Dr. Gary Joseph Volkell, DO

• Migraines: one of the most prevalent types of headache, migraines typically last from two hours to three days, causing a throbbing pain on one side of the head. Nausea, sensitivity to bright lights, fatigue, and blurred vision all may accompany migraines. While migraines have no known cure, medications and lifestyle modifications may ease symptoms. Avoiding behaviors that may trigger migraines such as lack of sleep or loud, repetitive noises can improve headaches.
• Tension headaches: also known as stress headaches, these headaches are characterized by pain in the upper top part of the head and behind the eyes. Tension headaches are common and have no exact cause; however, certain practices may increase the likelihood of developing them. For example, wearing one's hair up in a tight hairstyle or wearing a restrictive hat can put pressure on the scalp, leading to a tension headache. Other causes of tension headaches may include alcohol or nicotine use, caffeine, teeth grinding, stress, overexertion, and eye strain. Some people find posture improvement, alternating sleeping positions, and neck exercise can alleviate tension headaches. Over-the-counter pain relievers such as ibuprofen (Advil, Motren) and naproxen sodium (Aleve) may also reduce tension-headache pain.
• Sinus headaches: this type of headache causes pain in the sinuses, but may progress to pain and pressure in the eyes, forehead, and cheeks. These headaches are often accompanied by nasal congestion, fatigue, and ache in the upper teeth and may or may not be caused by sinus infections or sinusitis (sinus inflammation). Some sinus headaches are allergic headaches, which arise from allergic triggers such as seasonal allergies (pollen allergies) or hay fever, causing sinus pressure and facial pain. Other symptoms of allergic headaches include nasal congestion, irritated or watery eyes, runny nose, and sneezing. Allergic headaches may be treated with antihistamine medications such as cetirizine (Zyrtec). Allergic headaches are common during pollen season, which is usually around springtime.
• Cluster headaches: these headaches occur suddenly and cause stabbing, sharp pain from one eye down to the one side of the neck. They are often referred to as the most aggravating and painful type of headaches. Other symptoms of cluster headaches include nasal congestion, droopy eyelid, and enlarged pupil on one side of the face. In the past, it was widely believed that cluster headaches were caused by a bevy or "cluster" of multiple types of headaches, such as a combination of an allergic headache and a tension headache. Medical experts now recognize that cluster headaches are a separate and unique form of headache. Cluster headaches last for around twenty minutes to two hours. They may recur throughout the period of a day or several weeks, but usually dissipate within a month. Treatment for cluster headaches includes over-the-counter pain medications such as ibuprofen (Advil, Motren) and naproxen sodium (Aleve). Prescription Prednisone can help with swelling and Verapamil may reduce pain by relaxing the blood vessels.

Living with headaches is challenging; headaches can prevent people from fully enjoying life. Medical treatment and care in avoiding certain triggers can help those with headaches begin to feel normal once again.

Hemorrhagic strokes are particularly dangerous, as they may go undetected. For example, someone who forcefully hits his head may simply ice his wound and not seek medical treatment, unaware that blood is leaking into his brain from a ruptured vessel. When blood leaks into the brain, the blood gathers and begins to compress the brain tissue. At the same time, the damaged vessel does not deliver blood as it normally does. Since the brain cannot function without a steady supply of blood oxygen and nutrients, the brain begins to die and may cease functioning. Hemorrhagic strokes can result in impaired movement, speech, cognitive ability, and physical functioning and may even cause death.

Certain risk factors may increase one's likelihood for developing a hemorrhagic stroke:

• High blood pressure
• Bleeding disorders (such as hemophilia)
• Blood vessel abnormalities
• Brain tumor
• Liver disease
• Drug abuse

There are two types of hemorrhagic stroke: intracranial hemorrhage stroke and subarachnoid hemorrhage stroke. Intracranial hemorrhages cause bleeding inside of the brain, while subarachnoid hemorrhages happen when bleeding occurs in the region between the brain membrane and the brain. Both types of hemorrhagic strokes require immediate medical treatment, which can prevent severe and life-threatening brain damage. Signs of hemorrhagic stroke include:

• Fever
• Disorientation or confusion
• Difficulty speaking
• Difficulty walking
• Impaired vision
• Weakness in the face, legs, or arms
• Severe headaches

When someone suspected of having a stroke reaches the hospital, the patient will usually receive a CT or other scan that provides an image of the brain. The scan results can reveal clotted or leaking blood in the brain. Physical exams, neurological exams, and blood tests may also be used to check for blood clotting and sugar. Treatment generally begins immediately if a stroke is detected.

Hemorrhagic strokes are treated with blood-saving medication and surgery. For a hemorrhagic stroke caused by an aneurysm (blood vessel bulges) rupture, surgery might be performed to stem the bleeding. Another treatment is endovascular coiling, where a catheter (thin, hollow needle) is used to place a platinum wire coil at the spot of the aneurysm. The coil blocks bleeding and prevents the aneurysm from continuing to leak blood. A similar technique is stent-assisted coiling, which adds a stent (small wire-meshed tube) into the blood vessel to block the leaking opening of the aneurysm. These procedures are usually combined with blood-thickening medications. Blood transfusions may be administered if substantial blood loss has occurred.

Hemorrhagic stroke patients who may have lost some essential functions while the blood flow to their brains was obstructed may receive post-stroke rehabilitation to rebuild their physical and mental abilities. Some restorative treatments include occupational, physical, and speech therapy. Patients may also receive care from a neurologist, who can develop individual treatment plans, and rehabilitation psychologists who may help patients with their emotional, behavioral, and cognitive recovery. Some stroke patients require lengthy rehabilitation and may never fully regain function, while others may recover more quickly. While the fastest recovery improvements are usually seen in the first three or four months, rehabilitation from hemorrhagic stroke can last for years.

If someone begins to show signs of hemorrhagic stroke, contact emergency services and call 9-1-1 immediately, since blood flow must be restored as soon as possible to avoid significant brain damage. If an ambulance takes the person to the hospital, paramedics can initiate hemorrhagic stroke treatment as soon as the patient enters the ambulance, allowing for more prompt medical intervention and care.

Ischemic strokes are severe because it restricts blood flow and an inadequate blood supply damages the brain, which cannot function without a steady supply of oxygen and nutrients. Ischemic strokes may alter appearance by leaving one side of the face paralyzed, also affecting speech and communication. Additionally, ischemic strokes can result in impaired movement, cognitive ability, and can impede important physical functions like walking.

The main cause of ischemic stroke is from plaque (deposits of fat and cholesterol) accumulating in blood vessels. Plaque causes atherosclerosis, a condition where the blood vessels narrow and harden with cholesterol, fat, and calcium, causing damage to the endothelium (inner layer of cells in the arteries), which in turn restricts blood flow. At some point, a large blockage of plaque or bits of broken up plaque may result in an ischemic stroke.

People who are older are more likely to have ischemic strokes due to accumulated plaque. Additionally, certain repeated behaviors are associated with an increased risk of ischemic stroke. These behaviors include:

• Smoking
• High fat diet
• Lack of exercise
• High salt diet
• Alcohol abuse

Conditions such as heart disease, diabetes, high blood pressure, and high levels of cholesterol and lipids are also known to be correlated with ischemic strokes. If possible, people are advised to avoid modifiable risk factors (factors one can change themselves) such as smoking and lack of exercise by keeping an active lifestyle and a healthy diet.

Signs of stroke include:

• Disorientation or confusion
• Difficulty speaking
• Difficulty walking
• Impaired vision
• Weakness in the face, legs, or arms
• Severe headaches

When someone suspected of having a stroke reaches the hospital, the patient will usually receive a CT or other scan that provides an image of the brain. The scan results can reveal clotted or leaking blood in the brain. Physical exams, neurological exams, and blood tests may also be used to check for blood clotting and sugar. Hospital treatment generally begins immediately if a stroke is detected.

Medical treatment for ischemic strokes includes a thrombolytic medicine which breaks up and disperses blood clots. This medicine can greatly improve stroke recovery and long-term health. However, the thrombolytic medicine must be administered as soon as possible to achieve these results. Other treatments for ischemic strokes are blood thinners and thrombectomy, a surgical procedure to remove a blood clot in the brain. Thrombectomy is performed using a catheter (thin needle) to the artery to reach the blood clot and mechanically remove it. With the clot removed, normal blood flow to the brain resumes. Thrombectomy is typically performed at most six hours after a patient shows signs of a stroke.

Ischemic stroke patients who have lost some essential functions while the blood flow to their brain was obstructed may receive post-stroke rehabilitation to rebuild their physical and mental abilities. Some restorative treatments include occupational, physical, and speech therapy. Patients may also receive care from neurologists, who can assist patients in recovering certain brain functions and cognitive abilities, and rehabilitation psychologists, who may help patients with their emotional, behavioral, and cognitive recovery. Some stroke patients require lengthy rehabilitation and may never fully regain function, while others may recover more quickly. While the fastest recovery improvements are usually seen in the first three or four months, ischemic stroke rehabilitation can last for years.

If someone begins to show signs of ischemic stroke, contact emergency services and call 9-1-1 immediately since blood flow must be restored as soon as possible to avoid significant brain damage. If an ambulance takes the person to the hospital, paramedics can initiate ischemic stroke treatment as soon as the patient enters the ambulance, allowing for more prompt medical intervention and care.