A Question of Health: Midlife crisis

Migraine linked to the menopause; salad and the five-a-day campaign; and dust-induced coughing

My wife is 49 years old and, presumably, is going through midlife changes to her system. She has always been prone to headaches and, occasionally, migraine attacks just prior to her period. Recently, these migraines have become very severe. The last attack lasted five days and she had to lie down for most of the time. She has taken every sort of pain-reliever, to little avail, at best achieving short-term relief. I know she is not alone in experiencing these symptoms. Is there any way, short of HRT (which she does not want to have) to get rid of these headaches? Can you recommend a way of reducing the pain and debilitation each month?

My wife is 49 years old and, presumably, is going through midlife changes to her system. She has always been prone to headaches and, occasionally, migraine attacks just prior to her period. Recently, these migraines have become very severe. The last attack lasted five days and she had to lie down for most of the time. She has taken every sort of pain-reliever, to little avail, at best achieving short-term relief. I know she is not alone in experiencing these symptoms. Is there any way, short of HRT (which she does not want to have) to get rid of these headaches? Can you recommend a way of reducing the pain and debilitation each month?

Migraines at any time of life are debilitating. Children and teenagers lose time from school, young people miss work, and people such as your wife are made miserable and take to their beds for days at a time. Simple painkillers such as paracetamol and ibuprofen are good enough for some people. But for a five-day attack that occurs once a month, they are clearly not good enough. From the information that you provide, it does sound as if the migraines are related to the menstrual cycle. HRT might just solve the problem, but if she does not want to take hormones, she will need to go down a different treatment path.

First of all, it is important to identify and avoid trigger factors. Lack of sleep, lack of food and stress can all play a part in setting off a migraine. There are two possible drug approaches to prevention and treatment. Your wife can take something regularly to attempt to prevent the migraines. Several drugs are effective, including beta-blockers such as propranolol or atenolol, or a group of drugs called calcium channel-blockers. Sometimes, a low dose of an antidepressant does the trick, despite the fact that the migraine sufferer is not suffering from depression.

Another way of dealing with migraine is to take something at the first sign of one. The most effective treatments are probably a family of drugs called the triptans – sumatriptan was the first to be developed. These can often stop a migraine in its tracks. If your wife's GP is unable to help her to solve the problem, she could be referred to the City of London Migraine Clinic (020-7251 3322), which specialises in the problem. The clinic also has a website with lots of useful suggestions: www.colmc.org.uk.

SALAD DAYS

Whenever the recommended five daily helpings of fruit and vegetables are referred to, no mention seems to be made of salad. How does salad rate when compared with green vegetables? Is it a good substitute?

The average person in the UK eats about three portions of fruit and vegetables a day (though a typical 19- to 24-year-old eats less than one portion a day). The Government's five-a-day campaign, which encourages everyone to eat five portions of fruit and vegetables a day, is perfectly happy for you to eat plenty of salad. And as most salad ingredients are exceptionally low in calories, if you are watching your waistline, salad is ideal.

One portion is about 80g (about 3oz), so a decent-sized bowl of mixed salad would count as a portion. If you prefer, you could try 10 radishes or three sticks of celery. Raw green peppers have lots of vitamin C, tomatoes are a good source of vitamin A, and all raw vegetables contain fibre. Eating these things raw is better than cooking them, as cooking destroys some important nutrients such as folic acid and vitamin C.

DUST ON THE LINE

On the day that the London Underground Central Line was reopened, I ingested or inhaled something that has caused a pain/tightness in my oesophagus area, as well as some coughing. This seems to be more than just a "scratch" in the throat. What remedies are available, and what course of action should I pursue? I have asked the Health and Safety Executive for a note of the composition of the voluminous dust that accompanied the reopening of the line, but to date, I do not know what was in it.

I doubt whether there is much that you can do, apart from continuing to cough and hoping that the problem will resolve itself. You may have inhaled some small particles that are particularly irritating to the lungs. If the problem doesn't resolve itself in a few weeks, see a doctor and think about having some lung-function tests and a chest X-ray. Your onset of pain and coughing may have nothing to do with the dust on the Tube, and it is important to consider other causes, such as infections or chest diseases.