Dear Doctor: Do NSAIDs really increase the risk of heart attacks, as I read in the news recently? I take aspirin or Tylenol whenever I get a headache, which is at least a few times each month. Should I be worried?

Dear Reader: Nonsteroidal anti-inflammatory drugs, or NSAIDs, are a widely used group of medications taken to reduce or relieve mild to moderate pain. Ibuprofen, which sells under brand names like Advil and Motrin, and naproxen, which appears under brand names like Aleve and Naprosyn, are among the more popular NSAIDs. Others include diclofenac and celecoxib, both of which require a prescription. And to get right to your question, yes, a body of research warns that NSAIDs are associated with an increased risk of heart attack and stroke.

It's estimated that up to 30 million people in the United States turn to NSAIDs each day to deal with aches and pains, cramps, fever and swelling. The drugs work by blocking the enzymes that produce compounds known as prostaglandins, which trigger the inflammatory response that your body uses to heal itself. That inflammatory response is what causes the aches, pains, fever and swelling when we get hurt or fall ill.

However, NSAIDs can also act on platelet aggregation and cause blood clots, increase fluid retention, raise blood pressure and cause arteries to constrict. When this happens in the right combination and in the wrong person, it can lead to a heart attack or a stroke. Some of the more minor side effects associated with NSAIDs include stomach upset, nausea, diarrhea, rash and constipation.

In 2005, the Food and Drug Administration issued a warning about the link between NSAIDs and stroke and heart attack. A decade later, working from the results of additional research, the FDA strengthened that warning. Since then, numerous studies have come to the same conclusion.

Most recently, a study from the University of Montreal Hospital confirmed the link between NSAIDs and heart attack or stroke. Researchers found that after as little as one week of use of NSAIDs, heart attack risk increased between 20 and 50 percent. One month after the drug was stopped, that risk declined sharply.

While some NSAIDs require a prescription and are taken under a doctor's guidance, quite a few are available over-the-counter. That means that unless buyers are taking the time to read the small print on both the bottle and that origamilike paper insert in the package (and, really, how many of us actually do?) and then strictly following the dosage guidelines, they risk running into trouble.

As for whether you need to worry, the answer is no.

The aspirin you're taking is an NSAID, but the good news is that it is exempt from the stroke/heart attack warning. In fact, because aspirin inhibits the clotting of blood for periods of time ranging from four days to a week, it is commonly used to prevent heart attacks and strokes. Tylenol, the other popular over-the-counter pain reliever you're taking for headache pain, is not considered to be a NSAID. However, do be sure to read the label -- when it is not used properly, Tylenol can affect the liver.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I've suffered with migraines for years, and my doctor wants to give me a daily medication to prevent them. I'm reluctant to rely too heavily on drugs. Aren't there any vitamins or non-prescription medications I can take to prevent migraines?

Dear Reader: The short answer is yes: You can reduce your risk of migraines through non-prescription methods -- and you're not alone in trying to do so. Migraines affect about 12 percent of people in the United States, occurring more often in women, in people between the ages of 30 and 39, and within families.

The headaches can last for hours or up to three days, causing an inability to focus and significant lost productivity. A retrospective analysis of migraine sufferers found that emotional stress was a trigger for 80 percent of them, missing a meal was a trigger for 57 percent, and lack of sleep was a trigger for 50 percent.

When it comes to behavioral interventions, relaxation techniques, cognitive therapy, consistent aerobic exercise and good sleep hygiene can all decrease the frequency of migraines. Now let's look at the data on nutritional supplements.

We'll start with coenzyme CoQ10. In a small 2005 study, patients who experienced migraine headaches two to eight times per month were randomly assigned to take either a placebo or 100 milligrams of CoQ10 three times per day for at least three months. The authors measured success as a greater than 50 percent reduction in the frequency of migraines. Only 14.4 percent of those who took the placebo showed this level of reduction, but 47.6 percent of those who took CoQ10 reduced their frequency of migraines by that amount.

Then there's the B vitamin riboflavin. A small 1998 study found that 59 percent of people who took a daily dose of 400 milligrams had a greater than 50 percent reduction in the frequency of migraines, compared to 15 percent of those who took a placebo. However, it took three months for riboflavin to show this benefit.

Knowing that sleep problems increase the risk of migraines, researchers in a 2016 study compared the effects of 3 milligrams of melatonin to the effects of the anti-depressant amitriptyline or of a placebo. After three months, 54.4 percent of people who took melatonin had a 50 percent or greater reduction in frequency of headaches compared to 39.1 percent in the amitriptyline group and 20 percent in the placebo group. That seems promising, but note that a 2010 study of people who took 2 milligrams of melatonin for a two-month period did not show significant benefit when compared with a placebo.

Now let's move on to botanicals. Small studies have suggested that the root of the butterbur plant, Petasites hybridus, can decrease migraine frequency, but the plant can be toxic to the liver and, in animal studies, has led to genetic changes that could lead to cancer.

Feverfew is another potential treatment. A combined analysis of six trials of the herb yielded conflicting results. Overall, the studies showed that feverfew can decrease the frequency of migraines by 0.6 times per month compared to placebo. Note that it can cause rebound headaches if abruptly stopped, however.

In short, more studies are needed. That said, CoQ10, riboflavin and melatonin all seem like reasonable approaches to help prevent migraines.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My sister-in-law read that sandboxes are full of germs, and now she won't let her kids play with my sons in our backyard. I can see how a public playground might be less than clean, but isn't she overreacting by putting my yard off-limits?

Dear Reader: It's possible that your sister-in-law is reacting to the results of a small study from Spain, which made a bit of a splash last summer. Researchers in Madrid tested the sand in 20 public sandboxes for children and 20 public sandboxes for dogs (who knew?) and found that both types of sandboxes were hosting a nasty bacterium called C. difficile, or C. diff.

Nine of the 20 children's sandboxes contained the pathogen, and 12 of the 20 dog sandboxes had it as well. Most commonly seen in nursing homes and hospitals, where it can spread from patient to patient, C. diff causes an intestinal infection that sometimes leads to severe diarrhea. Some of the C. diff strains in the Spanish sandboxes showed increased toxin production, and some were resistant to antibiotics, which are the primary form of treatment.

But this study isn't the first to point out the risks of sandboxes. By their very nature -- exposed to the potentially dirty hands, feet and bottoms of multiple children, and available to insects and animals -- sandboxes are a likely breeding ground for all sorts of unpleasantness. This includes bacteria left behind by human contact, as well as common parasites like roundworm eggs and hookworm larvae from the feces of infected animals.

While this all sounds quite dire, there are steps you can take to make your backyard sandbox safer, and to protect your children in whichever sandbox they use.

For your home:

-- Keep the sandbox covered when not in use. Whether you use a tarp or a wooden cover, it's important that the fit be tight. Cats, rats, mice and raccoons prefer a dry place to do their business.

-- If the sand gets wet during play, be sure to let it dry thoroughly before covering. Molds, yeasts, bacteria and other unhealthy things love a moist environment.

-- Replace sand regularly. Be sure to use play sand rather than construction-grade sand, so it will not contain silica.

-- Rake and sift the sand frequently to check for debris. If you find any scat, you have to assume the entire box is contaminated. Dig it all out and start fresh.

For your kids:

-- Make it a rule that they wash their hands before and after playing in any sandbox.

-- We're sorry, but with younger children you're going to have to keep an eagle eye to make sure hands -- and sand -- don't get into the mouth.

-- Wash and disinfect any and all sand toys your kids use. It just takes a minute and makes a big difference.

-- Clothes that have been in the sandbox should head right into the washer. Shoes should be thoroughly brushed clean.

It sounds like a lot of work, but depending on how your kids feel about the sandbox, it can be worth the effort. And who knows? Your sister-in-law may even relent and let her kids come over.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)