Q. I get bad, throbbing headaches and get so nauseated I can't do a thing for hours! Pain pills just don't help. What can I do?

A. You have migraines, which affect 18 percent of women and 6 percent of men. Untreated migraines often last 4 to 72 hours. There's often sensitivity to light or sound, and worsening when you climb stairs. You may get auras, where you see zigzag lines, flashing lights or other patterns before the headache. Migraines often start between ages 10 and 20 and peak in middle age. Carsickness is common in people with migraines.

See your physician to make sure something serious isn't causing your headaches. Wake up the same time on weekends that you do on weekdays, because over- or undersleeping can cause migraines. So even if you party till 3 a.m., get up at your usual time.

Drink the same amount of caffeine on the weekends that you do on workdays, as caffeine withdrawal can cause migraines. And think about possible triggers like aged cheeses, dairy products, fatty foods, alcohol, chocolate, stress, fatigue, exertion, skipped meals, perfumes, nitrates and nitrites in preserved meats, or exposure to glare or flickering lights.

It sounds like you've already tried drugs like ibuprofen and naproxen (Aleve, etc.). If so, ask your doctor about serotonin-active drugs like naratriptan, rizatriptan, sumatriptan, zolmitriptan or dihydroergotamine. These can be given by mouth, nasally, or by self-injection.

But beware of rebound headaches, where you get frequent headaches from overuse of pain pills like Vicodin (hydrocodone), oxycodone, Midrin (Isocom), serotonin-active drugs, ergotamine and pills containing butalbital or caffeine.

This can even lead to daily headaches. To avoid this, don't use such drugs more than two days a week.

Feverfew, riboflavin (vitamin B2), acupuncture, spinal manipulation, and hypnosis don't work that well. But relaxation training, thermal biofeedback combined with relaxation training, EMG biofeedback and cognitive-behavioral therapy can reduce migraine frequency.

And if you're still getting two or more bad episodes a month or need to use headache pills more than twice a week, think about daily pills to prevent migraines in the first place. The best are propranolol (80 to 240 milligrams a day), timolol (20 to 30 milligrams a day), topiramate and valproic acid. Amitriptyline (30 to 150 milligrams a day) or nortriptyline sometimes works.

Be patient. It may take two to three months before headaches improve. In women, migraines that occur with their periods can be prevented by taking frovatriptan 2.5 milligrams twice a day for six days, starting two days before their periods.

Many folks with migraines suffer needlessly, and finding the treatment that works for them can make a huge difference in their enjoyment of life.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.