For two years I suffered throbbing migraines seven days a week. I went to two top doctors who prescribed tablets and I had 78 Botox injections. Nothing helped.
Earlier this year, I went on a cruise and my headache disappeared — but when I returned home, within days it was as bad as ever. I thought I must be doing something I did not do on board and the answer was eating salami. I had a few slices every day for about two years.
I Googled salami and found that processed foods could cause migraines. Is that right?
Joy Shaw, by email.
As anyone who experiences them will know, migraines are more than ‘just’ a bad headache, and having daily migraines for those two years must have been a depressing and troubled time in your life.
Migraine is very common, affecting about 17 per cent of women and 6 per cent of men, but the causes are complex.
Nitrates, the preservatives used in many processed meats, including salami, are a known trigger for migraines in some people
We used to think that migraine headaches were triggered when the blood vessels in the brain became dilated. However, it’s now thought the process begins with oversensitive nerve cells in the brain causing inflammatory changes in pain-sensitive tissues.
As well as a headache, some migraineurs will have neurological symptoms. These may be visual (for instance, seeing bright lights or shapes), auditory (a ringing or buzzing in the ear), a tingling or burning sensation in the face or limbs, or weakness of the hand or arm on one side. This is known as migraine with aura.
Most people find they have a key trigger for their migraines. In one recent study of nearly 2,000 migraineurs, 75 per cent reported that they had at least one trigger for their attacks.
Eighty per cent of these patients identified emotional stress as a trigger (with the migraine sometimes coming on as the stress lessened, rather than the stress itself triggering it). Other common triggers they noted included hormonal changes (in women), missing meals, sleep problems, bright lights, alcohol, heat and exercise.
Nitrates, the preservatives used in many processed meats, including salami, are a known trigger for migraines in some people.
Although avoiding salami has resulted in you now being migraine-free, do bear in mind that nitrates and other preservatives used in salami can be found in other types of food. Even a vegetable such as spinach contains nitrates, albeit in lower quantities.
My suggestion is that you consider yourself in remission rather than ‘cured’: the point is you have an innate migraine tendency and, all too commonly, other triggers may begin to kick-start symptoms at some stage.
So I very much hope that your migraine experience remains in remission, but don’t be surprised if it comes back. In the meantime, make sure you eat regularly, get plenty of sleep, drink enough water and take some daily exercise. All are steps known to help prevent migraine.
My preferred way to keep fit has been swimming (once or twice a week, normally). Usually I swim a leisurely breaststroke for an hour, ending with a few fast lengths.
But after one swim last June, I cricked my neck and still haven’t recovered. I don’t sleep well and wake up numb down my right leg and arm. I also feel queasy most of the day. I have been swimming a couple of times since, but felt worse afterwards. I will be 60 this June and wonder whether this is my body saying ‘Nice knowing you, but I’m packing in now’.
Peter Russell, London.
The neck — known medically as the cervical spine — is one of Mother Nature’s worst design faults.
The human head weighs about 8kg, which is considerable given the seven cervical vertebrae that support it and act as a pivot to give it considerable movement.
The price of the head’s great mobility has been the loss of structural strength in the neck. This fragile structure also carries the spinal cord as it exits from the skull, via a channel known as the spinal canal.
Your symptoms, now persisting for many months, give me cause for concern because you need a diagnosis. Pain, tingling or numbness in one arm or hand is a common problem with a variety of potential causes — although essentially the nerves are compressed in some way.
Typically this is because of arthritic changes in the vertebrae, or even a bulging disc (the spongey ‘shock absorbers’ that sit between the vertebrae).
Less common is when one arm and the leg on that side are affected, as in your case (although again, the causes are likely to be a bulging disc or arthritic changes, which cause symptoms by pressing on the cord within the spinal canal rather than compressing nerves as they exit between the vertebrae).
Whatever the theory, the longevity of your symptoms calls for further investigation at this stage. A physical examination to check for weakness (of arm or leg), and checks to detail whether there is impairment of sensation in each limb may provide some evidence for such a cause. But more clarification will come from a scan, ideally an MRI, of your neck.
There is nothing to be lost from consulting a physiotherapist pending further investigation for advice about pillows (to adjust your sleeping position), as well as exercise activities, and that might prove helpful in reducing your symptoms.
Swimming breaststroke involves the neck being extended and then cocked well back. Physiotherapists mostly advise avoiding this stroke in patients with neck pains
Swimming breaststroke involves the neck being extended and then cocked well back, and my physiotherapy colleagues mostly advise avoiding this stroke in patients with your combination of symptoms. It’s recommended that patients swim on their backs, with the neck flexed, chin on chest.
But the key is to see your GP once more to explain the months of persistent symptoms and to discuss the possibility of getting a referral for a scan.
Statins do save lives
Imagine there is a drug that can prevent a serious disease. Surely patients would clamour for it — and doctors would be flat out prescribing it.
Well, that drug exists: statins can prevent heart disease, heart attacks and strokes. Yet new NHS England figures show that more than 150,000 patients a year at risk of heart disease are not getting them.
But doctors and patients are wary after much publicity about their side-effects.
Patients must always be free to exercise their wishes, but the fact that so many are missing out on the potential lifesaving benefits saddens me.
In my view… bacteria may not be the enemy
For decades, bacteria were seen as the villain in medicine — but more recently we’ve learned that many, or at least those that live in our gut, can play a vital role in health. Too much of the wrong sort is linked to weight gain, cardiovascular disease, stroke and even possibly dementia.
But nothing in medicine is ever black and white. Take the role of organisms called fusobacteria. For some years, we’ve known that these are found in greater quantities in colon cancer tissue.
The bacteria’s DNA is found in 50 per cent of colorectal cancer cells but is not found in healthy cells nearby. But what it was doing in these cells was not clear. Now, Fusobacteria have been found in metastatic colon cancer cells (i.e., in cancer that has spread), suggesting that they could be more than a bystander and could actually cause the tumours.
Research is ongoing to see whether tumours can be prevented by identifying carriers of these organisms and eradicating them with suitable antibiotics.
But antibiotics can also upset the balance of our gut bacteria, potentially allowing the ‘bad’ to flourish — perhaps leading to health problems such as weight gain and cardiovascular disease. See what I mean about nuance?
The problem is that our good bacteria are constantly under attack from our reliance on antibiotics and our dedication to an ever- cleansed lifestyle. The key is not to act once the horse has bolted, as it were, stopping the bad bacteria once they’re in situ, but to prevent this imbalance in the first place.
In terms of gut bacteria, that means a diet low in processed foods and high in probiotics and prebiotics (the types of fibre good bacteria feed on, such as onions, leeks, artichokes) and avoiding antibiotics if possible.
Now research is focusing on how the bacteria that colonise our skin can be beneficial, too. It begs the question of whether we need to be washing ourselves so very much.