Q. I take Cafergot tablets for migraine headaches. For the past year, I've been having a migraine about once a month. Lately, I've been getting them more often, about once or twice a week. The attacks are really bad, and I'd like to try something to prevent them. What do you recommend?
A. You should work with your doctor to find a medicine that's right for you. There are several to choose from:
Beta blockers. Doctors use this class of drugs to treat a wide range of problems, from high blood pressure to angina. These medicines also work well in preventing migraines. Propranolol (Inderal) is the most widely used one, but others include Corgard and Blocadren.
Calcium blockers. These drugs are also used to treat heart problems, but they can work for some people to prevent migraines. Flunarizine, a calcium blocker not yet available in the United States, has shown promise in both treating and preventing migraine attacks.
Anti-depressants. Because of their effects on the nervous system, this class of drugs can prevent migraines as well as chronic tension headaches.
Periactin. This drug is a type of anti-histamine that helps some people with migraines or a type of headache called cluster headaches.
Sansert. I'll mention this drug only because it was one of the first preventive medicines for migraine. However, potentially serious side effects make it a drug of last resort.
Anti-inflammation pain relievers. These include ibuprofen (Advil, Motrin and other brands), naproxen and indomethacin. These drugs are used to treat an acute attack, but sometimes they'll help prevent an attack if you take them regularly. They also work well for migraines triggered by menstrual periods.
Clonidine. This blood pressure medicine has helped a few people with frequent migraines. As you can see, there are many drugs that may work for you. Based on your history, your doctor will decide whether there are some you should avoid and whether there are some that are better suited to you. For example, if you have both high blood pressure and frequent migraines, one of the medicines that will treat both of these conditions would be a logical choice.
The first question you'll need to answer is whether your attacks are severe enough or frequent enough that you'll want to go to the trouble of taking a medicine every day to prevent or decrease the attacks. The next question involves deciding which medicine will work best for you with the fewest side effects. Fortunately, most migraine sufferers can find a medicine that works for them.
Other steps that may help lessen the pain are relaxation exercises, biofeedback, avoiding stress or foods that seem to trigger an attack and applying ice packs. These non-drug treatments are particularly good for people who can't or don't want to take medicines, such as children and pregnant women.
Follow-Up: Swimmer's Ear
Q. Can you answer another question about ear tubes? My son had frequent ear infections before getting his tubes put in. His doctor advised against getting any water in his ears. What I'm wondering is whether he can go swimming this summer if he wears earplugs?
A. Many doctors recommend against getting water in ears that have tubes in them, to prevent introducing an infection. However, not all doctors agree, and some believe that with proper precautions you can swim with ear tubes in place.
Although ear tubes have been in use for more than 30 years, it wasn't until a few years ago that some ear specialists decided to test whether getting water in the ears was harmful. In one study, doctors took 85 children with ear tubes and divided them into three groups: swimming without earplugs, swimming with earplugs, and no swimming allowed.
The doctors found that children who didn't swim and those who swam with earplugs had the same rate of infection, 30 percent. Oddly enough, children who swam without earplugs had fewer ear infections -- only 16 percent. Other studies have also backed the apparent safety of swimming with ear tubes.
One possible explanation for these results is that the earplugs provided no real protection. They may even have damaged the delicate skin lining the ear canal, allowing an infection to develop. Children who swam without earplugs had their ears irrigated, perhaps removing germs that might naturally cause an infection. They also may have used medicated drops to prevent an infection after swimming.
Many ear specialists recommend putting some medicated eardrops in your ears after swimming to help prevent infection. This treatment can prevent "swimmer's ear" -- infection of the ear canal -- whether there are tubes in the eardrum or not.
If your child does swim with ear tubes, it's recommended that he avoid diving. If he does get an infection even after using ear drops, it's probably wise to avoid swimming altogether.
Because of the difference in opinion about swimming with ear tubes, I recommend that you check with your doctor about whether your child can swim with tubes in place and about using eardrops.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
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