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Myth or Fact

1) Just as narrowing of heart vessels can be opened by balloon angioplasty and stents, vessels inside the brain can be treated to the patients benefit.

Answer: Myth.

Unfortunately intracranial balloon angioplasty and stenting have been shown in repeated trials to be harmful to the patient unlike heart vessel stenting. Two major trials, SAMMPRIS, and more recently the VISSIT study have shown that stenting is associated with a worse outcome when compared to medication management alone. (VISSIT trial showed the combined risk of stroke, death or bleeding was approx 24 % in the intervention arm vs 9% in the medical arm, 15% vs 6% in the SAMMPRIS trial which used the wingspan stent).

If you or someone you know has a stroke due to a narrow vessel and is out of the 6 hr window then consider medical management with an antiplatelet agent such as aspirin, plavix ( clopidogrel), or aggrenox ( ASA and Dipyridamole) along with a cholesterol lower agent also known as the statin group of drugs eg: Lipitor (Atorvastatin ) or Zocor ( Simvastatin) or Crestor ( Rosuvastatin). Cilostazol and Angiotensin Converting Enzyme inhibitors may help additionally lower the risk of stroke.

1) Butterbur ( a herbal extract) is helpful for migraines.

Answer: Fact.

The AAN American Academy of Neurology endorses the use of butterbur based on level A evidence that butterbur 75mg twice a day helps in migraine prophylaxis.