Food “Triggers”

There are many things that may trigger migraine. In many cases it may not just be one trigger that causes a migraine but several triggers occurring around the same time that lead to a migraine.

Studies suggest that cured meats and aspartame may increase the risk of headaches in a person who suffers from migraine.

For many foods there is not good scientific evidence that shows they are significant triggers for migraines. Other foods that people with migraine report are triggers include aged cheeses, red wine, excessive caffeine, citrus fruits, and yeast.

Additionally, the Cleveland clinic suggests that the following foods may be common triggers for migraine however no evidence exists that this is the case: avocados, smoked or dried fish, onions, garlic, potato chips, tomato base products, beans, dried fruits, some cultured dairy products (cultured), organ meats, pickled foods, and some tropical fresh fruits.

Food triggers vary quite a bit from individual to individual. To determine your triggers it is important to keep a headache diary and track your migraines.

Food allergies may also play a role in triggering headaches. If you think you are allergic to a food you should have testing with an allergist to confirm this and then avoid the food.

To learn more about food triggers, speak with your healthcare provider.

By: Brooke Steiger, FNP


Subdural hematoma (SDH) is a form of intracranial hemorrhage characterized by bleeding into the space between the dural and arachnoid membranes surrounding the brain. SDH is often crescent shaped because bleeding follows the contour of the overlying dura. Acute SDH occurs due to bleeding within the subdural space and may resolve by resorption or become chronic by membranous encapsulation and hygroma formation. The most common cause of SDH is head trauma related to motor vehicle accidents, falls and assaults. Other causes include intracranial hypotension, ruptured cerebral aneurysm, and cerebral vascular malformations.
The initial presentation of SDH has a wide spectrum of clinical manifestations including:
· Drowsiness
· Cognitive impairment
· Vertiginous sx ( lightheadedness and dizziness)
· Mood irritability
· Apathy/depression
· Headache
· Imbalance
· Seizure
An extensive neurological workup to include head CT, possible CTA of head and neck, brain MRI, and blood work are needed to make the diagnosis of SDH.

By: Jordan Shankle, PA


What is Pain?

Chronic pain can be classified as nociceptive, neuropathic, and/or “centralized”:

• Nociceptive pain is caused by stimuli that threaten or result from bodily tissue damage. It is expected after surgical and other acute traumatic injury, and is associated with a range of musculoskeletal and visceral conditions that involve inflammatory, ischemic, infectious, or mechanical/compressive injury. 

• Neuropathic pain results from a maladaptive response to damage or pathology of the somatosensory nervous system, and consists of a central and/or peripheral disorder of pain modulation. Causes of neuropathic pain are varied, and include peripheral (eg, painful diabetic neuropathy, postherpetic neuralgia, nerve trauma, autoimmune disorders) and CNS sites of initial injury or disease (eg, stroke or spinal cord injury, multiple sclerosis, trigeminal neuralgia).

• Nociplastic pain (also called centralized pain or pain hypersensitivity) results from altered pain sensory processing and impaired central pain modulation. Centralization can occur as a consequence of persistent noxious stimulation from either or both nociceptive and neuropathic pain, and most “centralized pain” is a mixture of both.

Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors. Thus, evaluation of a person with chronic pain requires a search for a biomedical cause, psychologic and social evaluation, and assessment of physical function and sleep. Please call The Manhattan Center for Headache and Neurology for an appointment with one of our dedicated and caring providers for a complete evaluation of your pain.

–Alice Wong, NP


Most people understand that a typical migraine is often accompanied by sensitivity to light and noise, nausea, and dizziness or lightheadedness.

Some people, however, experience other symptoms as well. Other symptoms include but are not limited to irritability, chills, ringing or whooshing sound in ears, tingling in hands arms or face, heat intolerance, loose stools, indigestion, nasal congestion, visual changes, and fatigue.

Because every individual is unique, some may experience a few or many accompanying symptoms not typically associated with migraine.

To treat these symptoms, an individual’s usual rescue medication for migraine should be used and, in some cases, an additional medication may be indicated.

If you have questions about your unusual migraine symptoms, talk with your medical provider.

By: Brooke Steiger, NP


Post lumbar puncture (LP) headache, also known as Post Dural puncture headache ( PDPH) is a common complication after a diagnostic or therapeutic lumbar puncture. Additionally, these types of headaches can occur during an attempted epidural catheter placement. Headache characteristics include dull, achy pain localized in the frontal, occipital or holocephalic region. Headaches are positional (worsened when upright, and better when lying supine); and they may or may not be accompanied by stiff neck, light sensitivity, nausea, visual changes or auditory/hearing symptoms. Post Lumbar headaches tend to develop within 5 days of a lumbar puncture being performed and typically resolves within 1 wk. Common risk factors include female gender, pregnancy, prior headaches, and lower body mass index. PDPH is a clinical diagnosis, usually made by identifying positional headaches within 72hrs – 5 days after a Dural puncture. Of note, secondary causes of sudden headaches may need to be excluded as well.

The Manhattan Center for Headache and Neurology has competent providers for further evaluation and potential treatment options.

aluation and potential treatment options.

By: Jordan Shankle, PA


Giant cell arteritis is a condition that can cause headaches, trouble seeing, and jaw or arm pain. Also called GCA or temporal arteritis, it is a type of blood vessel inflammation that damages arteries. The most commonly affected arteries are those that start in the neck and travel into the head and scalp. It usually occurs in people aged 50 and older. Temporary loss of vision can be an early sign of GCA. Up to 10 percent of people with GCA can develop partial or complete blindness. If untreated, loss of vision can be permanent and/or can affect the other eye. Other symptoms of giant cell arteritis can include, new cough, fever, feeling tired, and weight loss.
If GCA is suspected, your provider will order blood tests for inflammation, ie, the erythrocyte sedimentation rate (ESR or “sed rate”) and C-reactive protein (CRP). The diagnosis must be confirmed, either by biopsy of the temporal artery or with imaging tests (ultrasound, MRI, or PET scan). Giant cell arteritis is treated with medicines called steroids. Many people feel better after taking their first dose. But most people need to take steroids for 1 to 2 years. If you have headaches, especially with vision loss, please call The Manhattan Center for Headache and Neurology for an evaluation.
–Alice Wong, NP


Hypnic Headache, also known as “alarm clock headache”, is a relatively uncommon type of headache disorder. This headache syndrome occurs, almost exclusively, after or around the age of 50 and is slightly more prominent in women; ration 2:1. Clinical features include recurrent episodes of dull or throbbing head pain, during sleep or early hours of the morning. Patients often are awakened from sleep. Headaches tend to occur greater or equal to 10 days per month, and persist for at least 15 minutes, no more than 2-3 hours. Head pain intensity is moderate to severe and can be disabling. Headaches may or may not be associated with migrainous features to include nausea, vomiting, photophobia, and phonophobia. Trigeminal autonomic features may be present as well, although not required for diagnosis. Common comorbid conditions include hypertension and migraine.
The diagnosis of Hypnic Headache is clinical, with a key feature of absence daytime attacks which distinguishes hypnic headache from most other types. This can be a chronic syndrome lasting many years.
The Manhattan Center for Headache and Neurology has competent providers for further evaluation and potential treatment options.
By: Jordan Shankle, PA

Ultrasound-Guided Trigger Point Injections
Trigger points are commonly seen in many of our patients alone or in combination with migraines and other headache syndromes. They are responsible for localized pain in the affected muscles (head, neck, and/or shoulders) as well as distant areas, called referred pain.
A trigger point injection is a procedure where a medication, usually a local anesthetic, is injected into the painful muscle to provide relief in the affected muscle and the area of referred pain. In this office procedure, our providers insert a small needle into the patient’s specific areas of pain (trigger points). The injections usually contain only local anesthetics, but occasionally may contain a steroid medication.
Correct needle placement in a trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve pain. The Manhattan Center for Headache and Neurology is now offering ultrasound-guided trigger point injections. The use of ultrasound allows us to observe needle placement, reduce risk, and improve results for our patients. Please call to schedule your consultation to see if this treatment is appropriate for you.
–Alice Wong, NP

We are approaching the holiday season which is fun and festive but for some people can set the stage for more frequent migraines and headaches.

Here are some tips for surviving the holidays:

Be aware of triggers
For many patients the holidays means indulging in traditional and delicious food and drink. The holidays are meant to be enjoyed but be aware of your triggers. If you choose to partake in food or drink that are known triggers be prepared with appropriate medication or treatments that you can use at first sign of headache.

Take time for self care
The holidays can be stressful with many different events and family obligations but it’s important to make time to take care of your health. This means getting enough downtime and doing all the other things you typically think of to keep healthy like drinking enough water and exercising.

Try to stick to routine as much as possible
With the holidays comes different events and activities that may interrupt your typical daily routine which can trigger headaches. You may be traveling to visit family or attending holiday parties. It is important to continue your same sleep schedule as much as possible. Also if you attend a party one night, maybe consider staying home the next night.

Try to stress to a minimum
With all the good things the holidays bring, they may also add increased stress due to social events and family gatherings. Keep migraines at bay, by planning ahead. For example if you’re planning on making a big meal for your family, try to prepare some dishes in advance or make it a potluck where everyone brings dishes to help.

By: Brooke Steiger, NP


Tremor, defined as involuntary, rhythmic movement of a body part. It is one of the common of all movement disorders. It can be caused by alternating or synchronous contractions of different muscle groups. Tremor can vary from patient to patient; and is classified by clinical characteristics such as body distribution, tremor frequency or if it occurs at rest versus with movement. Tremor can also be classified based on associated neurologic and systemic signs. Etiologies include specific neurologic disorders, toxins, vitamin deficiency or toxicity, and adverse reactions to medication. Tremor can be genetic or acquired. Examples of common tremor syndromes include Physiologic Tremor, Essential Tremor, Orthostatic Tremor. Furthermore, a detailed neurologic examination is important to identify specific features of Parkinson’s disease, Dystonia or Guillain-Barré syndrome. The Manhattan Center for Headache and Neurology has competent providers for further evaluation and potential treatment options.

By: Jordan Shankle, PA