Doctor’s Orders: More than what you think

Medications are not your stereotypical things you think of. Have you ever gone to the doctor and been instructed to go to physical therapy? Have you ever had blood drawn and been told you were dehydrated so you should drink more water? These things are considered ‘Doctor’s Orders’ as well.
Ignoring an ‘order’ or suggestion can take a toll on your health. When visiting your neurologist, we listen to what you tell us. Sometimes patients do not like to start with actual medications. In these cases, we ‘order’ or suggest other things such as supplements. These supplements such as magnesium, Coenzyme Q10, B2, and B12 can help reduce the frequency and severity of your headaches. We listen to patients, and hope you listen to our suggestions as well 😊

Heat and your mood: It’s not just a winter thing

Are you a person who loves summer time? Is all you can think about getting on the beach, stretching out with music or a good book by the water? What about those of you who love winter? Those who countdown opening day to the ski mountain, so they can hit the slopes? Moods change with season!
Seasonal Affective Disorder (yes, some people call this SAD although it is not the actual terminology) is a real thing. When most people hear about Seasonal Affective Disorder winter is the automatic thing to jump to due to lack of light, cold days, and less time outdoors. However, there are proven studies that show this is not the only cases!
Heat and summer is just as big a culprit in Seasonal Affective Disorder for many people. People with migraines often have a hard time enjoying certain hot sunny days due to the heat and humidity. This drives them inside where they can feel disjointed and removed from their friends and family. If we were all able to be on the beach mostly, we might be able to handle this a bit better, but alas many of us are in extremely warm humid cities dealing with migraine pain.
Remember you are not alone when you start to feel down. Some ways of finding entertainment during these days are visits to fun indoor attractions where there are still plenty of people. Have your friends and family attend a book reading or stroll along window shopping (indoors of course). Try that restaurant you always wanted to go to but could never find the time. There is no shortage of ideas that you all can find together!

Nerve Blocks and Headaches

Did you know that nerve blocks can be used to treat various headache disorders? Nerve blocks have shown the best evidence in cluster headaches, however, they have also been used for chronic migraines, chronic daily headache, hemicrania continua, and other headache disorders.

A nerve block is an injection used to decrease inflammation or block the pain signal along a specific nerve distribution.

Nerve blocks may provide rescue in the following situations:
Patients who have failed their home medications.
Patients who need relief between botox injections.
Weaning patients with medication overuse headache from their acute therapy.
Nerve blocks also may be appropriate for pregnant patients. In pregnancy, lidocaine is considered a category B drug, so can be a reasonable migraine prophylaxis if it works for someone

Nerve blocks work very quickly and provides almost instant relief.

We do nerve blocks at MCHN for patients who may experience any of the situations above. Please call us to schedule an appt. if you think you may be a candidate, or if you need further information regarding nerve blocks and treatment of headache disorders.


People often wonder what depression can be, because it is not the picture that many people envision. This is not a sign of weakness or negative personality; it simply means that you need some help in the moment. Often this is due to a chemical imbalance in the brain. Major depression is considered an episode of sadness or apathy (lack of interest or concern), along with some other symptoms, that lasts at least two weeks and is severe enough to interfere with your daily activities. Depression is a considerable public health condition that is very treatable.
Emotional Symptoms:
The principal symptoms of depression are having a sad mood or a loss of interest in life. Activities and hobbies that you used to look forward to may lose their appeal. It is possible that you may feel guilty even when there is nothing to feel guilty about, feel worthless, have feelings of helplessness, or having thoughts of suicide. If you ever having thoughts of suicide immediately reach out for help. The national suicide hotline is always available at 1-800-273-8255; or you can chat anonymously on their website at .
Physical Symptoms:
Depression can also be linked to physical symptoms. This can include feeling fatigue and a decrease in energy. You may also have some insomnia and/or early morning awakening. Conversely you may feel more tired than normal or have excessive sleepiness. It is also possible to have persistent aches and pains, cramps, headaches, or digestive problems that do not resolve with treatment. A change in your appetite is possible, and can occur either with an increase or a decrease in appetite.
Without proper treatment depression can have a significant impact on your daily life. Your career, hobbies, and lifestyle may all be affected. People may even stop enjoying sex, and relationships can suffer. Knowing this information helps you to be more aware if your mood starts to change. If you feel like you are becoming depressed or are experiencing depression, please reach out for help. Treating the chemical imbalance in the brain or finding other modalities that may help is part of the treatment process. Let us help you if you feel depressed.

Changing the Stigma: Mental Health by Amanda Moret, PMHNP

I started writing this before Kate Spade and Anthony Bourdain. I am glad I now have the chance to address this topic for all. Mental Health, good times and bad, should be something we talk about to others!!
Talking about mental health, mental wellness, and mental illness can be scary for some people. For many years people associated these conversations with stigmas or being disgraced. Some considered others weak for talking about these conditions, however that is no longer the case. We as a community are changing the “stigma” of discussing mental health and seeking treatment when you do not feel like you are performing at peak mental function.
For example, if you had a medical condition such as asthma and needed treatment you would not be shamed for this. You would seek treatment to improve your breathing and ensure that you were performing at your peak levels. The same is true for mental health. If you are feeling down, anxious, nervous, stressed, or simply feeling different than you used to…. why would you not look for something to improve these feelings?
By being open and talking about these issues with our friends and families the associations have changed over time. More often these days people are aware of celebrities and people in the spotlight speaking about these issues and are becoming more cognizant of how prominent this is in society. Keep an open mind when discussing mental health, and remember it is okay to not feel your best. If you ever need help improving your mental health or getting back on track come visit us and see if we can help you.

Vestibular Migraines

Have you ever experienced vertigo, dizziness, nausea and vomiting with or without a throbbing headache. You may have gone to the ENT or your primary care physician and all your tests were normal. This could be vestibular migraines.

Treatment for vestibular migraines is similar to that of other migraines, which may include medicines to either stop or prevent an episode. Some of the recommended medications include:
Beta blockers
Calcium channel blockers
Tricyclic antidepressants
Serotonin or serotonin/norepinephrine reuptake inhibitors (SSRIs or SNRIs)
Making lifestyle changes can also help to reduce the frequency and severity of vestibular migraines.
If you think you may have vestibular migraines, call us at the Manhattan Center for Headache and Neurology and one of our providers would be happy to assist you with the best treatment plan to decrease your symptoms.

New observational study shows migraine patients skipping recommended treatments

A recently published observational study states that even when a headache specialist refers migraine patients for proven behavioral treatments like biofeedback, relaxation training or cognitive behavioral therapy, barely half of the patients follow through.

In the study, a group of 69 migraine sufferers treated at a large academic headache practice were referred for behavioral therapy, but just 57 percent got as far as making an appointment with the behavioral practitioner, researchers found.

The patients who ignored their doctor’s recommendation cited time limitations as the main barrier to treatment. Concerns about cost and insurance coverage were also an issue. And some were skeptical about whether the treatment would work; others worried about the potential stigma of seeing a psychologist, the study team reports in the journal Pain Medicine.

Evidence shows that behavioral therapy is more effective and safer in treating migraines as opposed to opioids, which are often being prescribed as the first line of treatment for migraines. To learn more about the benefits of behavioral therapy, click here to read the full coverage of this story.

Occipital Neuralgia

Did you know that you have nerves that run from the top of your spinal cord up through the scalp, called the occipital nerves? These nerves can get inflamed or injured resulting in pain to the back of your head or the base of your skull? This is called occipital neuralgia!
Occipital neuralgia can be confused with migraines or other headaches. Occipital neuralgia pain can be very intense and feel like a sharp, jabbing electric shock in the back of the head and neck. The pain is also described as burning, aching or throbbing, can be on one or both sides of the head, scalp tenderness, pain behind the eye and photophobia are also common symptoms.
Treatment for occipital neuralgia can be very different from migraines or other headaches.
Call us at the Manhattan Center for Headache and Neurology to set up an appointment with one of our providers to determine the right diagnosis and treatment plan for your symptoms.

Exciting news for patients with Episodic and Chronic migraines! AIMOVIG!!

Aimovig (Erenumab) – New Drug for Migraine Prevention

First FDA drug approved and designed to prevent migraines by targeting and blocking the calcitonin gene-related peptide (CGRP) receptor, disrupting a key component in the migraine pathophysiology.

Indicated for Episodic or Chronic migraines.

Based on the studies, patients with chronic and episodic migraines experienced 50% reduction in monthly migraine days over a period of 3 months and 4-6 months respectively.

Once monthly subcutaneous injection, designed to be self-administered.

Considering that this is a new drug, our providers at MCHN are administering the first dose and will teach you how to self-administer moving forward. They are also available to administer the injections monthly if that is your preference.

If you have chronic or episodic migraines, AIMOVIG could be the drug for you.

To learn more about aimovig, please call to schedule an appointment to discuss with one of our care providers.