DR. ELLIE CANNON: Was my sudden headache a pinched nerve – or something much worse?

Last week, while singing in my community choir, I felt a terrible vice-like pain in the back of my head. It disappeared after a while to a pain in the right side side of my head. Could it be a pinched nerve?

Dr. Ellie Cannon replies: This sounds like a thunderclap headache – a very severe, sudden pain often described as a blow to the back of the head. It may be normal to experience other symptoms such as nausea, drowsiness, neck pain or dizziness.

Usually the headache is most severe at first and may take up to an hour to go away. But often the pain can last a week or more.

Sometimes, but not always, this is the result of bleeding in the brain that may be the result of an aneurysm. This can be life-threatening.

It can be a sign of high blood pressure or the result of a sudden narrowing of the blood vessels in the brain, called vasoconstriction. This can be caused by exertion or stress, but also by straining, coughing or sneezing.

Some people have thunderclap headaches without a specific underlying cause, although this is rare. They may notice a trigger, such as coughing, exercise, or sexual activity.

There are case reports in the scientific literature of people with more unusual headache triggers, including singing.

Anyone with significant headaches should seek medical attention for urgent assessment and scans. This is especially important for people with new or sudden headaches, and for people who may be described as having their worst ever.

I am 88 and have just been diagnosed with cancer in several parts of my body. I have no pain and have been given morphine to help with a nasty cough, to be taken before I go to bed.

The instructions say ‘avoid alcohol’, but I miss my evening glass of wine. Could I still afford myself this privilege?

Dr. Ellie answers: Morphine is an opiate drug prescribed for palliative care – where the aim is not to cure the cancer, but to relieve symptoms and improve a patient’s quality of life as much as possible. It also suppresses the reflex to cough, similar to codeine linctus which we give for the same reason.

It is true that alcohol should be avoided along with morphine as it worsens side effects and contributes to drowsiness and confusion. This can be dangerous if people use a lot of morphine or drink a lot of alcohol.

But drinking a small glass of wine a few hours before taking morphine should not be a problem.

It can cause increased drowsiness, but in someone who takes the morphine before bed this is unlikely to be a problem. The benefits of enjoying the wine seem to be paramount here.

For a test drive, half a glass of wine could be tried first.

I have had three UTIs in the past six months and have been given antibiotics each time. Someone suggested I try it a drug called Hiprex, and I’d like to know what you think about it.

I am 68 and also suffer from IBS.

Dr. Ellie answers: In a postmenopausal woman suffering from recurrent urinary tract infections (UTIs), the most important thing to check is that any infection has been verified with a laboratory result.

This is to ensure that the infections are treated with the correct antibiotic each time, as some people have resistant infections and therefore may be given the wrong medication.

But it is also vital because sometimes symptoms are assumed or labeled as urinary tract infections when in reality they are not.

They have the symptoms that resemble an infection, but no infection is visible.

This is incredibly important because recurring urinary symptoms can also be a sign of other conditions including, in rare cases, ovarian cancer and more common things like thrush. Hiprex is not an antibiotic, but a medication used to prevent urinary tract infections.

The scientific evidence for its value has been growing, and for anyone with recurrent urinary tract infections it is worth asking their doctor for a trial.

Antibiotics are also used to prevent urinary tract infections, and a nightly dose is another option.

UTIs that occur around menopause may be related to a drop in the hormone estrogen.

The hormone is important for the bladder and urethra, as well as the vagina, and a lack of estrogen can sometimes be a cause of recurring urinary tract symptoms in women. This idea can be tested by trying estrogen cream, which is used vaginally and has only local effects on the pelvic area.

You can also buy a supplement called D-mannose, which is worth trying if you don’t try anything else.

Take it regularly every day for a month or two to see if it helps.

My unease about the Ozempic rush

I have spent much of the past week talking to patients and on TV about the so-called ‘miracle slimming shot’ Ozempic.

The interest followed news that the drug reduced the risk of heart attacks, even if people taking it weren’t that overweight to begin with. This is important because we previously thought the benefits came from shedding pounds.

It’s good news. But I can’t help but worry.

Obesity exists because of people eating huge portions, junk food specials, and a general lack of physical activity that starts at school age and just gets worse and worse.

Instead of the solution lying in tackling one of the causes, we will solve it with expensive medicines. It all seems a bit upside down to me.

Do you have a question for Dr. Ellie Cannon? Email DrEllie@mailonsunday.co.uk

Dr. Cannon cannot enter into personal correspondence and her responses must be placed in a general context.