Migraine classically begins a year or two before puberty, when it is more common in boys, but after puberty three times as many women as men are affected. The number of people affected increases until the age of 40, then begins to decline. When there is a family history of migraine, as in 50 per cent of cases, it is not difficult to predict which children will develop it in later life, although the symptoms in early childhood are different. My father and sister suffered from migraine, as I did, but even when my three children were very young I guessed — accurately — which of them would develop migraine later (the child, when stressed, appears pale, sweaty, shivering, and even feels as if he has a temperature; once he has had some sleep and the excitement or exam is over, all is well).

Our reader’s lifestyle — a busy work and social life and travelling, as well as the duties involved in running a household — is the traditional background of migraine. A neurologist for whom I once worked told me that “being chased by time” (ie, having too little time for the tasks of the day) was a standard way of inducing a migraine attack.

Other precipitating factors include tiredness, a strenuous schedule and starvation — even missing a couple of meals can bring on an attack, especially if the reason is a heavy workload. Nasal and sinus infections, alcohol in excess or of a type that disagrees with the sufferer, eating particular “trigger” foods and, in women, hormonal changes associated with their menstrual/ovulatory cycles, have a marked influence.

Migraine sufferers like to cite the old clinical observation that they are more likely to be clever toffs than sons and daughters of toil, but statistics suggest that this imbalance is in fact related to the number in each social sector who attended their doctors.

The first line of treatment, to alter lifestyle, is rarely possible in practice — it is difficult to modify an obsessive, meticulous personality, so most patients need drug therapy. Prophylactic (preventive) treatment is usually considered if there are more than two attacks a month. The most commonly prescribed medication is beta blockers. The effect of these on my migraine was miraculous — my attacks fell from two or three a month to one or two a year. Other prophylactic drugs are amitriptyline — a tricyclic antidepressant, given in small doses — and the 5HT antagonist pizotifen, given at night. Methysergide is a partial 5HT antagonist but its side-effects, including nausea and dizziness, can be disturbing.

These measures are not always successful but recently a new therapy, Topamax (topiramate) has been licensed for prophylactic use in patients who have more than three migraine attacks a month and have failed to respond to other treatments.

Three trials have shown that when this medication, usually used as an anticonvulsant, was given prophylactically for 14-month periods, it reduced the number of crippling migraine attacks and often enabled patients to carry on with their normal lifestyle. Topamax is prescribed only by hospital doctors, or for patients whose treatment is shared between hospital and GP.

Last week’s question on atrial fibrillation produced a heavy and generally enthusiastic correspondence. The supplementary questions can be divided into three groups, as follows. What are the dietary restrictions associated with anticoagulant treatment with warfarin? What is good, helpful exercise? Have I underestimated the problems of people with uncontrollable atrial fibrillation?

The most important aspect of diet when a patient takes warfarin is alcohol. Once they start on warfarin they must thereafter take exactly the same amount of alcohol each day. Whatever the occasion — parties, weddings, reunions, birthdays — the rule applies. If the patient has opted to take half a bottle a day, they must have that half bottle whether they are hot or cold, sad or elated — no more and no less, Sundays included.

Diet is more difficult. The usual advice is to follow the same bland, schooldays diet with a standard amount of vegetables and fruit daily. The amount of vitamin K (found in many fruits) has to be watched, and there have also been reports that large amounts of vitamins C and E may occasionally help to destabilise warfarin control.

Tobacco can also unbalance warfarin, but the most obvious destabilising foods are fruits — especially cranberry, which potentiates warfarin. Quinine in old-fashioned tonic water also has this effect, whereas ginseng reduces the body’s response to warfarin. The patient’s clinic will check for the effect of any additional or different drugs prescribed. In general, the key is to follow a balanced diet and stick to it religiously.

The exercise rules for anyone with cardiovascular troubles are the same: it should always be brisk without being violent and undertaken at least three days a week, preferably daily. Heavy exercise once a week is worse than none, while twice a week is not much better than being a couch potato.

The best exercise is daily brisk walking, cycling (if the air is not too polluted) and swimming (provided the heart is normal, which is not guaranteed if there is atrial fibrillation). Standard, regular exercise for those at risk of cardiovascular incidents should, if possible, be twice that of apparently healthy people with no obvious cardiovascular risk factors — that is to say, instead of 30 to 45 minutes of brisk walking, slightly more than an hour a day. These rules apply even if the patient was an Oxford Blue in his youth, a marathon runner or spent all his army leave climbing in the Himalayas. The only exception to daily exercise is when the weather is inclement, whether too cold (especially if windy), or hot and muggy.

Some readers thought that we had underrated the dangers and distress of atrial fibrillation. I thought that we had perhaps been too worrying, especially by mentioning the greatly increased incidence of stroke in patients who are fibrillating, and hence the need for anticoagulation.

Like 5 to 10 per cent of over-65s, I have experienced atrial fibrillation. But, as in most cases, the problem was resolved and normal rhythm was restored. Those readers most concerned about the lifestyle implications were younger ones whose atrial fibrillation had proved difficult to control. Most of them probably had “lone” atrial fibrillation, ie, no cause for it could be discovered. These people may well have terrible problems. Sometimes cardiac ablation — a description of which was omitted last week for lack of space — is a possible answer.

Ask Dr Stuttaford Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context.