Although most women with migraine develop the disorder in their teens or twenties, 8 to 13 percent report the new onset of migraine during perimenopause. This is thought to be caused by peri-menopausal hormonal fluctuations. It may also be due to other causes that are frequently co-morbid with migraine: anxiety, depression, and sleep disturbances for which midlife women are at increased risk. The majority of standard migraine treatments are indicated regardless of menopausal stage, but symptoms, co-morbid disorders, existing medications, and patient preferences can all impact the choice of treatment. In addition to the mainstays of acute and preventive medications (NSAIDs, triptans, anti-epileptics, beta-blockers, and tricyclic antidepressants), the new drug class of monoclonal CGRP antibodies provides a promising and well-tolerated option for midlife women. An integrated approach can include mental health therapy, massage, relaxation techniques, and/or biofeedback training. MCHN also offers injections and IV therapy for pain, dehydration, nausea, vomiting, and dizziness. For more information, please call The Manhattan Center for Headache & Neurology to discuss with one of our caring providers.

—Alice N.S. Wong, NP

Pavlović JM. The impact of midlife on migraine in women: summary of current views. Womens Midlife Health. 2020;6:11. Published 2020 Oct 6. doi:10.1186/s40695-020-00059-8

Primary Stabbing Headache

There are many different types of headaches. If you experience one type of headache, particularly if you suffer from migraine, you may be more likely to experience another type of headache.

Primary stabbing headache is also known as “ice-pick” headache because pain is concentrated in a very specific area of the head, often the lower jaw, behind the eyes, upper cheeks, or forehead. Sometimes this may even occur in your teeth. It may occur as a single sensation or series of stabbing sensations lasting for a few seconds and goes away and may occur many times a day.

There are several treatment options for this type of headache however it is important to speak with your provider if you are having this symptom as they will need to rule out other causes.

If you feel you are affected by this type of headache, call The Manhattan Center for Headache & Neurology to schedule an evaluation. Our caring providers will create a customized treatment plan just for you!.

By: Brooke Steiger, NP


Lumbosacral radiculopathy is one of the most common problems seen in a neurologic consultation.
Acute lumbosacral radiculopathy can be separated into three general categories from least to most severe. The first being sensory/painful radicular pattern, characterized by radicular pain and a segmental pattern of sensory dysfunction but no other neurologic deficits. In addition, patients may experience mild motor deficit patterns, characterized by radicular pain, sensory dysfunction, and mild nonprogressive segmental motor weakness and/or reflex change. Lastly patients may have marked motor deficit patterns, characterized by radicular pain and sensory dysfunction with severe or worsening motor deficits.
Lumbosacral radiculopathy is a condition in which a disease process causes functional impairment of one or more lumbosacral nerve roots. The most common cause is structural (ie, disc herniation or degenerative spinal stenosis) leading to root compression. The acute time period starts at the time of symptom onset and extends up to four or six weeks.
The diagnosis of a lumbosacral radiculopathy is clinical, and can usually be made based upon compatible symptoms and examination findings. However, patients should be evaluated for less common mechanisms associated with permanent and progressive neurologic disability, as prompt diagnosis and treatment may improve outcome.
In patients who do not have an indication for urgent treatment, conservative symptomatic treatment is used during the acute period. While acute lumbosacral radiculopathy is often extremely painful, symptoms spontaneously improve in many cases. As examples, the clinical course may variably wax and wane when due to lumbar spinal stenosis from degenerative arthritis and may be self-limited when due to disc herniation.
To learn more, call The Manhattan Center for Headache and Neurology to schedule an evaluation with one or our exceptional providers!

By: Jordan Shankle, PA


Neck pain is a common problem that many people suffer from. It is thought about 80% of people suffer from neck pain in their lifetime and between 20%-50% experience it on an annual basis.

Unfortunately, it is a very common symptom associated with migraine as well.
According to the 2018 Migraine in America survey, about 69% migraine patients surveyed reported they have neck pain with their migraines.

Migraine symptoms associated with neck pain may include pain at the base of the head, stiffness or tightness in the neck, pain that radiates from neck upwards to top and front of head, and a decrease in ability to easily move the neck.

Some migraines may also be triggered or worsened by damage to the joints in the neck caused by injury or normal wear and tear and postural problems.

It is important to recognize that your neck pain may be a symptom of migraine which may be responsive to your abortive migraine medications or treatments.

Also, you may need your provider to assess if you have any underlying neck or postural issues that could be addressed with other therapies including physical therapy, massage, acupuncture, or medication.

For more information regarding neck pain and migraine, speak with one of our healthcare providers at The Manhattan Center for Headache & Neurology.

Brooke Steiger, NP


Carpal tunnel syndrome or CTS refers to the complex of symptoms and signs as a result of compression of the median nerve as it travels through the carpal tunnel. Common symptoms associated with CTS include pain and paresthesia, and less commonly weakness, in the median nerve distribution. CTS is the most frequent compressive focal mononeuropathy seen in clinical practice.
The pathophysiology of CTS is multifactorial. Increased pressure in the intercarpal canal is thought to play a key role in the development of clinical CTS. Risk factors for CTS include Obesity, Female gender, Coexisting conditions (eg, diabetes, pregnancy, rheumatoid arthritis, hypothyroidism, connective tissue diseases, preexisting median mononeuropathy) and Genetic predisposition.
The role of repetitive hand/wrist use and workplace factors in the development of CTS is also common.
The classic symptom of CTS is pain or paresthesia (numbness and tingling) in a distribution that includes the median nerve territory, with involvement of the first three digits and the radial half of the fourth digit. The symptoms of CTS are typically worse at night and often awaken patients from sleep. Some patients note improvement with these symptoms by shaking or wringing their hands or by placing them under warm running water.
The pain and paresthesia may be localized to the wrist or involve the entire hand.
CTS is a clinical diagnosis. The diagnosis is suspected when the characteristic symptoms and signs are present. The most important of these are nocturnal pain or paresthesia in the distribution of the median nerve.
Electrodiagnostic testing can be helpful to confirm or exclude CTS. It is also useful to gauge severity of nerve compression and to aid in decisions regarding surgical intervention. Imaging studies may be useful for the evaluation of CTS in some cases, if there is concern for a structural abnormality of the wrist.
Call The Manhattan Center for Headache and Neurology to schedule a consultation. Our exceptional providers will further evaluate and facilitate acute and extended management.
Jordan Shankle, PA


As we make our way through this pandemic it is important to be aware of changes in our bodies and how we feel.

In addition to typical upper respiratory symptoms such as cough and runny nose, one of the most common symptoms that we see often in the media is loss of taste and smell.

A very important symptom that may be an early warning sign of COVID-19 infection is headache. In fact, it is estimated that up to 13 percent of patients with COVID-19 have headache.

The COVID-19 infection may appear in several ways. You may have a new type of headache that feels like whole-head pressure, rather than one-sided as is typical with migraines. Alternatively, you may be triggered by the infection to have worsening of your typical migraine or migraine-related symptoms. These symptoms may include dizziness, fatigue, brain fog, and numbness and tingling.

In some individuals, you may see the headache as the first symptom, prior to cough or runny nose.

Additionally, the headache or persistent migraine or migraine symptoms may persist even after COVID-19 infection has resolved.

If you have a new type of headache or you are having persistent migraine or migraine symptoms, it is important to speak to your provider.

Brooke Steiger, NP


Cervical dystonia, also known as spasmodic torticollis, is the most common isolated focal dystonia seen in clinical practice. It affects the muscles of the neck and shoulders. Cervical dystonia may appear as horizontal turning of the head (torticollis), lateral tilt of the neck (laterocollis), flexion of the head (anterocollis), or extension of the head (retrocollis).
A subset of patients with cervical dystonia have an associated head tremor. In some patients, the head tremor is of relatively large amplitude, jerky, and irregular; other patients have a smaller-amplitude, more regular tremor that resembles essential tremor. A head tremor due to cervical dystonia is usually distinguished from essential tremor by the directional preponderance of the movement imposed by the neck dystonia.
Patients with cervical dystonia may also have an associated hand tremor that does not have dystonic qualities. Although still controversial, it is generally accepted that nondystonic hand tremor in cervical dystonia is a part of the dystonic syndrome, as opposed to reflective of comorbid cervical dystonia and essential tremor.
Isolated dystonia is separated from dystonia attributable to another underlying condition by the absence of additional neurologic abnormalities (with the exception of tremor) and the lack of a possible acquired.
The age and anatomic distribution of dystonia at onset are important clinical clues for diagnosis. Atypical presentations (eg, a child with onset of dystonia in the neck or face, an adult with onset in the leg, or an adult who develops generalized dystonia) are not characteristic of isolated dystonia; they indicate the need to evaluate for another genetic or acquired cause. Generalized dystonia is rare with adult onset. In such cases, an acquired etiology should be sought such as exposure to dopamine receptor antagonists.
Laboratory testing in patients with dystonia is part of the etiologic evaluation for suspected acquired and hereditary dystonias or dystonia with atypical features. The specific workup varies depending on age and associated clinical findings. A workup may also include neuroimaging such brain MRI or CT of head.
Contact The Manhattan Center for Headache and Neurology to evaluate and facilitate acute and extended management. Our exceptional providers are passionate about treating you!

Jordan Shankle, PA


Migraines are a significant burden to those who have them, affecting their mood and motivation. But it goes beyond that. People who suffer from migraines are more likely to have anxiety andB depression and there is even some evidence that it may be more common in people with bipolar disorder.

The science behind this is that serotonin which is implicated in anxiety and depression also believed to activate nerve endings associated with migraine. Additionally, there is a strong hormonal link between migraines, depression, and the female sex hormone estrogen. Some studies show that a decrease in estrogen in the body may lead to migraine.

Several oral medications that are typically prescribed to treat migraines are also effective in treating depression and bipolar disorder.

Additionally, therapeutic counseling may help you manage your migraines. CBT, also known as cognitive behavioral therapy, has been found to help decrease the frequency of migraines and headaches.

For more information about migraines and mental health, speak to your healthcare provider. To book an appointment with our psychiatric NP Roxanne Singer Gheorghiu contact our office.

Brooke Steiger, NP


Migraine is a common neurologic disorder causing head pain. It is often accompanied with nausea, vomiting, visual disturbances and reduce activity/ productivity. Many medications that are used for acute migraine attacks may have side effects, are not tolerated well and cannot be used during pregnancy or in patients with ischemic heart disease. Magnesium deficiency has been proposed to play a role in the pathophysiology of migraine, and treatment of migraine with magnesium has gained considerable interest.
Though magnesium can be used medicinally in a variety of forms, attention has been given to the administration of intravenous (IV) magnesium sulfate as a migraine rescue therapy. Magnesium administration intravenously has better absorption and does not cause diarrhea or abdominal cramping. The typical amount of magnesium sulfate given intravenously is 1 to 2g.
Given its high safety profile, several clinical trials over the past few decades have sought to determine the efficacy of magnesium sulfate in treatment of severe or intractable migraines.
Treatment of migraine is multifactorial. Patients should monitor headache frequency, use trigger identification and implement early treatment strategies to optimize care and minimize symptoms. Acute treatment like IV therapy is available at The Manhattan Center for Headache and Neurology, please contact us for further evaluation and treatment options.

Jordan Shankle, PA


Natural Supplement Profile: Vitamin C

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin that is naturally occurring in foods including fruits and vegetables. It may be found in vegetables such as peppers, cabbage, brussel sprouts, broccoli, potatoes, and spinach and in fruits such as citrus, berries, and tomatoes.

The benefits of vitamin C include enhancing function of your immune system, maintaining eye health, and protecting against cardiovascular disease. It also is important in blood vessel health and the maintenance of collagen and cartilage in your body.

Some people may be more susceptible than others to deficiencies in vitamin C including smokers, people with certain gastrointestinal conditions, or those with a limited diet.

You may have heard about high dose vitamin C recently in the news due to its recent use in treatment of acute severe COVID-19 infections. There are currently clinical trials underway to evaluate its effectiveness against COVID-19.

We are pleased to announce that our office will be offering vitamin C IV infusions by appointment.

If you are interested in this treatment, please schedule an appointment with one of our providers at The Manhattan Center for Headache & Neurology!

By: Brooke Steiger, NP