Dr. Keith Roach
Dear Dr. Roach: I read your recent column about migraine and stroke. About 40 years ago, I started having occasional visual-interference episodes with zigzags, blurred central vision, and more that lasted about 30 minutes. My doctor diagnosed them with ocular migraine.
When I read about migraines, the first possible cause listed were preservatives, so I started reading labels. My episodes occurred only after eating foods containing nitrites and sulfates. It was very consistent, so now I read labels and avoid them. And thanks to the fact that more meals are now being prepared without them, at age 85, I haven’t had a single episode in many years. It has made me a more mindful and healthy eater.
Will I still be more likely to have a stroke? Is this a common cause of these auras, or do the causes vary between people? I would hope that other people will also find a definite cause and solution like me. – DW
Answer: Food additives, especially nitrites, but also sulfites and sulfates, are known migraine triggers in susceptible people. Finding and eliminating migraine triggers can be helpful, but not everyone is able to identify their triggers.
Red wine (which contains small amounts of sulfites, even if not much is added) is one of the most common food triggers, but caffeine (and caffeine withdrawal) is another common cause. Poor sleep, excessive stress, and hormonal changes (especially in menstruating women) are also commonly reported.
Some perceived triggers may actually be the initial part of the headache. Chocolate cravings may be part of the genesis of headaches, so people may think that chocolate caused the headache, when in fact, the headache was already occurring.
Headache with aura can be confused with stroke. My column in January tried to point out that positive findings like zigzag lines make migraine with aura very likely, while transient ischemic attacks and stroke are highly unlikely.
However, the risk of stroke is increased in people who have migraine with aura. This is especially the case in young women. I suspect, but can’t prove, that having fewer migraines after removing the trigger, as you have, possibly reduces the risk of smaller, increased strokes.
Nevertheless, it is important for all people with migraine to do everything they can to reduce their risk of stroke through a healthy lifestyle. Increased blood pressure and cholesterol may be worth treating, even if they are quite mild. Diabetes should be controlled as much as possible. Finally, with strong evidence that the shingles vaccine reduces the risk of stroke, I recommend that you make sure you get the two-dose shingles vaccine.
Dear Dr. Roach: I am a 75-year-old woman hoping to reverse her hair loss. I currently use minoxidil, but I am not seeing any improvement. What else would you suggest? – GE
Answer: Most women lose some hair at the age of 70. The most distinctive pattern is the general thinning which is somewhat worse at the crown. I recommend seeing a doctor about this to ensure a diagnosis. There are also other patterns of hair loss, some of which are related to thyroid disease and – less frequently – to serious systemic diseases.
If the diagnosis is confirmed as female pattern hair loss, in addition to minoxidil (which can be used either topically or as a low-dose oral pill), spironolactone (or other antiandrogens) would be the other first-line treatment. Some physicians use prostate medications such as dutasteride, and ketoconazole shampoo may also be helpful. These medicines are usually used in combination with each other.
Finally, laser or low-level light therapy, microneedling, and platelet-rich plasma have some benefit, although these are much more expensive options. A dermatologist is a specialist in diseases of the hair and scalp.
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Dr. Roach regrets that he is unable to answer individual letters, but will include them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu.
