If you are having a stroke, a stroke center may be the place to go.

When talking about stroke, doctors often say that "time is brain." The faster you get medical help, the greater the chances of surviving and recovering from a stroke. A movement to establish special stroke centers across the country is ushering in a seemingly contradictory phrase: the old real estate adage "location, location, location." The rise of stroke centers means that emergency medical crews could bypass a nearby hospital and take a few extra minutes to reach a more distant one.

Stepping up prevention efforts could brighten up predictions.

Baby boomers have been blamed for a litany of social woes, from the breakdown of the American family to global warming. The American Heart Association (AHA) adds another: sparking a huge increase in cardiovascular disease and health care costs over the coming decades. But this one boomers could walk away from — literally.

The baby boom began in 1946 and ended in 1964. By 2030, anyone born during that period will be ages 65 and older, the key years for cardiovascular disease to blossom. (We use the term "cardiovascular disease" to cover a range of heart and artery conditions, including heart attack, stroke, heart failure, and peripheral artery disease, among others.)

Q. I have heard that one symptom of a stroke is "the worst headache you can imagine." I recently had a migraine that was so much more painful than previous ones that I worried it was a stroke. Is there any way to tell a migraine from a "stroke headache"?

A. The term "stroke" covers several distinct events that differ in location and cause. Some types of stroke can trigger a headache; others usually don't. To understand the connection, it's helpful to know a bit about the brain and pain. Brain tissue, and the blood vessels embedded in it, doesn't register pain. But the membranes that surround the brain and the blood vessels that run through them do register pain.

The carotid (pronounced ka-RAH-ted) arteries in the neck are the main supply route for blood to get to the brain. But atherosclerotic plaque can gum them up, just as it does the coronary arteries that provision the heart. If that plaque ruptures, blood clots can form that block the carotids or other, smaller arteries, resulting in an ischemic stroke.

Narrowed carotid arteries can be identified with an ultrasound before a stroke occurs. The examinations are noninvasive and inexpensive. Some hospitals are charging the public as little as $45 for an ultrasound of their carotid arteries.

These drugs may harm more than help after a stroke linked to a degenerative brain condition.

The drugs known as statins do many good things. They are the most powerful cholesterol-lowering agents discovered so far. They help prevent heart attacks in people who have had one, as well as in those at high risk for one. They lessen the risk of having an ischemic (clot-caused) stroke, the most common kind of stroke in the United States. Use of statins has been linked to stronger bones, better brain health in old age, and other noncardiovascular benefits.

It's never too late to strike out against a potentially devastating brain attack.

Like close cousins, heart disease and stroke share a common lineage. Both emerge from a mix of nature (genes), nurture (upbringing and environment), and personal choice (smoking, exercise, etc). For most of us, personal choice largely determines whether a stroke lies ahead. Guidelines on the prevention of stroke suggest that a healthy lifestyle can cut the risk of having one by 80%. No drug, device, or other intervention can come close to doing that.

Unnecessary blood transfusion can do more harm than good.

Blood transfusion deserves a prominent place in the pantheon of medical advances. It has saved countless lives on the battlefield and in hospital emergency departments. It is a life-prolonging treatment for people with conditions that prevent the body from making blood or blood components, from kidney disease and cancer to disorders such as hemophilia and sickle cell anemia. But whether blood should be routinely transfused during or after heart surgery is a question that more and more people are asking. The answer is tilting toward "no."

Lower doses are as effective as higher doses and are likely to be safer.

Women ages 55 to 79 should consider taking a daily aspirin to reduce their risk of having a stroke, according to new guidelines from the United States Preventive Services Task Force (USPSTF), an expert panel that reviews evidence and recommends preventive health strategies. The guidelines reflect evidence showing that the cardiovascular benefits of aspirin vary by gender. Aspirin reduces women's risk for ischemic stroke, the most common kind (caused by blood clots), but not heart attacks. In men, it lowers the risk of heart attacks but not strokes.

The guidelines, which were published in the Annals of Internal Medicine (March 17, 2009), apply only to people with no history of heart disease or stroke. The USPSTF discourages aspirin therapy in women under age 55, because their risk for stroke is generally so low that the risk of aspirin-related gastrointestinal bleeding outweighs any benefit. Because evidence was lacking, the group made no recommendation for women ages 80 and over.

Early treatment of the most common type of stroke, ischemic stroke, can limit brain damage and vastly improve outcomes. Ischemic stroke is the kind caused by atherosclerosis, which causes blood clots that block the blood supply to a part of the brain. Yet too few ischemic stroke patients receive important clot-busting drugs, which are most effective when given within three hours after symptoms start. Patients often arrive at the hospital after that window of opportunity has closed. They delay getting treatment because stroke symptoms may not be that pronounced or they are mistaken as coming from other, less serious problems.

As a result, doctors are looking for ways to make it easier for the layperson to identify a stroke. The Cincinnati Prehospital Stroke Scale is one such attempt. Some experts say it leaves out too many symptoms. Others say it will cause false alarms because it's not specific enough..

"Mini-strokes" have major risks

What's the difference between a stroke and a transient ischemic attack (TIA)? At first, not much. They look the same, feel the same, and stem from the same thing — blocked blood flow to the brain. But a stroke lasts for hours, maybe longer, while a TIA fades away after a few minutes.

Don't be fooled by the disappearance of symptoms. Even after they are gone, danger still lurks in the form of other TIAs, stroke, and even death.