 Hello, and welcome to Quality of Life. I'm your host, Dave Augustine. This episode, our topic of discussion is headaches and strokes. And it just so happens that May is Stroke Awareness Month. Joining us to help talk about this subject is Dr. Thomas Weifel from Prevea Neurology. Dr. Weifel, welcome to the show. Thank you very much. Another special announcement is we also have the Sheboygan North High School Broadcasting class here today joining us and watching our production. So thank you to that class for also joining us. Dr. Weifel, how long have you been in the study of neurology, and what does neurology consist of? I've been practicing in Sheboygan since 1980. And neurology is the study of the brain, spinal cord, nerves, the diseases that affect those structures, and the treatments that we have available for them. OK. Getting into our topic a little bit deeper, headaches and strokes, what are headaches and what causes them? Headaches basically is any condition that causes discomfort or pain in the head, face, jaw, or neck. And there are many different causes for headaches. And we can review those as we go along. Sure. I think one of the biggest two differences is the migraine. That one seems to be a whole different type of pain versus a regular traditional headache, where I decide you got whatever. What's a migraine versus a regular type of headache? Well, actually, there are probably hundreds of different headaches. And the American Headache Society has divided them into two main categories. There's primary headaches and then secondary headaches. Secondary headaches are kind of easy to understand because they're caused by something else, whether it's a tumor in the head or infection or an aneurysm or bleeding. And the primary headaches is the density of itself. In other words, there's nothing else that's causing it. But the headache is the condition. Migraine is a primary headache. Regular headaches, which are probably more classified as tension type headaches, are also primary headaches. So they're all in the same main category. OK. I have to ask this because I've always wanted to bought this. I go out on Friday night and I have a few beverages to drink, let's say. And they all say, oh, my goodness, do I have a headache the next morning? How does alcohol play in creating headaches? Alcohol dehydrates your body, actually. And it's kind of a poison or a pollutant to nerve cells. So the next day, the headache is caused by the biochemical changes that occur in the brain as a result of the irritation from the alcohol and also the dehydration that occurs from water brain pulled out of the brain itself. And sometimes people think that having another glass of alcohol will help that. But in all honesty, water is better. Water is better, definitely. With the different types of headaches, does that pose or is that a warning sign of possibly different threats or different conditions that could be going on? Absolutely. As I mentioned for the secondary headaches, those can be caused by potentially lethal problems, including the aneurysms or tumors or infections inside the brain. And those headaches need to be evaluated completely and treated in order to prevent further problems. OK. I'd probably answer this question already, but with the different types of headaches that are different types of cures or different things you can do to relieve the pain? Right. The cure for a secondary headache, if it's an infection, we treat that with antibiotics. If it's a tumor, then we treat it surgically or with medicines that might reduce swelling. Ultimately, the treatment for those problems is to treat the condition. But for primary headaches like migraine or cluster headache, the treatment is usually medical because it's a chemical problem inside the brain that's causing the pain in the nerve cells of the brain. And we have to kind of control that either with pain medication or with migraine-specific medication, which we have available. OK. Are there home remedies that people can use to help relieve the pain of headaches or help? Absolutely. I mean, over-the-counter medications can be very effective, aspirin, believe, ibuprofen. Those are very effective, especially if they're taken early in the course of a headache. One thing that we have to caution against is frequent use of any medication because a person can get medication overuse or rebound headaches similar to the alcohol withdrawal headache the next morning. You don't have the aspirin or the ibuprofen in your bloodstream, and you get a headache from not having that available. So we have to be careful about how much is used. Well, especially also how to infect your stomach. You know, they always say, I don't do so much. Ibuprofen or aspirin, because then you wind up hurting and infecting your stomach. That's true. So how does that work? OK, if I have a headache, I take aspirin. It goes into the bloodstream. So how does that actually cure the headache or make it go away? I've always wondered about that. The biochemistry of aspirin is such that it reduces inflammation through a very kind of cascade of anti-inflammatory effects. And migraine specifically is a headache that's associated with inflammation around the blood vessels inside the head. And if that can be either prevented or reduced with anti-inflammatory medications, then the headache can be relieved. OK, I often wondered about that. How an aspirin can make pain go away? It's like it knows where to go right to there and take care of it. Well, it's throughout your whole body. So it can treat a lot of different pains. OK, can joint or vertebrae alignment cause headaches? You know, once in a while you hear people go to a chiropractor and get an alignment, and that seems to help their headaches. It can. Physical therapies can be very useful to relieve the secondary features of a headache. There's a lot of time that there's musculature tension that's associated with migraine because the nerves for the pain center inside the head actually extend down into the upper levels of the spinal cord. And that sort of spreads the headache outside of the head into the neck. And relief of those structures mechanically can be helpful. Frequently we need to add medication in order to extend the benefit of the mechanical treatments or to prevent the headaches. OK, say if I have a headache that just won't go away. I've tried diaspora and I've tried anything else that I can think of. What should be the sequence of events or path I should take to eventually that may wind up with somebody like yourself? What steps should I go through? Well, I guess for intractable headaches, whether it's one episode, if it goes on for several days, for example, a migraine becomes intractable after 72 hours. And at that point in time, we use what we call rescue medication, which is pretty much anything that's available or anything that'll work. But we try to get people away from that particular situation by teaching them in sessions like this that there are many treatments available to prevent that from happening. And that's part of why we're here today is to tell people that there's a lot of treatments that are available that are specific for migraine either in prevention or in preventing the progression of a headache to that stage. OK. At what point would you see somebody as far as helping to treat a headache? If the headaches are intractable, we frequently get involved that way. And it's probably important to understand that if a person who has not had headaches in their lifetime begins to develop headaches, that's a totally different situation. And that's sort of a signal for the evaluation for a secondary headache, specifically something that might be happening inside the brain. So that would be another reason that I might get involved. Or if a person has a headache with other neurologic symptoms like vision loss or double vision or weakness in an arm or leg, those kinds of things are important to be evaluated. I know once in a while, I'll go along fine. And all of a sudden, it's almost like clockwork all of a sudden, I just get a headache and it will not go away. I can just actually, when I feel my head, I can feel it pounding and it just will not go away. I mean, I try ibuprofen, I try aspirin. And finally, the best thing to do is just to lay down and let it take its course. And even then, it usually takes a couple days. Correct. Again, physical treatments like ice might be helpful. Sleep is usually extremely beneficial. And if we have patients who don't have good sleep habits, frequently we'll use preventative medications that are sedating in order to reduce their headache frequency. OK. As I talked about earlier, mentioned earlier, May is stroke month or stroke awareness month. So I'd like to shift a little bit and talk about strokes. If we go basically, what is a stroke? What causes it? I think we have a slide. Yeah, we have a slide. OK. A stroke is caused by interruption of the blood flow to the brain. I don't know if we have that slide up. But in the slide, we can see that there's an outline of the head. And all the blood vessels are coming out of the chest, going into the head. And if we block with a blood clot any one of those little blood vessels, or if one of them breaks, then the blood flow doesn't penetrate the brain cells, and those cells will not work. That's what a stroke is. A stroke is loss of blood, basically, to sections of the brain. And ultimately, oxygen. Correct. But since your brain needs oxygen in order to function, the brain is basically a computer. And it creates electricity that controls the rest of your body. And it needs oxygen and glucose in order to function. And those things are carried by the blood. And if there's an interruption, then those nerve cells can't create electricity for control. OK. With strokes, what are the awareness signs of the strokes? The signals that you should watch for? We do have a kind of a quick way for people in home situations to kind of think about a stroke. I think that we have another slide to that effect. Basically, just to remember the word fast. So look at the face and look to see if there's an asymmetric smile. Check an arm to see if there's arm weakness or numbness. Check the speech to see if there's any slurring or if the words can't be produced. And at that time, you have to check your watch to learn what time it is, because the beginning of a stroke is crucial. We have treatments available within a certain period of time, specifically three hours. And we like to know when the stroke begins in order to determine what kind of treatments are available. And the other thing you do when you check your watch, you call 911 and come to the hospital. Right. OK. We have another slide that I'd like to talk about as well that you had mentioned. One is it's called the ischemic versus hermetologic. Right. The two types of strokes that exist, the more common is ischemic, which means that the blood flow is blocked. And the slide that we have available, the image on the left, shows a little blood clot inside a small blood vessel. And the blood can't get through. That's an ischemic stroke. And it occurs in roughly 85% of strokes. The other picture to the right demonstrates that the blood vessel is broken. And in that situation, the blood will not stay inside the arteries, but will just kind of diffuse through the whole brain. But the ultimate result is that the blood flow that's supposed to be going through the artery is blocked, or is ruptured, I should say. OK. Because it deals with blockages, are heart attacks and strokes related in any way? Yeah. The heart attack is identical to a stroke in the sense that the blood vessels, the little tubes that carry blood to the heart muscle that needs to kind of contract in order to push blood through the body, those blood vessels can get blocked. And if they do, then a certain section of the heart will die. That's a heart attack. The same mechanism occurs in strokes. The blood flow is blocked, and the brain doesn't get any oxygen, and it will die. So the mechanism is identical. OK. OK. Are there different severities of strokes or different types of strokes or different levels of strokes? I know we kind of went into that. But as far as the amount that it affects the brain or different parts of the brain? Right. Just like a computer, different sections of the brain perform different functions. And the arteries that go to these different regions, any one of them can be blocked. Some parts of the brain are relatively silent in terms of what we feel. So that if that area is blocked, you might not feel the effect of the stroke, or there we sometimes call mini strokes or TIAs where an artery can be blocked for a few minutes, but then open up kind of on its own. That's really good to know, because that's an in a situation where we can evaluate a person before they have a stroke. Other strokes occur, it can be a small stroke in a very critical part of the brain, and it could be quite devastating. So there's all variations of the same theme, but the mechanism is always the same. OK. My wife had a stroke a few years back and you treated her or treating her about the stroke. And her stroke, it dealt with the thalamus in her brain, which is basically the nerve center and all of that. The only reason why I know that is you told us so. As far as that goes. But with her symptoms or residual effects, she has just more chronic pain than actually it seems like limper dead parts of her body, so to speak. How does that happen, or how does that difference? Well, as I mentioned, it really depends upon which part of the brain is injured. In that example, the thalamus happens to be the pain center or the sensation center of the entire brain. All sensory fibers are feeding into the thalamus, and then from there, the thalamic or the nerve cells go to our consciousness. And in certain situations, if the thalamic nerve cells are injured, they might recover partially. And they're sending these unusual signals out to awareness, and that can be painful. That's how it works. She pretty much has chronic pain every day. And it's the weirdest things that will touch it off. Like if she touches plastic, or all of a sudden if she touches something, her other hand will get cold. Or if she gets something like rubs her arm here, her foot will hurt, or whatever. It's like it's sending out all the pain signals, but it doesn't know where to send it. Yeah, the brain, unfortunately, is very complex and sometimes unusual. But we have to understand that those situations do occur, and we do our best to try to manage them. Absolutely. Are there any medications that you can take which will help after you've had a stroke? To help manage pain? Well, most strokes are not associated with pain, in all honesty, especially in the initial stage of a stroke. Most strokes are associated with either heaviness, or tingling, or different kinds of sensations like that. And in that situation, most of us, through our experience, have had our leg fall asleep. So we kind of walk it off, or we wait a little bit, go lay down until it wakes up. That's what you should not do if you're thinking you're having a stroke, or if somebody is thinking you're having a stroke, because time is critical. So you really have to kind of be aware of those things that we mentioned earlier about looking fast, face, arm, speech, and time. And pick up the phone and go to the hospital, because waiting is nerve cell death. Well, and that's where people will go, well, you know, it was hurting, but now it's better, or I felt a little tingle here, a little tremor. Well, now it's not doing it, or whatever. At what point do you just say, well, it was just a goofy, knee-jerk reaction, same thing with a heart attack, like when my father had a heart attack. Well, now the pain's gone. Maybe I shouldn't go. And I says, no, you're going in, and well, it's a good thing. I did take them in. Correct. I mean, those many episodes, or those TIAs, are extremely important, because we need to know about that so that we can prevent a stroke. Just today, I saw a patient in the hospital who was having on and off symptoms in his arm for a week. They would last for five or 10 minutes, three times a day. Actually, he was a VA patient. He called the VA, and they told him to get to the hospital. He has about a 99% narrowing of the artery in his neck, and he's going to have surgery in a few days. And he's perfectly normal right now. He's doing fine. But if that artery closed off, he would lose half of the strength in his body. But it's extremely important to be aware of those situations and follow up, and don't ignore them. What are some of the diagnostic procedures that you can perform that will help identify or reveal some of these conditions that possibly may cause a stroke or heart attack? We have amazing techniques that are not painful and can get unbelievable pictures of the brain, the arteries that go to the brain, while a person is just relaxing on a table. And MRI scans are extremely useful at that. Cat scans for an emergency situation to make sure that there is no bleeding. We have carotid studies that can take pictures of the brain through the artery, through the ultrasound. And more importantly, we have treatments that are available within the three-hour window, sometimes four and a half hour window after a person begins to have symptoms. So it's crucial that they get to the hospital so we can evaluate them to determine whether or not they're eligible for that treatment. OK. If a person has a stroke, can they fully recover? Absolutely. It depends upon where it is and how large it is. The early stages of a stroke are, I should say, the early stages of the region of involvement are kind of big. But the outside section actually can get some blood from the surrounding tissue. And the inside portion of a stroke ultimately will probably not recover. So it really depends upon whether or not we can get blood to that deeper section early enough in order to determine recovery. So kind of tying back what we talked about earlier about headaches and the types of headaches we have, are headaches possibly an early warning sign of possibly a stroke coming on? It could be, but it's not common. Most headaches are not associated with serious problems inside the head. And so even though a person feels like they're going to die with a migraine headache or they're nauseated and vomiting, the vast majority of the time that's not associated with a serious problem, especially if somebody has had those kinds of headaches previously. If an older person, older than 50, suddenly develops that kind of a headache, then that's different. And they should be evaluated quickly. For those who have a stroke, what are the types of therapy they can go through to help them recover? Physical therapy is very useful in terms of remaining mobile. We do have different kinds of treatments that are available also that are kind of sophisticated in order to prevent spasticity, which is a stiffness that develops as a result of brain injury. Botulinum toxin is a medication that can be injected in certain muscles to make sure that they don't get overly stiff and the joints don't get contracted and things like that. We have medications that can do the same thing. So between physical therapy and rehabilitation speech therapy, there's a lot of different available improvements a person can make over the months after a stroke. Is there also, I would imagine, mental counseling as well that needs to go on as well because it's a huge change? Sure, depression can be a problem. Yeah, I mean, it's not easy to be ill. And it's not easy to have your life change in a second. And those kinds of things are important as well. OK. Where would a person go if they wanted to learn more about strokes? Or what are some good resources they could look up? We have a slide that can kind of identify that. You can, on the computer, you can go to those websites and see what they have to offer. Or here locally, the stroke coordinator in Green Bay is Sarah Adalamenti, I think, is her. And then at St. Nick's, Shalyn Edson. Either one of those persons can be called and they have literature that could be given to people who are interested. What can a person do in their daily lives to help prevent stroke and to maintain, you know, definitely decrease the risk of a stroke? Sure. That's crucial. There's a list of risk factors that exist. Controlling high blood pressure. Controlling cholesterol. If you have diabetes, managing that closely, alcohol can be influential. Too much alcohol is bad. Actually, for men, two drinks a day is not bad. If anything, it might be beneficial. And for ladies, one drink a day is reasonable and potentially beneficial. So all of those factors are important. Controlling age refurbilation, which is a regular heartbeat or taking medication to prevent blood clots in that situation is also important. OK. How often, what are your office hours for, as far as, you know, patients you see, is it usually a pretty heavy schedule or a later schedule? Well, I get it. Always feels heavy. I don't know. I don't keep track. I don't keep track. I don't do the appointments. But yeah, we do our best to kind of take care of people and make sure that they are managed well. With respect to, obviously, strokes yet, may again is stroke awareness month. And very, very, very important topic to be aware of. How old can one actually have a stroke? Is it usually more in adults? Could children have them? Is it all ages? Well, it is all ages. But it's certainly more common probably after age 65. When we have a younger person who has a stroke in the 50s in that range, then we have to look for unusual reasons. Because atherosclerosis, which is the cholesterol that builds up in arteries, occurs with age or with risk factors like diabetes or high blood pressure or cholesterol. But in a younger person, they really haven't had the time to have that kind of problem develop. So we look for things like abnormal blood clotting. There are certain conditions that can occur where your blood clots too easily. And if that's the case, then that has to be treated in a special way, but it has to be figured out first. OK. Any final thoughts before we wrap up? Final thoughts. Well, on headache, migraine is an outrageously common problem. Probably 30 million people in the United States are affected, women more often than men. It's unfortunately under-treated, whether people just kind of manage on their own. But we do have migraine medications that can reduce the frequency of headaches. We can't cure it, but we can reduce the frequency of headaches and treat them when they occur so that people can live normal lives. In terms of stroke, the crucial thing to remember is to act fast, look at the face, arm, speech, and time. And if there's a question, call 911 and get to the hospital. Don't let TIAs go away without evaluation. OK. Dr. Zweifel, I'd like to thank you for joining us on this episode and talking about headaches and strokes. And again, May is Stroke Awareness Month. And on behalf of WSCS-TV, Dr. Zweifel from Prevea Health, I'm Dave Augustine. Thank you for watching.