Doctor, doctor: Oily hair and migraines | Dr Tom Smith

I'm a 71-year-old woman who has always had oily hair. I thought things would improve with the menopause, but they haven't. A few hours after washing, it looks as if I have been in the rain. Why is this?
The greasiness comes from glands in the skin of your scalp and, in some people, these secrete more oil than they do in others. Your oil production is simply a part of your normal physiology. That's why some people have to wash their hair every day and others can get away with doing so only once a week. All I can suggest is that you find a good shampoo/conditioner combination that works for you. The menopause doesn't seem to alter scalp oiliness much, except when it is linked with low thyroid gland function – then the skin becomes dry and coarse, and the hair more sparse. That certainly doesn't appear to be your case.

I suffer from migraines and these are often brought on by long journeys – after one seven-hour train trip to Venice, I spent a day and a half taking as many painkillers as I could and unable to eat or walk. I'm soon flying eight hours to the Caribbean to see my boyfriend, whom I haven't seen in three months, and I really don't want to be faint, nauseous and in pain for our reunion. Any advice?
Please go to see your doctor well before your trip and explain the severity of your attacks. Several prescription medicines prevent migraines, among them beta-blockers, pizotifen (an antihistamine that's structurally related to antidepressants) and the anti-epilepsy drugs valproate and topiramate. Taken as soon as you feel an attack coming on, combinations of dispersible or soluble aspirin, or an anti-inflammatory drug with an anti-emetic will often cut it short. Your doctor will discuss the most appropriate one for you and will, I'm sure, after hearing your story, provide you with a prevention and treatment package to give you the best chance of avoiding an attack. Yoga and/or the Alexander technique have helped several of my patients. Finally, go easy on the alcohol: many people don't link alcohol with migraine attacks, but it's a common cause of them.

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