Q. After being divorced several years ago I have started dating again. I am now spending time with a wonderful man but I have discovered to my dismay that whenever I have an orgasm I experience an excruciating headache. My vision is affected and the pain is so bad that I can’t do anything until it goes away.

A neurologist did a CT scan of my head and said everything was normal. Is there anything that can be done to prevent these migraines? They’re ruining my new relationship.

A. Headache associated with sexual arousal or orgasm is painful but not usually dangerous. Doctors call this “benign sexual headache.”

Seeing a neurologist was important, though, since a sex headache sometimes signals a serious problem like bleeding into the brain. One reader wrote: “When my husband was 25, he had a bad headache while having sex. The doctors told him it was viral. After a week of bed rest and Tylenol he felt better and went back to work. The next week it recurred, but this time the headache was fatal. He had a ruptured aneurysm in his brain.”

Since you have already been tested, ask your neurologist about preventive medication. Taking a pain reliever like ibuprofen or naproxen 30 minutes before sexual activity may prevent the headache. Doctors sometimes prescribe the blood pressure medicine propranolol as a preventive measure. And a letter in the journal Cephalalgia (July, 2002) reported that the anti-convulsant Lamictal prevented migraines triggered by orgasm in one woman.

Q. I was diagnosed with a low-thyroid condition many years ago. I have taken Synthroid, Levoxyl and Levothroid at various times, but nothing seems to help with my symptoms of weariness, depression, constipation, dry, cracked skin and horrible nails.

My doctor keeps adjusting my dose of thyroid medicine because the test results (TSH, T3 and T4) keep changing. I also take Prozac, Prempro and calcium and wonder if they are affecting my thyroid.

A. Your symptoms are typical of low thyroid function. Other signs of inadequate thyroid can include heavy periods, weight gain and low libido.

Calcium and iron can prevent absorption of medications like Synthroid or Levoxyl. Prempro and other estrogen formulations may affect test results, and Prozac might interfere with thyroid activity.

Lab numbers are important but don’t always reflect how a patient is doing. Some people need a balance of T3 and T4 to feel well. The thyroid medicines you have been taking contain only T4.

We are sending you our Guide to Thyroid Hormones with information on drugs that affect the thyroid and how to interpret lab results. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. T-4, P. O. Box 52027, Durham, NC 27717-2027.

Q. I was addicted to Afrin nasal spray for years. My doctors just told me to stop using it, but that never worked. I couldn’t breathe without Afrin. Then a physician prescribed Flonase and I was cured of my old addiction. Please let others know there is hope.

A. Rebound congestion from over-reliance on decongestant nasal sprays like Afrin can lead to long-term dependence. Steroid sprays such as Flonase, Vancenase or Nasonex can ease inflammation and limit drug-induced stuffiness.

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