Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

I must say that I am a little puzzled by your story. Plavix doesn't treat headaches, it is not used for that purpose. Not even the manufacturer suggests it to be used for that purpose.

Plavix is used to prevent formation of blood clots, blood clots which can be formed in the setting of atherosclerosis of blood vessels. Atherosclerosis of the blood vessels is a risk factor for stroke (or any type of infarction, in the heart, limbs etc). Plavix (or aspirin) is given for that purpose, to prevent stroke from happening. It is given on a regular daily basis, not when one has headache or any other symptoms. It doesn't guarantee prevention, it merely reduces the risk of clots, like simvastatin. So that is why I am a little puzzled, headache may be a sign of stroke, but once a stroke happens Plavix doesn't revert it. And a stroke doesn't come and go just like that with a tablet of Plavix.

Anyway, if one is to study in depth blood vessels for the presence of atherosclerotic plaques a simple brain scan is not enough. The study which needs to be done would be an Angio CT or even better an Angio MRI of the vessels in the head and neck. These exams use contrast and computer software to visualize blood vessels and detect atherosclerotic plaques if present, and their structure. If there are such atherosclerotic plaques in terms of medication it remains basically the same, Plavix and a statin such as simvastatine.

Only in some cases when these atherosclerotic plaques cause a significant narrowing of the blood vessels in the neck, generally over 70%, would some procedure be considered as medication might not be enough. By procedure I mean surgery to remove the plaque or intervention through a catheter and stent placement (a sort of ring which keeps the vessel open). These interventions are mainly for neck plaques in the vessels supplying the brain. When the narrowing is in the vessels inside the brain surgery is not possible, only in some rare selected cases may stenting be of benefit, in others Plavix and a statin remains the mainstay.

I remain at your disposal for other questions.

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Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information.

I still am not sure why Plavix would alleviate the headache. As I said it does nothing for pain and I would be more inclined to believe that there was a spontaneous improvement the first time around and a placebo effect in the other episodes. The usual dose of Plavix which I suppose you're under, 75 mg, doesn't even reach full effect on the first day, to have effect start immediately it is started with a loading 300 mg dosage continuing with 75 mg later (not that it relieves headaches with 300mg).

In terms of management for that 45 minutes episodes....it could be a TIA, a transient ischemic attack, transitory lack of blood flow to an area of the brain, a subtype of stroke which while transitory requires attention to prevent an established stroke in the future. So I would require the imaging exams I mentioned earlier to check for atherosclerotic plaques. In addition to them even if those result normal I would ask for a cardiac evaluation with heart ultrasound and heart rhythm studies. That is because heart arrhythmia are the other major cause of stroke and TIA so if no atherosclerotic plaques are found a heart source should be sought. In the meanwhile I would continue with Plavix, but not when there is a headache but on a regular daily basis as well as simvastatin.

Let me know if I can further assist you.

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