Doctor's advice - Concerned about his headaches

• Q. My boyfriend is 23 and he suffers from severe migraine headaches, sometimes for weeks at a time. They are so terrible he has to remain in bed and close all doors and windows to stop light from coming into the room. When he was 13, he was in a car accident. The headaches started a couple of years after that. About four years ago, he did a CT scan to see what was causing his headaches. The doctors wanted to cut his head open. He refused and the operation was not done. He has been on many medications. Some worked for a while but others didn't. He has a shoebox full of pills of different colours and sizes. But he still complains of the headaches. Is there any medication on the market that would ease these terrible pains?

A. I am very sorry to hear that your boyfriend's life is in such difficulties. Things cannot be well for you either.

Migraine is usually treated with a simple painkiller, taken together with a drug called metoclopramide, which helps the painkiller to be absorbed from the stomach. In people who have migraine, painkillers often fail to work, unless metoclopramide is given at the same time.

But I wonder if migraine is the correct diagnosis. This condition is often confused with other headache-causing disorders, such as cluster headaches.

As I'm sure you know, migraine is common. It hits women more often than men. Typically, it causes a one-sided headache, which goes on for several hours. The pain is often associated with seeing flashing lights or zigzag lines, and also with feeling sick, or even throwing up.

Very often, attacks are brought on by trigger factors such as:

1. Eating chocolate;
   
2. Eating oranges or sucking limes;
   
3. Working very hard;
   
4. Stopping after a long period of work (this is why migraines are commoner on Saturdays).

Does the above pattern fit your boyfriend's illness? Frankly, I am concerned about whether his headaches are related to that car accident which he had as a teenager. I am also worried by the fact that doctors who did the CT scan apparently wanted to open up his skull.

Why did they feel that way? Surgeons don't cut open somebody's head because of migraine! Perhaps they suspected some abnormality inside his skull, which needed to be removed.

All in all, I think your boyfriend should go back to the doctor who was treating him at that time, and ask him to decide exactly what is wrong. Meanwhile, please try the metoclopramide. I wish you both well.

• Q.  I am on the Pill. Does it matter that I have accidentally been taking them in the wrong order?

A. If you are on a standard Pill, it doesn't matter in what order you take the tablets. But if you are on a brand described as 'sequential', in which the dose varies from tablet  to tablet, it would matter a lot if you took them in the wrong order. You would probably get pregnant.

• Q. I am a 17-year-old guy, and recently I had three wet dreams in a single night. Does this matter? Will it harm me?

A. No, it doesn't matter, and it won't harm you. Three orgasmic dreams in a single night is unusual but just suggests that you are exceptionally virile.

• Q. I am extremely concerned about my boyfriend's pre-come. Frequently, when we are involved in love play, drops of it get inside me. I am terrified that it will make me pregnant. But my boyfriend says that he has read on the Internet that this fluid does not contain sperm. Is he correct?

A.  I receive a lot of questions about pre-ejaculatory fluid, or pre-come and, obviously, this is a subject of some concern for a lot of young people who go in for petting.

If a male gets excited, pre-ejaculatory fluid (PEF) can be produced by certain glands located near the urinary pipe. You can tell that it is flowing when you see one or two clear 'drops' at the end of the penis. However, not all guys produce PEF and, if a young man does not do so, that is nothing to fret about.

Now, doctors have traditionally said the pre-come may contain sperm and that it can get women pregnant. However, that view has been challenged in recent years. For instance, research in Boston and New York focused on the pre-ejaculatory fluid of several dozen guys. In most cases, the fluid contained no sperm. Some samples did contain sperm but they were not swimming around, so they may well have been inactive.

However, the results of this study may perhaps have been affected by the fact that 23 of the men were HIV-positive. As they were not in the best of health, perhaps it is not surprising that they had no active sperm in their PEF. On the other hand, a later study of 12 healthy Israeli men found that none of them had any sperm in their pre-ejaculate.

Nevertheless, a number of doctors have expressed the view that a guy's penis could contain sperms from his previous ejaculation and these could sometimes leak out into his pre-ejaculatory fluid.

Summing up, I am of the opinion that the danger of getting pregnant from pre-come has been exaggerated in the past. The fluid probably carries only a slight risk of causing pregnancy. However, it is known that PEF can contain germ and pass on infections so, really, I would advise you to keep it out of your vagina.

• Q.  I have been told that all females should get plenty of calcium in their diet. But what foods contain calcium, Doc?

A. It is true that all females should consume a reasonable amount of calcium, even when they are teenagers. The reason for this is that calcium helps to prevent brittle bones and fractures in later life.

Foods which contain good amounts of calcium include:

1. Milk (including skimmed and semi-skimmed milk);
   
2. Yoghurt;
   
3. Cheese;
   
4. Canned salmon and other types of fishes.
   
5. Any type of bread that has been fortified with calcium.

• Q.  I am 23 and pregnant for the first time. My fiancé and I are both pretty passionate people. In other words, we like sex a lot. He gives me the most intense physical pleasure. I am being looked after by both a doctor and a midwife. The two of them have assured me that it is OK to have sex during pregnancy. However, I could not bring myself to raise the subject of orgasm with them. So tell me, Doc, is it safe for a woman to reach climaxes when she is pregnant? I do not want to do anything that could cause the baby harm.

A. There is no evidence that female orgasm harms the unborn baby.

Email questions for Doc to saturdaylife@gleanerjm.com. Also read Doctor's Advice in Outlook magazine in The Sunday Gleaner