Medication Overuse Headache (MOH) is a disorder caused by excessive use of acute medications. It is defined as headaches occurring on 15 days or more per month in a patient with a preexisting headache condition, who has been overusing one or more acute treatment drugs for three or more months.
Medication overuse varies with each medication class. The triptan class (consisting of Sumatriptan or Imitrex, Rizatriptan or Maxalt etc.) on 10 or more days per month constitutes as medication overuse. Use of simple analgesics or NSAIDs such as Aspirin or Tylenol on 15 or more days per month constitutes medication overuse.
Common symptoms of Medication Overuse Headache include headaches on a daily basis or almost daily. These headaches tend to be present upon awakening, improve temporarily with medication and return when the medication wears off. Additional associated symptoms include nausea, anxiety, irritability, restlessness, difficulty concentrating, difficulty with memory and depression.
There are varies treatment options for Medication Overuse Headache that a physician can review with you. The overall treatment goal being the safe discontinuation of the overused medication without causing withdrawal. Many times a combination of pharmacological therapy (preventive treatment), non-pharmacological therapy, biofeedback, and physical therapy is used.
If you are someone who takes medications for acute treatment frequently contact your physicians and let them know thus the appropriate management can be done and medication overuse headaches can be avoided or treated.

Caroline Pruski, NP


Ubrelvy is a newer abortive medication for migraines which is classified as a CGRP-inhibitor. A CGRP-inhibitor is drug that blocks CGRP which causes pain cascade associated with migraine.

This is drug, also known as ubrogepant, is used as an acute treatment for migraine. Some studies have shown
The clinical trials for Ubrelvy showed that the side effects included nausea and fatigue and were the same as placebo.

One study showed that a significant percentage of study participants were pain-free within 2 hours of taking Ubrelvy and that many had complete relief of symptoms of nausea and sensitivity to light and sound.

Additionally, this medication is safe for patients who cannot use triptans such as those with cardiovascular disease including as high blood pressure, high cholesterol, and stroke.

For more information about trying Ubrelvy, CALL THE MANHATTAN CENTER FOR HEADACHE & NEUROLOGY. We look forward to seeing you!

By: Brooke Steiger NP


MSSNY Urges People To Seek Medical Care During The Pandemic
The New York Post (5/3, Campanile) reported the Medical Society of the State of New York (MSSNY) “is urging people to go to doctors’ offices for crucial medical care amid the pandemic.” In a statement, the group said, “Physician practices and healthcare facilities have seen massive drops in patient visits, caused by a combination of shelter in place orders and patient fear. This may lead to much more complex problems in the future, as patients miss routine screenings and preventative care.” MSSNY also said that “with proper safety precautMXions, a doctor’s office is one of the safest places for a patient.”

MCHN has implemented infection control procedures to protect non-COVID patients during the pandemic:
Staff members are screened for COVID-19 symptoms, wear masks and other protective equipment.
All patients are screened for COVID-19 symptoms before arriving for their visit,
all staff and patients are screened for COVID-19 symptoms at the center and given a temperature check with a “no-touch” thermometer.
All patients are also required to wear a mask, and social-distancing measures “will be enforced” in waiting areas.
The center is thoroughly cleaned and sanitized throughout the day

Please read the article in the NY POST for more information.

The Manhattan Center for Headache and Neurology encourages patients to not delay their neurological care. We follow strict infection control procedures to keep our patients and staff healthy. WE LOOK FORWARD TO SEEING YOU!

Migraine Healthline App

Now, more than ever, it is important to feel connected and supported as we socially distance.

An app called Migraine Healthline can help with this. This app helps people suffering from migraines to connect with other people with migraines.

There is a weekly live group discussion featuring a facilitator that allows you to ask questions and discuss with others.

Additionally, there are group discussions where you can post questions and discuss different topics of interest.

Also, as a member you may opt into push notifications allowing you to connect one-to-one with other app members.

On top of all that, the app provides access to articles regarding scientifically accurate and reader-friendly articles.

This app is free in your smartphone’s app store.

Take care and stay well!

By: Brooke Steiger, NP


It can be hard to determine if you have sinus headaches a result of the spring allergy season or migraine headache. Approximately 80 percent of people with migraine are misdiagnosed with sinusitis or “sinus headache”. There’s definitely an overlap with certain symptoms with the two disorders, especially the complaint of pressure or pain in the face. Looking at more than just the head pain but the associated symptoms of each disorder can help differentiate between the two.
Sinusitis associated symptoms can include cough, aches, postnasal drip, and thick yellow-green nasal discharge, itching (in the eyes, nose, and mouth), sneezing and tearing of the eyes. Migraine associated symptoms include nausea, vomiting, lightheadedness, dizziness, sensitivity to light and sound.
Additionally, identifying triggers and tracking when your headaches are worst can help differentiate between the two. Migraine attacks can be triggered by certain foods, caffeine, alcohol, weather, stress, lack of sleep, dehydration, sound, light and exercise. Sinus headaches are mostly only triggered by certain foods or drinks, environmental changes and animal dander.
Seeing a headache specialist like us at The Manhattan Center for Headache and Neurology can result in a correct diagnosis and proper treatment plan. Specialists like us are able to differentiate between the two, resulting in the right treatments and eventually less headaches.
We offer Telehealth visits covered by insurance! Same day appointments are available for in person appointments as well as virtual.
– Caroline Pruski, NP


The corona virus pandemic has caused significant disruptions in everyone’s lives. As a person living with headaches and migraines there are several things to consider.

Be prepared
It is important to have an adequate supply of your medication. Keep an eye on your supply of your daily preventative or abortive medication. Make sure to call your pharmacy for refills or your medical provider to refill well in advance of when you are scheduled to run out. If you are located in the NYC area, consider a pharmacy that delivers such as Capsule pharmacy.

Practice social distancing prevention

We all know it is important to practice social distancing in order to help contain the spread of the Coronavirus. It’s also a vital means of prevention to help protect your health.
Headache is a known some time of COVID-19. Although there is still much to be learned about COVID-19, we do know that viral infections may trigger migraines.

Consider alternative to in-person HCP visits and schedule TELEHEALTH APPOINTMENTS!

If you have concerns about going to your medical providers appointment in person, consider a telemedicine appointment. Many offices are closed for in person visits but are doing video visits for the cost of a co-pay. Our office is also open for emergency migraine treatments as well as diagnostic testing as well as telemedicine visits. If you have new or concerning symptoms, it is always important to consult with your health care provider and a telemedicine visit is a safe and easy way to do it.

If you have more questions about how COVID-19 may affect your migraine or headache, call the office to make a telemedicine appointment with your health care provider. The Manhattan Center for Headache & Neurology is offering SAME DAY TELEHEALTH APPOINTMENTS and IN OFFICE CONSULTATIONS!


FDA approves Lundbeck’s Vyepti™ (eptinezumab-jjmr) – the first and only intravenous preventive treatment for migraine

We are now scheduling appointments for Vyepti Infusions! This is the first intravenous (IV) treatment for migraine prevention and the latest in a new class of monoclonal antibodies used for the preventive treatment of migraine.

Eptinezumab is a humanized monoclonal antibody that binds to calcitonin gene-related peptide (CGRP) ligand and blocks its binding to the receptor. The drug is expected to launch commercially in April of 2020 and should be administered every three (3) months via a 30-minute IV infusion.

This is yet another very exciting development for people living with migraine.

Call The Manhattan Center for Headache & Neurology to schedule your very first Vyepti Infusion. Schedule a telehealth consult or an in person consult to determine if VYEPTI infusion therapy is right for you. Let us help you lead a pain free life!

Our center follows all rules and regulations to maintain a sanitized facility to ensure that you continue to be safe and healthy during this COVID-19 health crisis.


Some people can experience migraines lacking the actual head pain sensation, these are known as silent migraines. Other names for silent migraine include acephalgic migraine, amigranous migraine, migraine aura without headache and migraine equivalent. Migraine sufferers may experience only silent migraine attacks, while others may have a combination of silent migraines and typical migraines. Silent migraines are more common in people who suffered from migraine with aura when they were younger.

Even though silent migraines lack head pain, silent migraines result in symptoms that can be debilitating. Silent migraine is easily understood when looking at the phases of migraine. The typical phases of migraine include prodrome, aura, headache and postdrome. Silent migraines lack the head pain sensation in the headache phase.

Prodrome symptoms generally include changes in mood, depression, irritability and difficulty focusing for several hours to several days. The aura phase includes symptoms such as blurry vision, vision loss, seeing geometric patterns, flashing or shimmering lights, or blind spots in one or both eyes. Aura symptoms only occur in a third of migraine suffers and last anywhere between 5 – 60 minutes.

The headache phase of a migraine attack is characterized by headache pain that can last several hours to three days. In addition to head pain people also experience additional symptoms such as nausea, inability to sleep, anxiety, and sensitivity to sound, light and smell. Silent migraine suffers can experience all the associated symptoms of this phase but not the actual head pain. Postdrome also known as the “migraine hangover” includes symptoms such as fatigue, body aches, trouble concentrating, dizziness and sensitivity to light.

If you believe you have been experiencing silent migraines it is very important to see a medical professional like us at the Manhattan Center for Headache and Neurology. Ruling out stroke and other more serious disorders is crucial since the typical migraine head pain is not present. We also would be able to recommend appropriate and effective treatment options based on the type of migraine and symptoms you have been experiencing.

Caroline Pruski, NP


Botox for migraines is a therapeutic treatment that may help prevent the occurrence of chronic migraine.
Botox is FDA approved for chronic migraines defined as headaches occurring 15 or more days per month. It is delivered via tiny injections in the head and neck and is administered every three months. This procedure is done in the office by your healthcare provider and usually takes about the same amount of time as an office visit.
It is a particularly good treatment for patients who have tried many oral therapies that have not worked to prevent headaches.
For additional information about Botox for migraines including possible side effects, please make an appointment with one of our caring providers at The Manhattan Center For Headache & Neurology. We look forward to speaking with you!
-Brooke Steiger, NP

Migraine Is Commonly Misdiagnosed or Undiagnosed

Between 36 million and 40 million Americans experience migraines. Many of these migraine sufferers never receive an accurate diagnosis or proper treatment. This is mainly the result of migraine being such a widely misunderstood disorder. Many migraine suffers think they are just experiencing a headache, or think they are doing something to cause them (such as not drinking enough water). Migraine is even often misdiagnosed by medical professionals who aren’t headache specialists. Many migraine sufferers are told they just have “tension headache”, “sinus headache”, or allergies.
Migraine is not just a headache, it is a complex neurological disorder that can’t always be prevented by avoiding certain triggers. Physicians who are specially trained in treating migraine and other headache disorders can provide an accurate diagnosis, and a comprehensive treatment plan that can make living with migraine more manageable. Here at the Manhattan Center for Headache and Neurology we are all headache specialist who have expertise in the diagnosing and treating head pain disorders.
Here are a few signs and symptoms that differentiate a migraine from a headache or other disorders:
· Moderate to severe head pain that is often described as throbbing
· Pain is commonly unilateral (on one side of the head)
· Head pain can lasts anywhere from four hours to several days
· Associated nausea and even vomiting with your head pain. Even if the nausea is mild, it is more likely to be associated with a migraine than with other headache types
· A headache that worsens with any routine activity, physical activity or movement
· Headache severe enough to make you miss work or other activities
· Photophobia also known as sensitivity to light. Light sensitivity is very common in migraine, but very uncommon in other headaches. Sufferers often report that light, especially outdoor light and non-incandescent light, is very bothersome during an attack. Many sufferers report that light sensitivity can even trigger an attack
· Phonophobia, also known as sensitivity to sound. Even the sound of the TV or music can be irritating during an attack
· Sensitivity to certain odors. Certain smells can even trigger a migraine.
· Difficulty concentrating and processing information due to the headache
· Head pain associated with dizziness or vertigo.
· Temporary vision or language problems, or tingling and numbness, in addition to headache
· A family history of recurrent moderate-to-severe headaches.
· A history of being carsick or motion sick as a child is common in migraine suffers.
· Aura, also known as a visual warning sign before the migraine head pain. Auras can be flashing lights or zigzag lines.
– Caroline Pruski, NP