Dear Dr. Roach: I am 73, and in the last few years, I have experienced headaches for the first time in my life, and I do not know the cause. I am in excellent health otherwise. I am not overweight; I exercise three times a week at a fitness center; I do not have high blood pressure; and I don’t have any significant illness other than having irritable bowel syndrome. (I have a lot of gas, stomach discomfort and diarrhea about every seven to nine days.) I do take a probiotic daily and take Imodium for diarrhea. My only prescription medication is 10 mg of atorvastatin daily.
I used to get headaches every five to seven days, but in the last few months, I have been getting a headache every one to two days with the severity ranging from light to moderate. It usually lasts 30 to 90 minutes. The headaches are never during the daytime, usually in the evening, in the morning before I get up or during the nighttime. Once I get up in the morning, the headache usually goes away, and if I take an over-the-counter headache medicine with ibuprofen and caffeine, my headache improves. The headache does seem to coincide with my stomach discomfort from IBS.
My question is, do you think these headaches could be related to my IBS? Is this something to be concerned about? Do you think I should see a neurologist?
Anon.
Nearly everyone has suffered from headaches, and an occasional headache is not usually a cause for concern. But you have some factors that do raise my suspicions. The first is that it’s quite unusual to develop new headaches in your 70s. I am also concerned about the headaches worsening over the time span of just a few months.
IBS is a common cause of abdominal pain and changes in bowel habits. A headache is not a common co-occurrence. Migraines, on the other hand, are often presented alongside abdominal symptoms. Still, having migraines in your 70s is unusual.
If you were my patient, I would certainly consider a referral to a headache expert, such as a neurologist. In a situation like yours, I would expect the neurologist to order an imaging study of the brain, such as a CT scan or an MRI. Although most cases like yours do not have a worrisome cause for the headaches, there are enough red flags that I would recommend a careful evaluation.
Dr. Roach Writes: A recent column on ovarian cancer screenings generated numerous letters, and I am afraid that I didn’t do a good job of explaining.
It is appropriate for a woman with increased risk for ovarian cancer to have a referral to a genetic counselor for screening of a high-risk condition. This includes women with a family history of ovarian cancer. Most women in this situation will be offered multigene panel testing, which not only looks for genes like the BRCA family, but several other genetic conditions as well.
What isn’t appropriate is using an imaging test, such as a CT scan or an ultrasound, to look for ovarian cancer in absence of a known genetic risk factor. The first step is finding out whether there is a genetic predisposition.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
