Keith Roach, M.D.

By KEITH ROACH, M.D.

Syndicated columnist

Dear Dr. Roach:

I read your recent column about migraines and strokes. About 40 years ago, I began having occasional visual-interference episodes with zigzags, blurry central vision and more that lasted for about 30 minutes. My doctor described them as ocular migraines.

When I read about migraines, the first possible cause that was listed were preservatives, so I started reading labels. My episodes occurred only after eating food with added nitrites and sulfates. It was very consistent, so I now read labels and avoid them. And thanks to the fact that more foods are now being made without them, at age 85, I have not had an episode in many years. It has made me a more careful and healthy eater.

Would I still be more likely to have a stroke? Is this a common cause of these auras, or do causes vary in people? I would hope that others would find a sure cause and solution like I did. — D.W.

Answer:

Food additives, especially nitrites but also sulfites and sulfates, are known triggers of migraines in people who are susceptible. Finding and eliminating the triggers for migraines can be helpful, but not everyone is able to identify their triggers.

Red wine (which contains trace amounts of sulfites, even if more aren’t added) is one of the most common food triggers, but caffeine (and caffeine withdrawal) is another common cause. Poor sleep, excess stress and hormonal changes (especially in menstruating women) are also commonly reported.

Some perceived triggers may actually be an early part of a headache. Chocolate cravings can be part of the prodrome of a headache, so people may think that chocolate caused the headache when, in fact, the headache was already on its way.

Headache with aura can be confused with a stroke. A recent column of mine tried to point out that positive findings like zigzag lines make a migraine with aura very likely, while transient ischemic attacks and strokes are exceedingly unlikely.

However, there is an increased risk of stroke in people who have migraines with aura. This is particularly the case in younger women. I suspect but cannot prove that having fewer migraines after removing the triggers, as you have, probably does mitigate the small, increased stroke risk.

Still, it is important for all people with migraines to do what they can to reduce their stroke risk through a healthy lifestyle. Elevated blood pressure and cholesterol might be worth treating, even if they are fairly mild. Diabetes should be as well-controlled as possible. Finally, with strong evidence showing that the shingles vaccine reduces stroke risk, I’d recommend that you make sure you have had the two-dose shingles vaccine.

Dear Dr. Roach:

I’m a 75-year-old female who is hoping to keep her hair from falling out. I currently use minoxidil, but I’m not seeing any improvement. What else would you suggest? — G.E.

Answer:

Most women in their 70s lose some of their hair. The most typical pattern is a general thinning that is somewhat worse on the crown. I do recommend seeing a doctor about this to be sure of the diagnosis. There are other patterns of hair loss, some of which are related to thyroid disease and — less frequently — to serious systemic diseases.

If the diagnosis is confirmed as female pattern hair loss, then in addition to minoxidil (which can be used either topically or as a low-dose oral pill), spironolactone (or another anti-androgen) would be the other first-line treatment. Some physicians use prostate medicines like dutasteride, and ketoconazole shampoo can also be helpful. These drugs are usually used in combination with each other.

Finally, laser or low-level light therapy, microneedling, and platelet-rich plasma have some benefit, although these are much more expensive options. A dermatologist is the expert in diseases of the hair and scalp.

Dear Dr. Roach:

I have a question about possibly getting a measles vaccine at the age of 67. I do not recall ever getting measles. But I am the youngest of four, so it is likely that I was exposed through them. I happen to have my vaccination records as a child, and it does not show any inoculation for the MMR vaccine.

The last recorded vaccination was in 1967 after the introduction of this vaccine, which I believe was in 1963. Can I assume that I wasn’t given it because I had already had the disease? Or should I play it safe and get the vaccine now? I currently live in Florida, where we are in the middle of two outbreak areas. — L.P.

Answer:

You were born in 1958 or 1959. You are right that the vaccine was introduced in 1963, and without proof that you’ve gotten it, I would say that you’re considered to be possibly susceptible. You are quite right that you might have also had the disease; however, in an outbreak setting, it is prudent to be sure that you are immune as getting measles at the age of 67 is dangerous, with about a third of people requiring hospitalization.

There is no effective treatment for measles, and the best we can do is support someone and hope. In my opinion, the best option is to get tested for immunity. Your regular doctor can do this by checking your antibody level. If you are immune, there is no need for the vaccine.

I agree it’s likely that you are immune given your family situation. However, if the blood test is negative, then I recommend two doses of the vaccine, separated by at least 28 days.

People who do not live in an area of an outbreak do not need to get tested. Anyone who was born before 1957 can be considered immune. (Health care workers are excepted and still need antibody testing or documentation of their vaccination.) Anyone with documentation of two doses of a live-attenuated vaccine can be considered immune.

Dear Dr. Roach:

In a recent column about osteoporosis, you said that a hip fracture “is devastating.” I’ve heard this often, but honestly, I don’t really understand why this particular injury often leads to things going downhill. Could you elaborate? Thank you on behalf of us 83-year-olds! — T.G.

Answer:

A femoral neck fracture is the most common type of hip fracture in older adults. It is devastating because the statistics are grim: About 15% to 25% of people will die within one year, while the majority of survivors experience functional decline. Between 40% and 60% of people never regain the mobility that they had before the fracture, and 10% to 20% require a nursing home within a year.

The numbers are grim to a large extent because many people who fracture their hip already have quite significant medical problems. A person who has good function before a hip fracture has a much better chance of doing well after getting surgery to fix the hip. Even so, it’s far better to prevent a fracture than to treat one.

I have seen too many patients and family members do poorly after a hip fracture, which is why I work so hard to screen patients for osteoporosis and treat the condition to prevent a fracture.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu. Copyright 2026 North America Syndicate Inc. All rights reserved.