IV  Treatment  and SPG block for treating acute migraines

Why do you need IV Therapy ?

Acute migraine episode lasting anywhere from 24 to 72 hours, week duration failing  to respond to abortives accompanied by severe pain 8-10/10 intensity, nausea and debilitation.  Migraines tends to become more difficult to treat as it becomes more prolonged and more severe with time.  Nausea is most common with acute migraine which leads to poor oral intake and causes dehydration which further worsens the migraine and is harder to treat.

What is an  SPG Block?

Sphenopalatine Ganglion (SPG) is a group of nerve cells linked to the Trigeminal nerve, which is the main nerve involved during a headache.  SPG is located behind the nose which carries sensation, including pain and also plays a role in autonomic functions (tearing & nasal congestion). An SPG block is an application of a local anesthetics (or numbing medications) to block or partially block the SPG which in turn reduces head and facial pain.

IV Treatment effectively manages the acute pain, nausea, dehydration and in many cases either decreases the pain intensity or renders complete relief from the pain.

Core Principles of IV treatment along with SPG block

  • Ensure adequate hydration through IV fluids
  • Counteract nausea with antiemetic agent
  • Reduction or elimination of the acute pain through IV NSAID / SPG block
  • Reduction or elimination of the pain through application of local anesthetics.

Contact The Manhattan Center for Headache and Neurology is you are experiencing an episode of acute migraine to learn if you are a candidate for IV/SPG treatment.

By: Rajni Bala, FNP

SUNCT-Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing

This is a rare type of headache that is most common in men over 50 years old. This headache is unilateral with a burning, piercing or throbbing quality and of moderate to severe intensity. The pain peaks within seconds of onset, and lasts from 5 seconds to 4 minutes. Attacks are typically during the daytime. Patients can have up to 6 attacks per hour.

During the attacks, patients may experience:

  1. watery eyes
  2. reddish or bloodshot eyes (conjunctival injection)
  3. nasal congestion
  4. runny nose
  5. sweaty forehead
  6. swelling of the eyelids
  7. increased pressure within the eye on the affected side of head

These headaches are not usually responsive to regular treatment for short-lasting headaches, however corticosteroids and anti-epileptic drugs may help to relieve symptoms. There is no cure for this type of headache. It is not fatal, but can be very uncomfortable.

If you are experiencing any of these symptoms, please call us for an evaluation.

By: Tanesha Reynolds, DNP, FNP, certified in headache medicine by The National Headache Foundation

Is your jaw to be blamed for your migraine headaches?

Your temporomandibular joint known as TMJ is the hinge joint that connects your jaw to your skull. The pain created by your jaw as it clenches and grinds especially during stress and during sleep travels to your head, causing headaches and migraines.  A migraine of moderate to severe intensity felt at top or the sides of the head, causative factor may actually start at the bottom of your skull, triggered by TMJ. According to Cleveland Clinic’s center for integrative and Lifestyle medicine, “TMJ muscles, located underneath jaw and in cheeks and on top of and sides of head can generate and be a source of the chronic migraines.  It can also be accompanied by toothache, earaches, both shoulder and neck pain”. In our practice, these are the most common complaints made by patients that suffer from TMJ associated migraines. Call us to schedule a consultation with one of our caring provider!


Tips to ease headache, migraine pain associated with TMJ:

  • chew mint instead of gum, which lessens the stress on the jaw that triggers the migraine by preventing excessive mastication
  • Gently massage your jaw muscles
  • Stretch your neck throughout the day with specific neck exercises
  • Visit a dentist for appropriate fitting mouth guard
  • Behavioral Modifications: stress reduction, exercise, yoga .  

By: Rajni Bala, FNP

New York Times Diagnosis

Did you know that sinus headaches are the number 1 misdiagnosis in migraine? There are many other headache disorders as well that can mimic a sinus infection. The trigeminal autonomic cephalalgias (TACs) are a group of headache disorders in which sinus type symptoms and allergy type symptoms are characteristic.  In the New York Times article written by Lisa Sanders, seen below, an example of this is explored.

By: Audrey L. Halpern, M.D.

Her Allergies Were Getting Better, So Why Were Her Sinus Headaches Getting Worse?

– By Lisa Sanders, M.D.

“It was the pain that woke her that night — the worst pain the 60-year-old woman had ever felt. It was as if a C-clamp were tightened around her head and face, punctuated with pulsations of what seemed like an electrical current.

The feeling eased after 20 excruciating minutes. All that was left was a dull ache. And exhaustion: Her husband found her in a fetal position on the floor of their home in a suburb of Baltimore. He helped her into bed. She had to go to the E.R., he said. “What am I going to tell them?” she answered. “That I had a headache?”

The pain returned many times over the next two weeks, usually when she was asleep. Her eyes would water, her nose would run and then she would get this intense pressure behind her cheekbones and eyes. It felt like the worst sinus headache she’d ever had — and she’d had many since her bout with cancer 30 years before.”

Read More

CGRP HEADACHE MEETING led by Audrey, Halpern, MD on Thursday, October 25

Topics: CGRP Therapies and Migraines, Questions & Answers
Audrey Halpern MD, is excited to discuss the benefits of CGRP!
What is it? How can it help you?
A CGRP Drug is a unique migraine treatment that has shown promising results and has recently been been approved by the FDA!
Learn all about the different types of CGRP and which one may be best for you.
Audrey Halpern, MD has invaluable information that can help you!
Come to our headache meeting!
Bring a friend!
Remember, you are not alone when dealing with HEADACHES!
Refreshments and finger food served!!!
Meeting led by: Audrey Halpern, MD
The Manhattan Center for Headache and Neurology
Thursday, 10/25 at 6:00 pm
108 West 39th Street suite 1601, 16th floor NY, NY 10018
RSVP (please call and reserve your seat), 646-559-4659

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is categorized by repetitive, unwanted, intrusive thoughts (the obsession component) and irrational, excessive urges to do certain actions (the compulsion component). Even though people with OCD may know that their thoughts and actions do not make sense, they are often unable to control or stop themselves. Most people occasionally have obsessive thoughts or compulsive behaviors. However, to truly have OCD these symptoms last for more than an hour daily and interfere with daily functioning of the individual’s life.
Examples of obsessions include but are not limited to: thoughts about harming or having harmed someone; doubts about having done something correct such as turning off the stove or locking the door; unpleasant sexual images; or fears of saying or shouting inappropriate things in public.
Compulsions are repetitive acts that temporarily relieve the stress brought on by an obsessive thought. Examples of compulsions include but are not limited to: handwashing due to fear of germs; counting and recounting money because the individual is not sure that they counted correctly each time; checking to see if a door or window is locked multiple times, or if the stove is off more than once; as well as ‘mental checking’ such as repeatedly going through a mental checklist to ensure they have done everything more than once.
Although OCD is not curable, it is very treatable. Medications and therapies help to keep the disorder under control, so the individual may live a better life. If you have or are experiencing any signs or symptoms of OCD do not be afraid to reach out for help. Using the right treatment modality for you will help to calm your brain, give you a sense of peace, and reduce the obsessive thoughts that take over. Let us help you if you are experiencing any of this discomfort!

By: Amanda Moret PMHNP, FNP

Non-medication Treatments for Migraines

There are non-drug treatments for migraines that are effective for some patients. People try treatments that aren’t drugs for several reasons: a. they just don’t like to take medications, b. side effects of medications, c. other treatments have not worked, and d. comorbidities that prevent them from taking migraine meds.

Here are some of the most common non-drug treatments for migraines

Relaxation Techniques
Spinal Manipulation
Talk Therapy
Diet changes

By: Tanesha Reynolds, DNP, FNP

Hoarding Disorder

Hoarding disorder is defined by the drive to collect a large amount of useless or valueless items, coupled with extreme distress at the idea of throwing anything away. Over time, this situation can make a space unhealthy or dangerous to be in for a person.
Hoarding disorder can negatively impact someone emotionally, physically, socially and financially. This often leads to distress and disability. In addition, many hoarders cannot see that their actions are potentially harmful, and therefore may resist diagnosis or treatment. Intervention by family and friends may be needed to call attention to this and help the person get treatment.
Treatment is available for hoarding!! Different therapy modalities can help the person work on thought processes to begin to eliminate certain stressors from their life. Once these stressors are eliminated the individual can often feel able to eliminate the useless items they have collected, such as old newspapers, trash, and other items that do not have value. Early intervention is the best way to effectively treating hoarding disorder. If you or someone you know is beginning to exhibit any signs of hoarding please reach out for help.

By: Amanda Moret, PMHNP, FNP

Postural Tachycardia Syndrome in Migraineurs

Postural Tachycardia Syndrome (POTS) is a disorder that causes lightheadedness, fainting and a fast heart rate. POTS was found to be common among patients with migraines in a recent study reported by the National Headache Foundation.

According to the study, “46% of migraineurs experienced syncope—a loss of consciousness because of a drop in blood pressure—at least once and were more likely to experience recurrent syncopal episodes than people without migraine. These and other findings suggest that migraineurs may be predisposed to having symptoms of orthostatic intolerance—problems that appear when standing up but disappear when sitting or lying down.”

POTS is a very common autonomic disorder, but diagnosis is challenging and often missed.
If you are experiencing headaches, cognitive difficulty, postural lightheadedness, syncope, and postural tachycardia, it could be POTS. Gastrointestinal symptoms such as constipation, diarrhea, and frequent urination may also be present.

There is no cure for POTS, but medications and lifestyle changes can help to control the symptoms.

By: Tanesha Reynolds, DNP, FNP

AJOVY: FDA approves new CGRP monoclonal antibody!

On September 14th, the FDA approved Ajovy for migraine prevention This is the 2nd antibody to be approved specifically for the prevention of migraine. Indeed, it is a very exciting time for migraine research, migraine treatment, for migraine patients and care providers!
Ajovy is intended for migraine prevention in the form of monthly injections, in the case of Ajovy, there is a once every 3 month protocol that was approved. Also, tolerability by the patient has shown to be very good!.
This might be the right medication for you. Make an appointment to see our headache specialist to talk about migraine treatment options. We have Ajovy $0 copay cards available for our patients. During your consultation, inquire about eligibility! We are so excited to speak with you!