Q. Several weeks ago you answered a question from a woman who suffered an excruciating headache whenever she had an orgasm. Although her neurologist had done a CT scan and told her nothing was wrong, as many as 20 percent of brain aneurysms don’t show up with such a test.
Sex related headaches are a HUGE warning sign. A better test is an MRI angiography with gadolinium or a lumbar puncture done at the time of the headache. Please tell this person to find a new neurologist and get more tests. As an emergency physician, I have seen the tragic end results when patients are reassured by inadequate testing.
A. Thank you for pointing out how difficult it can be to diagnose sex headaches. Some people experience a gradual onset during sexual arousal.
Others, like this reader, report explosive head pain during orgasm. Bleeding in the brain can sometimes be responsible for these “exertional” headaches, which is why it is crucial to get a complete neurological workup.
If it proves to be a “benign sexual headache,” some doctors recommend taking ibuprofen or naproxen 30 minutes before sexual activity. Others prescribe the blood pressure drug propranolol or the anti-seizure medicine, Lamictal (lamotrigine).
Q. I was diagnosed with low thyroid several years ago and was put on Synthroid. At first I felt much better, but lately I am experiencing symptoms of low thyroid again. I am always tired and often cold, can’t lose weight and have very little interest in sex. I am also troubled with constipation, very dry skin and brittle, ridged nails.
My test results have been jumping around, but my doctor doesn’t seem interested in following up on this. Are there any advantages to taking Armour thyroid? I’d really appreciate any information you can send me.
A. The symptoms you mention are consistent with low thyroid activity. Laboratory results are essential for diagnosing thyroid dysfunction, but a new study in the British Medical Journal (Feb. 8, 2003) suggests that the standard test (TSH) doesn’t always correspond to the clinical picture.
To help you interpret your lab results and understand your treatment options we are sending you our new Guide to Thyroid Hormones. Anyone who would like a copy, please send $3 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.
Armour thyroid is dried thyroid gland in pill form. It fell into disfavor when synthetic thyroid (Synthroid) became more popular. Some physicians are now returning to Armour thyroid or prescribing a combination of T3 (Cytomel) and T4 (levothyroxine) for patients who don’t respond adequately to Synthroid alone.
Q. My cholesterol level is 240 and my HDL is 82. I can find no information on whether or not an HDL level above high normal is considered a problem. Do I need to take medicine for this?
A. HDL cholesterol is considered highly beneficial and may actually help protect against heart disease. Your ratio of total cholesterol to HDL is 2.9. Anything below 4.5 is considered good. Lowering your total cholesterol might also bring your HDL down, which would not necessarily be a good idea. A new test for inflammation called CRP may be worth discussing with your physician.