Dear Doctor: I hate having migraines. The pain is brutal, they knock me down for days and everyone thinks I’m just having a bad headache. Why do they happen? Can you tell me about any new therapies?

Dear Reader: For anyone lucky enough to never have had a migraine, it’s much more than just a bad headache. Migraine is an extended, often debilitating full-body experience. Severe throbbing head pain is typically accompanied by nausea and sometimes vomiting. Other symptoms are extreme sensitivity to light, motion and sound. A migraine can last for several hours or several days.

Many people also have a range of symptoms before an attack. Known as a migraine aura, it’s a cluster of visual, sensory and cognitive disturbances such as flashes of light, prickling sensations on the skin and lapses in speech or reasoning. Migraines often conclude with a phase known as postdrome, sometimes known as a migraine hangover. Postdrome can include nausea, continued sensitivity to external stimuli, body aches, exhaustion and problems concentrating. In addition, studies show that individuals with chronic migraine are at higher risk of anxiety and depression.

Despite having been studied for at least 3,000 years, we still don’t have a definitive answer for what causes migraines in an estimated 3 billion people worldwide. It is known to be a complex neurological disorder, likely with a genetic component. Women are three times more likely to suffer from migraines than men.

Behaviors known as “triggers” can launch a migraine. These include a skipped meal, irregular sleep, changes to caffeine intake and emotional or physical stress. Foods associated with migraine include chocolate, fermented foods, aged cheeses, alcohol in general and red wine in particular. Birth control pills and antidepressants are also believed to have an effect on migraine frequency. Unfortunately over-the-counter pain medications, which can provide relief, can also result in a “rebound” headache.

In the past, migraine patients relied on a variety of medications for relief, the majority of them created to treat other conditions. These include antidepressants, hypertension medicines, Botox injections, opioids and a class of drugs called triptans. Vitamins and supplements such as vitamin B2, magnesium, Coenzyme Q10 and melatonin have proven helpful. And although aerobic exercise is known to reduce the frequency and severity of attacks, people who have regular migraines often feel too poorly to exercise regularly.

Most recently, a new class of drugs known as monoclonal antibodies, the first medications developed specifically for migraine sufferers, are offering hope. The FDA approved three such treatments earlier this year. Delivered via a monthly injection, they have been shown to reduce the number of migraine days in some patients by half. They’re costly and don’t work for everyone, but it’s worth checking with your doctor to see if they might be right for you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: What’s going on with that outbreak of lung disease that’s hitting people who vape? Our 20-year-old son and a lot of his friends vape sometimes, and we’re getting worried.

Dear Reader: You’re not alone in your concerns. Federal health officials have said that close to 200 cases of a serious lung disease that appears to be associated with vaping have been reported. There now also appears to have been at least one death caused by this illness, an adult male in Illinois, according to officials in the state.

The Centers for Disease Control and Prevention is investigating reports from 22 states to date. Most cases involve males ranging in age from 17 to 38. The U.S. Food and Drug Administration is continuing to investigate a potential link between the use of e-cigarettes and serious neurological symptoms, including seizures, fainting and tremors.

Symptoms of the respiratory illness include pressure or tightness in the chest, shortness of breath and difficulty breathing that becomes progressively worse. Some patients also have experienced fever, weight loss, nausea, fatigue and diarrhea. Imaging tests of the patients’ lungs have all revealed abnormalities, including areas of increased density, known as opacities.

In some cases, patients have required mechanical ventilation to aid in breathing and have improved after treatment with corticosteroids. An 18-year-old man in Florida who vaped went to a hospital emergency room and learned he had a hole in his right lung, which had caused it to collapse. Tests for infectious agents have been largely negative, which has added to the mystery of what is causing the disease. One behavior all patients have had in common is recent vaping.

The challenge is that the similarities end there. The patients had inhaled a variety of products, including cannabis-based products, nicotine and homemade substances. They had used a number of different vaping devices. They had purchased the products in a variety of stores and via several different online retailers. This has led investigators to turn their attention to the delivery system of vaping devices.

E-cigarettes work by using a coil to super-heat a liquid and turn it into an aerosol, which is then inhaled. These super-fine particles can then be drawn deep into the lungs. Vaping liquids contain numerous volatile organic chemicals and other substances, not all of which are identified on the packaging. Some of them are known to be potentially harmful. The flavorings used in vaping liquids also contain numerous compounds whose long-term health effects are unknown.

As federal and state health officials continue to investigate, medical professionals and the public have been asked to report any vaping-related symptoms or illnesses, along with specifics about the products that were used, to state health authorities.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I feel like I’ve tried every diet, and no matter what, I just can’t seem to lose weight. A friend who had a surgery that removed part of her stomach was finally able to lose 65 pounds. I wonder if that’s safe?

Dear Reader: You’re referring to a sleeve gastrectomy, a laparoscopic surgery that promotes weight loss by changing the digestive system. In a sleeve gastrectomy, the surgeon removes about three-fourths of the stomach, then uses the remaining tissue to create a pouch shaped somewhat like a banana. The new stomach is significantly smaller, which restricts the amount of food that it can hold. That means feeling satiated faster and with a smaller volume of food. This change in stomach size also results in a reduction of ghrelin, the so-called “hunger hormone,” which is produced primarily by the stomach. A decrease in ghrelin causes a decrease in feelings of hunger.

Sleeve gastrectomy, which is not reversible, is an increasingly popular procedure that began in the early 1990s. Originally introduced as part of a two-step weight-loss surgery, it has since become a stand-alone procedure. Unlike other bariatric procedures, such as gastric bypass surgery, the sleeve gastrectomy isn’t as strongly associated with malabsorption of nutrients, which can lead to malnutrition.

Patients who qualify for this surgery are typically between 18 and 75 years old, are morbidly obese, have a body mass index (BMI) of 40 or more and prior difficulty trying to lose weight. Although results vary, patients can lose 60% of their excess weight in the first two years after surgery.

As with any surgery, sleeve gastrectomy carries risks. Bleeding, infection, adverse reaction to anesthesia and blood clots are risks common to all surgeries. Although rare, it is possible for the newly formed “sleeve” to leak. Longer-term complications can include an increase in acid reflux, hypoglycemia, malnutrition, gastric obstruction and ulcers. Some researchers believe the drop in ghrelin may also have long-term effects that are not yet known. Ghrelin not only stimulates appetite, it aids in fat storage and plays a role in regulating blood sugar and in the release of growth hormones.

After the procedure, while the digestive tract is healing, patients must follow a structured eating plan that provides nutrients but doesn’t stretch the newly constructed stomach. The first stage restricts patients to a liquid diet. This is followed by a gradual switch to pureed foods, followed by soft foods. About three months after surgery, patients will have completed a highly controlled switch to solid foods. Life with a sleeve gastrectomy means small, nutrient-dense meals. Dehydration is a risk, so it’s important to drink plenty of water each day.

In our own practices, we continue to first recommend conservative lifestyle interventions for weight loss. These include following a regular exercise program, working on nutrition and sometimes talking with a therapist. However, we have had patients who do everything correctly and are unable to reach a safe and healthy weight. In those cases, we find that weight loss surgery can be effective.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)