BLUE LIGHT AND MIGRAINE

Blue light is a particular spectrum of light emitted from electronic devices that may exacerbate headaches or even trigger a migraine attack. Additionally, blue light is emitted via fluorescent lighting.

In the current environment of increased dependence on technology due to work-from-home, many patients with migraines are finding that headaches may be occurring more often, especially after extended use of the computer.

There are several ways to mitigate the effects of blue light. You may buy eyeglasses that block blue light. There are also screen protectors you can add to your laptop or desktop screen. Additionally, if possible, taking breaks from computer work is recommended.

For more information about blue light and migraine, call The Manhattan Center for Headache & Neurology.to schedule an appointment with one of our caring providers.

Brooke Steiger, FNP

FOOT DROP

Foot drop, is a neurological disorder which is defined as inability to lift the forefoot due to weakness of muscles in the ankle/foot also known as the dorsiflexors. This condition may be the result of a muscular, skeletal, or nervous system problem. To develop a treatment plan for foot drop, a full evaluation and determination of the cause must be completed for each patient. Just as foot drop can have many causes, foot drop treatment can take many forms.

There are a plethora of etiologies that can cause foot drop; one of which are compressive disorders. The most common being compression of the peroneal nerve, which is located in a patients lower extremity ( hip, ankle, or leg). Foot drop may also be caused secondary to traumatic injuries to include knee/ hip dislocation, fractures, severe ankle inversions, blunt trauma. Foot drop secondary to iatrogenic causes is seen most frequently due to surgical procedures; more often secondary to protracted positioning in anesthesia, although other causes such as prolonged bed rest, splinting, and even pneumatic compression devices may cause symptoms.

Foot drop, may be partial or complete, developing acutely or over a period of days to weeks. Patients may complain of dragging their toes, problems walking or climbing stairs, or frequent falls.

When foot drop occurs due to peripheral nerve entrapment, the symptoms will differ depending on the affected nerve and site of entrapment. Foot drop caused by entrapment of the peroneal nerve may also result in decreased sensation, tingling, numbness, or burning from the lower lateral leg to the top of the foot.

Foot drop is generally a clinical diagnosis apparent from the history and physical examination. Extremity imaging is useful for ruling out fracture or other anatomic abnormalities, to help identify a likely etiology. Most patients will undergo electromyography (EMG), unless there has been an obvious traumatic nerve transection.

A number of nonsurgical treatment options are available for the management of foot drop. The approach to the patient depends upon the etiology of foot drop and the localization of the lesions. Treatment plans are individualized based upon the evaluation and diagnostic findings.

By: Jordan Shankle, PA

ACUPRESSURE


For some people, stimulating pressure points in the body to relieve muscle tension and promote blood circulation can reduce pain. If you press on the pressure point, it is acupressure; if you use a thin needle to stimulate the point, it is acupuncture. Pressure points are found in the ears, hands, feet, face, and neck. One of the most useful points, of the more than three hundred Chinese acupuncture points, is LI4 (or Hegu). Applying pressure to this dime-sized spot, located between the thumb and forefinger, can help with anxiety and pain. To self-administer acupressure on your Hegu point, put your thumb on top of the point and your forefinger/index finger on the other side of the hand. Press down firmly for about five minutes, moving your thumb in small circular motions. Repeat on the other hand. Do not do this if pregnant as it can induce labor. While more research is needed, a few studies indicate acupressure may also reduce nausea and fatigue associated with migraines.

—Alice N.S. Wong, NP

https://www.healthline.com/health/migraine/pressure-point-for-migraine
https://www.wsj.com/articles/SB10001424127887323893504578559772806704216

MIGRAINE WITH AURA


Aura can manifest as a mixture of positive and negative features. Positive symptoms indicate active discharge from central nervous system neurons. Typical positive symptoms can be visual symptoms for example ( bright lines, shapes, objects), auditory symptoms (eg, tinnitus, noises, music), somatosensory (eg, burning, pain, paresthesia), or motor (eg, jerking or repetitive rhythmic movements). Negative symptoms indicate an absence or loss of function, such as loss of vision, hearing, feeling, or ability to move a part of the body. Auras are most often visual, but can also be sensory, verbal, or motor disturbances.
A visual aura classically begins as a small area of visual loss often just lateral to the point of visual fixation. It may either appear as a bright spot or as an area of visual loss. Over the following five minutes to one hour, the visual disturbance expands margin and develops into geometric shapes or zigzagging lines.
Sensory aura is also common and typically follows the visual aura within minutes, although it may also occur without the visual aura. A sensory aura may be described as a tingling in one limb or on one side of the face. As the tingling sensation migrates across one side of the face or down the limb; it may be followed by numbness lasting up to an hour.
Less common than the visual and sensory auras is the language or dysphasic aura. Language auras cause transient problems for example mild difficulties with word finding to difficulty speaking.
Furthermore, motor aura, the limbs and possibly the face on one side of the body become weak, may also occur during migraine attacks.
Patients may also experience aura without an associated headache. Migraine aura without headache (also known as migraine equivalent and acephalgic migraine) manifests as isolated aura unaccompanied by headache.
The Manhattan Center for Headache and Neurology has competent providers to further evaluate and facilitate acute and extended management.
By: Jordan Shankle, PA

MENSTRUAL MIGRAINE


Migraine may be triggered by a variety of environmental factors but may also be triggered by changes within the body. For women, they may be triggered by changes in levels of hormones that occur throughout the menstrual cycle. These are known as menstrual migraines. About 60% of women with migraine experience menstrual migraines.

These migraines may be particularly persistent and difficult to treat. There are many different ways of addressing these with treatment. One clinical trial found that starting magnesium supplements daily 15 days prior to menses was helpful in treating menstrual migraines. They may also be addressed using typical abortive or rescue medications such as NSAIDs or triptans.

Additionally, oral contraceptives may help to alleviate symptoms by decreasing the drop in estrogen, however the effects may vary from person to person. It is important to discuss this with your provider to assess your stroke risk prior to starting oral contraceptives. In some cases, your gynecologist may work together with your headache specialist to coordinate treatment.

Call the Manhattan Center for Headache & Neurology and speak to one of o ur caring healthcare providers about the right treatment for your menstrual migraines.

By: Brooke Steiger NP

MIDLIFE, MENOPAUSE, MIGRAINES

Although most women with migraine develop the disorder in their teens or twenties, 8 to 13 percent report the new onset of migraine during perimenopause. This is thought to be caused by peri-menopausal hormonal fluctuations. It may also be due to other causes that are frequently co-morbid with migraine: anxiety, depression, and sleep disturbances for which midlife women are at increased risk. The majority of standard migraine treatments are indicated regardless of menopausal stage, but symptoms, co-morbid disorders, existing medications, and patient preferences can all impact the choice of treatment. In addition to the mainstays of acute and preventive medications (NSAIDs, triptans, anti-epileptics, beta-blockers, and tricyclic antidepressants), the new drug class of monoclonal CGRP antibodies provides a promising and well-tolerated option for midlife women. An integrated approach can include mental health therapy, massage, relaxation techniques, and/or biofeedback training. MCHN also offers injections and IV therapy for pain, dehydration, nausea, vomiting, and dizziness. For more information, please call The Manhattan Center for Headache & Neurology to discuss with one of our caring providers.

—Alice N.S. Wong, NP

Reference:
Pavlović JM. The impact of midlife on migraine in women: summary of current views. Womens Midlife Health. 2020;6:11. Published 2020 Oct 6. doi:10.1186/s40695-020-00059-8

Primary Stabbing Headache

There are many different types of headaches. If you experience one type of headache, particularly if you suffer from migraine, you may be more likely to experience another type of headache.

Primary stabbing headache is also known as “ice-pick” headache because pain is concentrated in a very specific area of the head, often the lower jaw, behind the eyes, upper cheeks, or forehead. Sometimes this may even occur in your teeth. It may occur as a single sensation or series of stabbing sensations lasting for a few seconds and goes away and may occur many times a day.

There are several treatment options for this type of headache however it is important to speak with your provider if you are having this symptom as they will need to rule out other causes.

If you feel you are affected by this type of headache, call The Manhattan Center for Headache & Neurology to schedule an evaluation. Our caring providers will create a customized treatment plan just for you!.

By: Brooke Steiger, NP

LUMBOSACRAL RADICULOPATHY

Lumbosacral radiculopathy is one of the most common problems seen in a neurologic consultation.
Acute lumbosacral radiculopathy can be separated into three general categories from least to most severe. The first being sensory/painful radicular pattern, characterized by radicular pain and a segmental pattern of sensory dysfunction but no other neurologic deficits. In addition, patients may experience mild motor deficit patterns, characterized by radicular pain, sensory dysfunction, and mild nonprogressive segmental motor weakness and/or reflex change. Lastly patients may have marked motor deficit patterns, characterized by radicular pain and sensory dysfunction with severe or worsening motor deficits.
Lumbosacral radiculopathy is a condition in which a disease process causes functional impairment of one or more lumbosacral nerve roots. The most common cause is structural (ie, disc herniation or degenerative spinal stenosis) leading to root compression. The acute time period starts at the time of symptom onset and extends up to four or six weeks.
The diagnosis of a lumbosacral radiculopathy is clinical, and can usually be made based upon compatible symptoms and examination findings. However, patients should be evaluated for less common mechanisms associated with permanent and progressive neurologic disability, as prompt diagnosis and treatment may improve outcome.
In patients who do not have an indication for urgent treatment, conservative symptomatic treatment is used during the acute period. While acute lumbosacral radiculopathy is often extremely painful, symptoms spontaneously improve in many cases. As examples, the clinical course may variably wax and wane when due to lumbar spinal stenosis from degenerative arthritis and may be self-limited when due to disc herniation.
To learn more, call The Manhattan Center for Headache and Neurology to schedule an evaluation with one or our exceptional providers!

By: Jordan Shankle, PA

NECK PAIN & MIGRAINE


Neck pain is a common problem that many people suffer from. It is thought about 80% of people suffer from neck pain in their lifetime and between 20%-50% experience it on an annual basis.

Unfortunately, it is a very common symptom associated with migraine as well.
According to the 2018 Migraine in America survey, about 69% migraine patients surveyed reported they have neck pain with their migraines.

Migraine symptoms associated with neck pain may include pain at the base of the head, stiffness or tightness in the neck, pain that radiates from neck upwards to top and front of head, and a decrease in ability to easily move the neck.

Some migraines may also be triggered or worsened by damage to the joints in the neck caused by injury or normal wear and tear and postural problems.

It is important to recognize that your neck pain may be a symptom of migraine which may be responsive to your abortive migraine medications or treatments.

Also, you may need your provider to assess if you have any underlying neck or postural issues that could be addressed with other therapies including physical therapy, massage, acupuncture, or medication.

For more information regarding neck pain and migraine, speak with one of our healthcare providers at The Manhattan Center for Headache & Neurology.

Brooke Steiger, NP

CTS


CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome or CTS refers to the complex of symptoms and signs as a result of compression of the median nerve as it travels through the carpal tunnel. Common symptoms associated with CTS include pain and paresthesia, and less commonly weakness, in the median nerve distribution. CTS is the most frequent compressive focal mononeuropathy seen in clinical practice.
The pathophysiology of CTS is multifactorial. Increased pressure in the intercarpal canal is thought to play a key role in the development of clinical CTS. Risk factors for CTS include Obesity, Female gender, Coexisting conditions (eg, diabetes, pregnancy, rheumatoid arthritis, hypothyroidism, connective tissue diseases, preexisting median mononeuropathy) and Genetic predisposition.
The role of repetitive hand/wrist use and workplace factors in the development of CTS is also common.
The classic symptom of CTS is pain or paresthesia (numbness and tingling) in a distribution that includes the median nerve territory, with involvement of the first three digits and the radial half of the fourth digit. The symptoms of CTS are typically worse at night and often awaken patients from sleep. Some patients note improvement with these symptoms by shaking or wringing their hands or by placing them under warm running water.
The pain and paresthesia may be localized to the wrist or involve the entire hand.
CTS is a clinical diagnosis. The diagnosis is suspected when the characteristic symptoms and signs are present. The most important of these are nocturnal pain or paresthesia in the distribution of the median nerve.
Electrodiagnostic testing can be helpful to confirm or exclude CTS. It is also useful to gauge severity of nerve compression and to aid in decisions regarding surgical intervention. Imaging studies may be useful for the evaluation of CTS in some cases, if there is concern for a structural abnormality of the wrist.
Call The Manhattan Center for Headache and Neurology to schedule a consultation. Our exceptional providers will further evaluate and facilitate acute and extended management.
Jordan Shankle, PA