Dear Dr. Roach: In March 2009, a family member was having terrible flu-like symptoms accompanied by horrific headaches. The symptoms lingered on for what seemed like forever, getting worse, even with hallucinations and cold sweats. At first, the doctor he visited thought he had mesothelioma, but after numerous tests and much research, decided it wasn鈥檛 cancer, and in July 2009 he was diagnosed with Wegener鈥檚 granulomatosis.
He ended up in the critical-care unit for four weeks and was given only two days to live, even being revived twice while there. He survived and is fairly healthy today. He is in remission and is now being weaned off prednisone, methotrexate and perhaps other drugs.
Do you know what caused him to contract this awful autoimmune disease? He had been very healthy, and luckily was in good physical condition when it was diagnosed. Thank you.
S.R.
Wegener鈥檚, also known as granulomatosis with polyangiitis, is an autoimmune disease of unknown cause that commonly presents with oral or nasal inflammation or ulcers, lung symptoms, abnormal X-rays and kidney problems. A biopsy of the affected tissue shows inflammation and granulomas (giant cells) around blood vessels. A blood test, ANCA, usually is positive. Unfortunately, we don鈥檛 really understand why the body attacks the cells around blood vessels. Infection, genetic predisposition and drugs all have been postulated.
Early diagnosis can lead to effective treatment, often involving prednisone or other steroids, and medicines that partially suppress the immune system. More information is available at wegeners-granulomatosis.com.
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Dear Dr. Roach: Both of my daughters are in their 40s and going through menopause (according to their doctors, so they are not guessing about this). Both daughters are having migraine headaches that are so severe that they are missing work (and both are practically workaholics who usually are able to tough it through physical problems). The migraines occur almost every time they have a period. Migraines are not daily during that time, but episodic (usually one per period). They do not have migraines except during menses.
One daughter was put on estrogen, which has helped her cramping, but she still is getting migraines. The other daughter has been referred to three physicians who all told her there was nothing that could be done but go on estrogen. She is now 49 years old and concerned that if she goes on estrogen at this point, she will simply have the same migraine issues again when she goes off it and wonders if that is actually worth just delaying having to deal with the migraines.
Is there any other solution besides estrogen for severe hormonal migraines?
S.S.
Estrogen-associated migraines are common. However, it usually is the drop in estrogen that triggers the migraine. That鈥檚 the reason many women get migraines around the time of their periods, as estrogen levels normally decline then.
For many women, migraines get worse years before menopause 鈥� and by 鈥渕enopause,鈥� I mean when periods stop altogether. As the periods become erratic, and sleep cycles are interrupted by hot flashes, migraines become worse, as they have in your daughters. However, once periods stop entirely, episodic migraines usually get dramatically better on their own.
During the erratic time before menses completely stop, estrogen pills, cream or insertable ring can be used to maintain a more constant estrogen level, which usually improves the headaches. This can be slowly tapered off when the periods could be expected to be finished.
