Q. I don't drink wine often, but recently I realized that I was getting severe headaches after only a glass or two. I rarely have a mixed drink, but if I do, should I expect the same reaction, or is there something in wine that causes headaches?
A. You may be reacting to something specific in wine, but chances are you'd have the same reaction to any alcoholic drink.
You probably had a migraine headache, a type of headache caused by dilation of blood vessels in the brain. Many substances in food can trigger a migraine attack by making blood vessels dilate. Among these are the amino acid tyramine, a protein building block especially found in aged cheeses, and nitrites, used in curing meats.
Wines, especially Chianti, which are rich in tyramine, are known for setting off a headache. However, some people who are bothered by red wine can get away with drinking white. But alcohol in general can cause headaches in migraine sufferers, and you may run the risk of getting a headache with any type of alcoholic drink.
Besides alcohol, other headache-provoking foods in people prone to migraines are: Aged and processed cheeses -- although cottage, cream and American cheese are usually O.K.; Aged, canned, cured or processed meats or those containing nitrates, nitrites or meat tenderizers (for example, hot dogs, lunch meats and smoked fish); Caffeine-containing foods or drinks, such as coffee, tea or colas and chocolate; Foods made with the flavor enhancer mono-sodium glutamate (MSG), such as many Chinese foods; Foods made with soy sauce, yeast or yeast extracts (such as sourdough bread but not ordinary commercial bread).
If you consistently find that a certain food triggers a headache, you may need to avoid it.
Q. I'm a 27-year-old woman who recently underwent laser surgery for genital warts. I had treatment to my cervix, vulva and vagina, and consider myself lucky -- I had this problem detected in time to cure it and prevent it from become something more serious.
I first discovered something was wrong when I had an abnormal Pap smear, a class II. A biopsy of my cervix showed dysplasia (markedly abnormal cells), which my doctor treated with cryosurgery (freezing). Unfortunately, my Pap smear remained abnormal.
I was surprised when my gynecologist asked me if I had ever noticed any genital warts, and I said no. Then I remembered my old boyfriend had had some. It turns out that I did indeed have genital warts almost too tiny to be seen. My doctor says they're the cause of my abnormal Pap smear, and a possible cause of cervical cancer.
Why isn't more known about this condition, which apparently is becoming an epidemic like herpes?
A. Doctors are increasingly discovering that genital warts are responsible for many abnormal Pap smears and inflammation of the cervix (cervicitis). The bad news is that genital warts do seem to cause changes leading to cervical cancer in some women; the good news is that with early detection and treatment, this threat to women's health can be eliminated.
All warts are caused by a skin virus called human papilloma virus. HPV comes in many subtypes, some causing warts commonly appearing on the fingers, others causing plantar warts on the soles of the feet. Several HPV subtypes cause genital warts -- also known as condyloma -- and recent research links these with cervical cancer.
Certainly, any visible genital warts should be treated by one of several methods, including topical application of liquid podophyllin, freezing (cryosurgery), laser vaporization or surgical excision. However, some genital warts may not be visible to the naked eye, and only show up on abnormal Pap smears.
Class II Pap smears point to infection or inflammation. (Class I is normal and Class V is definite cancer.) Your doctor will treat any vaginal or cervical infections to try to clear up the inflammation. If that's successful, fine; if not, and particularly if any cervical cells show dysplasia, you'll need further evaluation with colposcopy.
A colposcope is a magnifying instrument doctors use to closely examine the surface of the cervix. Your doctor can take small biopsies of any areas that appear abnormal. Then, provided there's not a significant number of cancerous cells, he or she can freeze these areas, in most cases clearing the condition. In some cases of HPV infection and genital warts, re-treatment is necessary.
Once you've had genital warts, you should be sure to have regular Pap smears to make sure the problem isn't returning. Because genital warts are sexually transmitted, you should also have your partner checked and treated if necessary. Because genital warts can be difficult to detect, some doctors are using colposcopes to better examine men, especially after a topical (and painless) application of weak acetic acid (white vinegar), which highlights small warts from the surrounding normal skin.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.