Seasonal Changes & Cluster Type Headache

Tulips are blooming, the birds are chirping, and an extra hour of daylight is upon us. Spring is near! To most, extra hours of daylight is meaningful in the sense of more vitamin D exposure, more outside extracurricular activities and vacation! These positive aspects can transcend into happiness! However, those diagnosed with episodic cluster type headache can beg to differ.

Daylight savings affects the circadian rhythm and seasonal changes can result in sleep dysregulation.

Cluster type headache is characterized by agonizing painful attacks that can last 15 minutes up to an hour. Pain is excruciating and usually localized on one side of the head. Associated symptoms include lacrimation, eyelid droop, nasal congestion and/or rhinorrhea. These attacks tend to occur at predictable times and approximately 80% of patients report that these headaches follow a 24 hour cyclical pattern.

More daylight often means a disruption in sleep patterns. The change in season interferes with the biological clock and could potentially lower the threshold for activating a cluster attack.

The Manhattan Center for Headache and Neurology and its sister site Nervana Neurospa have exceptional providers that can help patients with Cluster headaches understand the mechanisms that contribute to an uptick in attacks due to seasonal fluctuations. Additionally, we can provide options for pain relief!

Cheers to a prosperous Spring!

By: Jordan Shankle, PA

Migraine or Sinus Headache?

You can ask yourself the following questions from the ID Migraine Questionnaire developed by Dr. Richard Lipton, Albert Einstein College of Medicine:
· In the past three months, how disabling are your headaches? Do they interfere with your ability to function? Are you missing work, school or family activities?
· Do you ever feel nausea when you have a headache?
· Do you become sensitive to light while you have a headache?
If you answer “yes” to two of the three questions, there is a very high chance you have migraine. Those with headaches from sinus disease are less likely to answer yes to the above questions.
If you think your sinus headaches could actually be migraine attacks, please make an appointment with one of our providers to evaluate.
–Alice Wong, NP

Delayed Onset Migraine

Delayed onset migraine or “Late Life Migraine”, is a primary headache syndrome. Symptoms are similar to classic Migraine. However, onset is after the age of 50. Additionally, this type of migraine is associated with Aura without headache. The most common type of aura is visual aura. This aura classically begins as a small area of visual loss. It may either appear as a bright spot or as an area of visual loss. Duration is between five minutes to one hour. These visual auras are often followed by sensory aura ( abnormal sensations ), speech disturbances and or motor auras ( muscle weakness).

The Manhattan Center for Headache and Neurology has exceptional providers to help diagnose and potentially treat this type of headache syndrome.

By: Jordan Shankle, PA

Workplace Accommodations for Migraine


Living with migraines can be a debilitating experience, especially when trying to navigate the demands of a typical workday. However, workplaces can play a crucial role in supporting employees who suffer from migraines by offering accommodations that enable them to manage their condition effectively. These accommodations can range from flexible work hours and remote work options to creating a conducive environment with adequate lighting and noise reduction measures. Additionally, providing access to quiet, dimly lit spaces where employees can rest during a migraine attack can significantly alleviate their symptoms and enhance productivity once they return to work.

Moreover, fostering a culture of understanding and empathy towards migraine sufferers is essential for creating a supportive work environment. Educating managers and colleagues about the impact of migraines and the importance of accommodations can help reduce stigma and promote inclusivity. By implementing these measures, employers not only demonstrate their commitment to the well-being of their employees but also harness the diverse talents and contributions of individuals who might otherwise struggle to perform at their best due to migraine-related challenges.

By: Andrew Chan, PA

Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: figures and trends from government health studies. Headache. 2018;58(4):496–505. doi: 10.1111/head.13281.

Begasse de Dhaem O, Sakai F. Migraine in the workplace. eNeurologicalSci. 2022 Jun 6;27:100408. doi: 10.1016/j.ensci.2022.100408. PMID: 35774055; PMCID: PMC9237352.

Migraine and Artificial Sweetener


Migraine is a neurological condition characterized by recurrent, throbbing headaches often accompanied by nausea, sensitivity to light, and other symptoms. While the exact cause of migraines is not fully understood, various triggers, including dietary factors, have been identified. Some individuals report a connection between the consumption of certain foods or additives and the onset of migraines. One controversial topic in this regard is the potential link between artificial sweeteners found in diet sodas and the occurrence of migraines. Some studies suggest that substances like aspartame, commonly used in diet sodas, may act as triggers for migraines in susceptible individuals. However, the evidence is not conclusive, and more research is needed to establish a clear connection between artificial sweeteners and migraine headaches.

Artificial sweeteners, such as aspartame, saccharin, and sucralose, are commonly used in diet sodas as sugar substitutes to provide sweetness without the added calories. Despite being approved by regulatory authorities as safe for consumption, concerns have been raised about their potential health effects, including their role in triggering migraines. Individuals who experience migraines are often advised to monitor their diet and identify potential triggers, which may include artificial sweeteners. It is essential for those prone to migraines to consult with healthcare professionals for personalized advice, as triggers can vary widely among individuals. The relationship between artificial sweeteners and migraines remains an ongoing area of research, with experts aiming to provide clearer insights into the potential impact of these additives on migraine susceptibility.

Grotz VL. Sucralose and migraine. Headache. 2008 Jan;48(1):164-5. doi: 10.1111/j.1526-4610.2007.00983.x. PMID: 18184301.

Migraine or Sinus Headache? 


You can ask yourself the following questions from the ID Migraine Questionnaire developed by Dr. Richard Lipton, Albert Einstein College of Medicine: 

In the past three months, how disabling are your headaches? Do they interfere with your ability to function? Are you missing work, school or family activities? 
Do you ever feel nausea when you have a headache? 
Do you become sensitive to light while you have a headache? 

If you answer “yes” to two of the three questions, there is a very high chance you have migraine. Those with headaches from sinus disease are less likely to answer yes to the above questions. 
If you think your sinus headaches could actually be migraine attacks, please make an appointment with one of our providers to evaluate.  Come visit us at The Manhattan Center for Headache and Neurology or Nervana Neurospa.

–Alice Wong, NP 

HORMONE RELATED HEADACHES

Hormonal Migraine is a subtype of Migraine associated with alternation in estrogen levels. Estrogen is a steroid hormone associated with female reproduction. Fluctuations in estrogen levels can be a result of menstruation, pregnancy, menopause, hormone containing contraceptives and in vitro fertilization.

Menstrual Migraine is the most common type of hormonal headache. It is diagnosed over a minimum of three menstrual cycles. Menstrual Migraine can occur with or without aura; although without aura is most common.

The pathophysiology of estrogen impacting migraine headaches is complex related to numerous changes in the neural networks involved in pain response. Additionally, supporting data include genetics.

Hormonal migraine is mostly a clinical diagnosis – Neuro imaging and blood work may be required to rule out secondary causes of headaches. Treatment varies based on headache severity and frequency.

The Manhattan Center for Headache and Neurology and its sister site, Nervana Neurospa, has amazing providers that will help diagnose and potentially treat hormonal related migraines.

By: Jordan Shankle, PA

Neuroplasticity in Migraine

In the realm of migraine research, the concept of neuroplasticity is emerging as a pivotal player, reshaping our comprehension of the brain’s dynamic responses to pain. Neuroplasticity, the brain’s ability to rewire itself, holds intriguing implications for understanding and treating migraines. As we explore the mechanisms behind this adaptability, it becomes evident that the brain’s structural changes play a crucial role in migraine experiences. The discovery of synaptic pruning, long-term potentiation, and the formation of new neural pathways provides insights into potential therapeutic avenues. Harnessing neuroplasticity could revolutionize migraine management, offering hope for more effective treatments that target the brain’s adaptable nature and alleviate the burden of migraine sufferers. As research progresses, the future promises a deeper understanding of how neuroplasticity influences migraine patterns, leading to innovative strategies for prevention and relief.
Ferrari MD, Klever RR, Terwindt GM, Ayata C, van den Maagdenberg AM. Migraine pathophysiology: lessons from mouse models and human genetics. Lancet Neurol. 2015;14(1):65–80. doi: 10.1016/S1474-4422(14)70220-0.
Wessman M, Terwindt GM, Kaunisto MA, Palotie A, Ophoff RA. Migraine: a complex genetic disorder. Lancet Neurol. 2007;6(6):521–532. doi: 10.1016/S1474-4422(07)70126-6.

Occipital Nerve Blocks and Pregnancy

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Primary headaches (tension, migraine, and cluster) are common in the reproductive population. Headache treatment during pregnancy is made more difficult by clinician discomfort with treatment options, concern for masking secondary headaches, and fear of potential fetal effects from headache treatments. As a result, treatment of headache disorders is often delayed during pregnancy.
Occipital nerve block is a well-established treatment for tension and migraine headache in the nonpregnant population with both abortive and prophylactic treatment benefits. Occipital nerve block is a safe, commonly performed procedure that involves a subcutaneous injection of local anesthetic with or without a steroid component bilaterally into the area around the occipital nerves. A recently published randomized trial assessed the efficacy of occipital nerve block compared with standard care of an oral cocktail of acetaminophen and caffeine for the treatment of acute headache in pregnancy.
In this randomized controlled trial of pregnant people, treatment with occipital nerve block resulted in lower visual pain scale scores at 1 hour and more rapid turnaround in maternal emergency room. The study found no difference at 2 hours, but the reduction in visual rating scale scores at 1 hour is encouraging. The study suggests that occipital nerve block is a quick-acting, effective treatment for acute headache in pregnancy. Furthermore, in an emergency care setting or for refractory headache, occipital nerve block has some improved outcome metrics compared with standard care. Given the multiple limitations that pregnant people face in acute headache treatment, occipital nerve block should be considered as a primary, secondary, or alternative acute headache treatment in pregnancy. The trial supports the option of occipital nerve block use for pregnant patients.
At MCHN/Nervana, we have used occipital nerve blocks with success. Call for an evaluation to determine if this treatment is appropriate for you.
–Alice Wong, NP
Reference: Bushman, Elisa T. MD; Blanchard, Christina T. MS; Cozzi, Gabriella D. MD; Davis, Allison M. MD; Harper, Lorie MD, MCSI; Robbins, Lindsay S. MD, MPH; Jones, Benjamin MD; Szychowski, Jeff M. PhD; Digre, Kathleen B. MD; Casey, Brian M. MD; Tita, Alan T. MD, PhD; Sinkey, Rachel G. MD. Occipital Nerve Block Compared With Acetaminophen and Caffeine for Headache Treatment in Pregnancy: A Randomized Controlled Trial. Obstetrics & Gynecology 142(5):p 1179-1188, November 2023. | DOI: 10.1097/AOG.0000000000005386

ZINC


ZINC

Zinc is a trace element that is essential to the human body for many functions, including supporting healthy functioning of the immune system. Zinc is also responsible for maintaining healthy skin, healthy eyes, and reducing inflammation in the body.

Deficiencies in zinc may lead to hair loss, fatigue, and frequent infections.

Some studies have found that zinc helps with recovery from upper respiratory infections like the flu and colds.

You can obtain zinc from foods such as fish, beans, eggs, meats, and cheese. You can take zinc via oral and IV supplementation.

If you are interested in zinc for your health, book an IV at our sister office Nervana Neurospa.

By: Brooke Masilak, FNP