FOR RAPID INTERVENTION IN MIGRAINE AND STROKE

By Helen Borel, R.N.,Ph.D.

TO TIMELY COMBAT THE MISERY OF MIGRAINE
AND THE DANGERS OF STROKE...

MDs and RNs MUST BE INTIMATELY 
KNOWLEDGEABLE about NORMAL BRAIN 
VASCULAR (BLOOD VESSEL) FUNCTION
It wouldn’t hurt, however, for everyone to know some of the
facts in this overview to familiarize all with the urgency of
emergency care for stroke victims...and the urgency for specific
medication to reverse the temporary brain abnormality in
migraine sufferers.

THE TWO TYPES OF STROKES 
AND THEIR TREATMENTS
Strokes (CVAs, cerebrovascular accidents) are generally
divided into two pathologic groups: those due to bleeding
from a vessel into the brain, and those that cut off a sort of pie
section of the brain from oxygen and other nutrients because of
a clot that lodges in vital spaces in a brain blood vessel. There
are neurosurgical procedures for both of these CVA
pathologies. One attacks the clot itself, if a medication won't
dissolve it; the other utilizes certain instruments that clip 
off an offending bleeder in the brain, saving the patient's
life as well as his/her motor and speech functions.

Prior to considering brain surgery for stroke patients at risk of
another CVA due to a blood clot, there is a clot-dissolving 
medication that can be administered in the ER (Emergency
Room) by ER physicians. But this is a serious medical step 
requiring close monitoring of the patient's condition to
prevent the clot-dissolver from itself causing a brain hemorrhage
and yet another stroke to further incapacitate the patient. If the
clot dissolver doesn't work, brain surgery may have to be
performed to extract the clot.  Once removed, this type of
stroke patient has a better chance of recovery.

A cerebral hemorrhage, however, may prove more difficult
to treat because the hemorrhage, fast flowing, and fast accumu-
lating in the brain is spreading its damage by impinging on vital
cerebral centers. When the neurosurgeon approaches this kind
of lesion, he has his work cut out for him.

ATTENTION TO MIGRAINEURS’ 
(sufferers of migraines) NEEDS  When it comes to
migraineurs, even though migraine syndrome patients are
never candidates for brain surgery for their painful head
symptoms, a thorough knowledge of neurovascular anatomy
(structure) and physiology (function) - the affected organs
and their functions that comprise brain blood vessel circulaton
- is essential to correctly diagnose and treat these usually very
incapacitated head pain patients.

NORMAL BRAIN BLOOD VESSEL FUNCTION
The common carotid arteries, situated within the lateral
aspects (the sides) of the neck are the key circulatory
conduits that conduct oxygenated (filled with oxygen) blood
to the brain. Remember, the brain cannot function for more
than some minutes when it is starved for oxygen. So that any
condition that impedes or blocks blood flow to the brain will
severely compromise its oxygen supply and, therefore, its
function. Prolonged, such interruption in brain oxygen will
cause death or a tragic vegetative state.

THE COMMON CAROTID ARTERIES -
there’s one on each side of your neck...
you can even feel it pulsating  
The common carotid artery is a large blood vessel located
in the neck; in fact there are two of them, one on either side
called the Left Common Carotid Artery and the Right 
Common Carotid Artery. Not only do these vital vessels
play a vital role in stroke causes and treatments, they also
play a pivotal role in the migraine process.

[To learn more about the migraine process itself, and its
treatments, I’ll be posting an article about it soon. Which
will be titled: "Migraine: A Headache to Doctors 
as well as Patients"]

Here's a little experience 
with your own common carotid arteries: Lightly press your
middle fingers on the middle of either the right or left side of
your neck, more toward the front of you. You will feel your
artery's healthy pulsations as it pumps oxygenated blood
(oxygen-rich blood) via both carotids up to both sides of
your brain. This normal flow, however, is compromised
in CVAs and in the migraine process.

THE INTERNAL SKULL CAPS 
THAT PROTECT THE BRAIN -THE MENINGES
The meninges are the three layers of tissue protecting the brain.
Your meninges, these vital tissues that line your inner skull and
help to cushion the soft tissue of your cerebrum (brain), are
divided into three layers. These are called the dura mater,
the arachnoid mater, and the pia mater.

The dura mater is attached internally to the cavernous skull. The
arachnoid mater, so named because of its spidery features, and
richly vascularized (rich with blood vessels) lies between the pia
and the dura. And the pia mater lies over the brain itself as an
adherent layer of protection for our delicate, fleshy human
computer. In life, these meninges are not far apart, but in very
close relation to each other.

Additionally, you must be aware that the scalp - the strong skin
which tightly covers your outer skull, also receives a rich 
supply of oxygenated blood from higher branches of 
both common carotid arteries. Moreover, the two main
common carotid arterial branches situated on each side of
your head not only supply oxygen-rich blood to your scalp
but to your meninges as well. The common carotid branches 
are called the external carotid and the internal carotid.
The external carotid arterial branch is the vessel that 
supplies oxygenated blood to the meninges.

The second common carotid, called the internal carotid 
arterial branch, flows into other cerebral arteries to supply
blood and oxygen to the brain itself.

NORMAL BRAIN BLOOD VESSEL FUNCTION
Arteries, which normally supply oxygenated blood, as well as
veins which remove waste from body circulation, are capable of 
dilating and constricting due to their elastic layers
between their inner and outer linings. (Most body organs have
three layers to handle various essential organ functions.) Blood
vessel elasticity is more pronounced in one’s arteries. Any
Dorland's Medical Dictionary will illustrate the comparative
differences between a dilated blood vessel and a constricted one.

Dilation and constriction of arteries and veins enable them
to control the flow of blood and, when necessary, they may
constrict to control bleeding. The latter is the physiologic effect of
a bodily substance that comes into play at sites of hemorrhage to
inhibit dangerous outflow.

IMPAIRED BLOOD FLOW 
PRECIPITATES STROKE OR MIGRAINE...
CVA DUE TO PLAQUE,
MIGRAINE TO ABNORMAL ARTERIAL DILATATION
Obviously, a dilated artery will carry more blood more rapidly to
the tissue or organ it supplies. Equally as obvious, a constricted
artery will carry less blood, and more slowly, to the part it usually
supplies with nutrients and oxygen.

Additional small anatomic vessels 
complete the blood vessel picture. These are your arterioles.
These tiny branches of arteries are arterial endpoints that are the
minute, close-contact vascular deliverers of oxygen and nourish-
ment directly to all body tissues and organs. Remember your 
arterioles. Nothing vital can get through to them when the larger
major blood vessels to the body and brain are blocked by athero-
sclerosis.  As is the case in blockade of the coronary artery
(the arterial "crown" surrounding and embedded in the
myocardium, the heart muscle layer), as in carotid artery
narrowing, as when a clot produces a CVA, or as in a suddenly
triggered cerebrovascular dilatation (excessive expansion of
brain arteries) known to cause the torture of migraineurs.

This “lesson” in the anatomy and physiology of brain vasculature
and that of other blood vessels should deepen the reader’s
knowledge of the risks of heart attack and stroke from various
causes of damaged vessels...and of the role blood vessel
dilatation plays in triggering and extending migraine attacks.
(Many things may “trigger” a migraine attack: allergies, weather,
a food ingested such as onion, stress, alcohol, strong coffee,
strong sunlight....and unknowns.)

There are many preventive measures
to avoid heart attacks and stroke. Among these are attention
to best nutrition, appropriate exercise, control of diabetes
mellitus and other metabolic conditions (such as thyroid disease),
and appropriate medical interventions for any other conditions
such as inherited tendencies toward negative contributory
factors. Genetic predisposition to obesity, for example.

As for Migraine Attacks, 
there are a number of ways to handle these.  The headache
of migraine is terrible. It’s not your ordinary headache from
tension or hunger or tired eyes.  For those migraineurs who can’t
avoid migraine headaches, they are bedridden, suffer severe
nausea, dizziness and blinding photophobia (inability to tolerate
light).Thus, they are trapped for hours, sometimes days in a dark,
dark room all shaded...unable to eat without vomitting, unable to
really rest; trapped with black blinders to cover their eyes
because few medicines can help them...at least this used
to be the case.

Some Migraineurs Experience AURAS 
(warning sensations, often visual) and 
SCOTOMATA (optical events like wavy lightning flashes)
Luckily, a certain percentage of migraineurs experience what’s
known as an “aura” in enough time, approximately a half hour,
before the actual headache would have begun.  Hard to describe,
unless you’ve experienced it, the aura comprises a visual 
distortion with narrowing, blanking out of the text when reading,
blurring of the text, visual “lightnings” like shimmering, flashing lights,
a mild nausea, and lightheadedness. These “early warning signals”
allow the aura-experiencing group of migraineurs to immediately
take their medication (which they should always carry with them)
which wards off the headache entirely,  leaving the migraineur a bit
lightheaded but not in pain, not suffering the full-blown
migraine attack.

These lucky migraineurs have, for decades enjoyed the use of
Cafergot ® (ergotomine with caffeine) a pill which, taken as soon
as the “aura” begins prevents the headache and prevents the full-
blown effects of the dilated brain and also of the possibly dilated
other body blood vessels. This Rx drug, manufactured by Sandoz
Pharmaceuticals, reversed the blood vessel dilatation, thereby
preventing the onset of the headache unavoidable to
the non-aura migraineurs.

Unfortunately, Sandoz has stopped manufacturing this
inexpensive migraine headache preventive medication.  Probably
because Cafergot ® could no longer be profitable in the current
Rx market...due to the advent of a more expensive class of
migraine drugs,  “serotonin receptor agonists”
(the neurochemical serotonin plays a role here).  These are
known as the triptans, “triptan” being the last part of the chemical
name of all the new brands of so-called migraine drugs.  But,
remember, these don’t help the class of migraineurs whose auras
have been their mainstay, alerting them to take their Cafergot ®,
preventing their headaches from ever starting in the first place.

Sadly, this new-era of more expensive migraine drugs
does not have that capacity.  And so the “aura” group of
migraineurs now have a real headache to deal with: How to
find a way to abort their migraine processes in the absence of
the key Rx medication that Sandoz no longer manufacturers.

(c) Copyright 1984 and 2015 Dr. Helen Borel. All rights reserved.

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by this author of Journey Into Self: Holistic Interactive 
Integrative Psychoanalysis - that gets your life, your career,
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fulfillment, contact me at emotional_health@earthlink.net

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