dr. roach

DEAR DR. ROACH: I would like to know what you think about brain supplements and whether you would recommend any. My age is 84 and I am in good health, but my memory is getting bad. — B.S.

ANSWER: I see advertisements daily for supplements touted to have benefits in preventing or slowing progression of dementia. A careful review of the published data (where there is any) reveals no consistent evidence that supplements are effective in the treatment or progression of Alzheimer’s disease. There may be one exception: vitamin E. Patients who want to try that in reasonable doses, such as 2,000 IU daily, may have a modest benefit. These benefits are likely to be smaller than with the approved prescription treatments for Alzheimer’s disease, and even those are fairly small in most cases.

Regular moderate exercise; a mostly plant-based diet high in fruits, vegetables and legumes and with moderate fish and low meat; and cognitive exercises all are much more likely to show benefit than any medication or supplement. Conditions that can adversely affect brain health, especially poorly controlled diabetes and blood pressure, should be aggressively treated.

DEAR DR. ROACH: After six weeks of severe headaches, which were originally thought to be migraines, I was diagnosed with thunderclap headaches. These headaches suddenly stopped, and I have not had another for over two years. The doctor gave me a prescription for Maxalt to be taken as soon as I feel a headache coming on. It can be repeated twice within 30 minutes of each dose. Would you please explain this condition? — P.M.

ANSWER: A thunderclap headache is, as its name suggests, a very severe headache that begins suddenly and reaches full intensity within one minute. This is a medical/surgical emergency, as one of the most common causes of TCH is a subarachnoid hemorrhage, usually caused by rupture of an aneurysm. This possibility must be evaluated immediately (call 911!) with imaging studies and a lumbar puncture, also called a “spinal tap.” People will usually describe it as “the worst headache of my life,” and treatment is aimed at repairing the aneurysm as quickly as possible.

There are other causes of thunderclap headache, which can be considered after exclusion of subarachnoid hemorrhage. The course of your condition — that is, multiple episodes over several weeks — suggests you have a condition called reversible cerebral vasoconstriction syndrome. In this condition, some of the arteries in the brain constrict and stay constricted for a prolonged time. It is not known why this happens.

It is most common in women in their 40s. There are several predisposing conditions and medications, including preexisting migraine, although people with migraines know immediately that a TCH is NOT a typical migraine. Triptans, such as rizatriptan (Maxalt) is one of the medicines that can trigger reversible cerebral vasoconstriction syndrome, and many authorities recommend against using them. Double-check with a neurologist about this treatment. Otherwise, there are no specific treatments for RCVS. Ninety percent to 95% of people will have a course like yours, with no permanent damage and no recurrence.

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