What a difficult time your daughter is having — migraines are much more than a simple headache and can prove debilitating.
The condition affects more than one in ten people and is a disorder of the brain that, in most cases, is inherited.
There are a number of factors that can trigger these painful episodes including stress, menstruation, missing meals, changes in the weather, too much or too little sleep, alcohol and a long list of other possibilities.
You tell me in your longer letter that your daughter has previously tried the prescription treatment rizatriptan.
Although this medication is effective in tackling the pain, using it too often can actually trigger more attacks, known as rebound headaches.
The emphasis, therefore, should be on prevention rather than treatment.
Migraines are no longer thought to be caused by blood vessels in the head going into spasm, but possibly by some malfunction in the area at the base of the skull called the brain stem.
The range of medications that have been shown to be effective for prevention include beta blockers (such as propranolol), low-dose antidepressants (typically amitriptyline) or anticonvulsants (sodium valproate or topiramate).
This type of approach must be carefully orchestrated by a doctor skilled in the treatment of migraine.
Concentrating on lifestyle factors will also help: getting enough sleep — but not too much — is undoubtedly useful, though far from easy in an active young person.
Routine mealtimes, regular (daily) exercise and a good fluid intake (enough water) is vital. And, again, this requires discipline and a positive approach.
CONTACT DR SCURRTo contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.
Next, whatever else has been prescribed by your daughter’s doctor, add a daily dose of coenzyme Q10.
You can buy this at a chemist or health food outlet and she should take 200mg.
Evidence suggests that, over time, it can reduce the frequency of attacks by 50 per cent.
Coenzyme Q10 is a naturally occurring substance found in every cell of the body, and taking a supplement is not likely to cause any side-effects.
A second natural supplement that she should take is vitamin B2. Give her 400mg each day — a high dose. Studies have shown that, by three months, the severity and frequency of migraine is also reduced by 50 per cent.
The one side-effect is that it colours the urine very bright yellow, which at first can be alarming.
Both of the above natural supplements take weeks if not months to achieve full benefit.
Do encourage your daughter to be patient, and ask her to keep a careful record in a diary of migraine attacks, as it is the best way to determine whether any of these steps are helpful.
Next month I am due to have an operation on my hands to treat carpal tunnel syndrome. This condition has been painful and debilitating, but I am concerned about the surgery (my faith in doctors took a knock when my condition was misdiagnosed for a long time as rheumatoid arthritis). What are the chances of the operation being successful, and will it restore sensitivity to my fingers? Name and address supplied.
Your anxiety is completely understandable, but I hope that what follows will be reassuring.
The carpal tunnel is a small space in the wrist joint — not much bigger than a postage stamp.
This tight gap acts like a passageway through the wrist from the forearm to the hand, and a number of structures must pass through this, including tendons, blood vessels and the median nerve.
This major nerve is about the thickness of a pencil and supplies the thumb, index, and middle fingers and part of the ring finger, as well as the area of the palm around the base of the thumb. Problems start to arise when this tunnel becomes squashed, trapping the nerve and triggering pain, tingling, numbness and weakness in the hand. Obesity can increase the risk as it exerts pressure on the wrist, and a number of other conditions have been linked to it, although we are still unclear why these trigger the syndrome. These include pregnancy, diabetes, rheumatoid arthritis, underactive thyroid and certain activities such as manual labour or using vibrating tools. I often experience it myself after long motorcycle rides, from gripping the handlebars too tightly. More from Martin Scurr... How can I get this heavy feeling off my chest? 03/06/13 Ask the doctor: Bad breath is ruining my self-confidence 27/05/13 Ask the doctor: Will my shingles pain ever go away? 20/05/13 Ask the doctor: Is blood in my urine a reason to worry? 13/05/13 Ask the doctor: Why am I seeing stars in my eyes? 07/05/13 Ask the doctor: What has caused my unbearable leg pain? 29/04/13 Ask the doctor: Why are my teeth starting to crumble? 22/04/13 Ask the doctor: Why do my wife's hands bruise so easily? 01/04/13 VIEW FULL ARCHIVE There was a suggestion that it could also be caused by typing (carpal tunnel syndrome is regarded as a form of repetitive strain injury), but there is no real evidence to support this.The condition is diagnosed by the characteristic pain or tingling in the thumb or fingers — especially at night. But doctors can confirm the diagnosis with a test called a nerve conduction study, carried out at a hospital. Here, electrodes are placed on the hand and wrists, and by applying very small electric currents, doctors can ascertain whether there is any nerve damage.There are many treatment options, with the choice depending on the extent of the problem. In mild cases, the diligent use of a splint at night to hold the wrist straight will resolve the problem after a few days or weeks in up to 90 per cent of patients. However, this may not work in those who have had symptoms for more than a year, in older patients or those who suffer from constant rather than sporadic tingling. Those who are more severely affected, such as yourself, may require a minor operation called a surgical decompression, where the roof of the tunnel (known as the transverse carpal ligament) is removed to give the nerves more space. Studies show that improvement can initially be slow, but after one year a complete or substantial recovery is seen in more than 90 per cent of patients.Bear in mind that full recovery will take many months, but even if not perfect, the final outcome will be almost complete relief.By the way... Being a GP is about duty, not cushy office hoursI am increasingly worried about a paradox that is emerging in healthcare. Within the hospital service, there is a healthy debate about how the quality of care can be maintained at weekends in order to provide a genuine seven-day service. But the idea of 24/7 care from your GP — the service every GP once gave since the creation of the NHS — is now but a distant memory, thanks to the renegotiation of GPs’ contracts in 2004. Doctors shelter behind the European Working Time Directive, which stipulates that no one should work more than an average 48 hours per week However, last week the issue of 24/7 commitment from GPs was reopened as they became responsible for commissioning healthcare services.Surveys show that the public continue to be confused about what to do when medical emergencies occur out of hours.In the former era, it was call the GP or perhaps dial 999. But now there is a set of options, none of which involves talking to a doctor — least of all one who knows you. And you can forget house calls. The GPs themselves have made it clear that they have no intention, ever, of even discussing a return to the old days, with nights and weekends on call. They shelter behind the European Working Time Directive, which stipulates that no one should work more than an average 48 hours per week. On top of this, many family doctors are part‑time and focused on the need to achieve a contented work-life balance. In my career span, the proportion of women doctors has increased from about ten per cent to more than 50 per cent of the workforce, and many of them have other priorities. But then, what did we sign up for when we went to medical school? Was it not about service rather than gain? Vocation rather than employment? Dedication to the care of others was the motivating force. A student who went for an interview for a university place to study medicine would have been very unlikely to get in if they had pushed for a short and comfy working week.I fear for the final outcome. What we have at present is a mess — the result of the uneasy interface between politics and medicine. And if GPs won’t step into the breach, who exactly are they going to commission to run their out-of-hours services?
