for Alzheimer’s disease, and even those are fairly small in most cases.
Dear Dr. Roach: After six weeks of severe headaches, I was diagnosed with thunderclap headaches. These headaches suddenly stopped, and I have not had another for over two years. The doctor gave me a prescription for Maxalt to be taken as soon as I feel a headache coming on. It can be repeated twice within 30 minutes of each dose. Would you please explain this condition? P.M.
Dear P.M.: A thunderclap headache is, as its name suggests, a very severe headache that begins suddenly and reaches full intensity within one minute. This is a medical/surgical emergency, as one of the most common causes of TCH is a subarachnoid hemorrhage, usually caused by rupture of an aneurysm. This possibility must be evaluated immediately (call 911!) with imaging studies and a lumbar puncture, also called a “spinal tap.”
There are other causes of thunderclap headache, which can be considered after exclusion of subarachnoid hemorrhage. The course of your condition — that is, multiple episodes over several weeks — suggests you have a condition called reversible cerebral vasoconstriction syndrome. In this condition, some of the arteries in the brain constrict and stay constricted for a prolonged time.
It is most common in women in their 40s. There are several predisposing conditions and medications, including preexisting migraine. Triptans, such as rizatriptan (Maxalt) is one of the medicines that can trigger reversible cerebral vasoconstriction syndrome, and many authorities recommend against using them. Double-check with a neurologist about this treatment. Otherwise, there are no specific treatments for RCVS. Ninety percent to 95% of people will have a course like yours, with no permanent damage and no recurrence.