Richmond Times-Dispatch

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.

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