MINDFULNESS

Mindfulness is the practice of being present in the current moment. This means applying focused attention to what you are doing at any given moment. This means when distractions from the present moment present themselves that you consciously refocus your attention to what you are actively doing.

Meditation involves the process of quieting the mind to achieve a state of relaxation of the mind and body. One may meditate sitting with the eyes closed for varying lengths of time anywhere from a few minutes up to 20- 30 minutes at a time. Some people count their breaths and some may use a mantra which is an expression repeated in their head as they are sitting quietly. The point is to focus attention on the restful state without other thoughts coming into the mind but when they do actively refocusing on the meditation.

Some research has shown that incorporating mindfulness and meditation into daily life can have an impact in reducing stress and frequency of headaches. One study from 2014 showed that patients who practice meditation had about 1-2 fewer migraines per month and headaches lasting about an average of 3 hours less than those who did not practice meditation.

Another study showed that the practice of mindfulness significantly reduced pain-intensity and decreased anxiety and depressive symptoms.

For more information about meditation and mindfulness talk to your healthcare provider.

Brooke Steiger, NP

MIGRAINE WITH AURA

Migraine with Aura as explained by Dr Audrey Halpern

Aura, often referred to as the “warning sign” of migraine can be a variety of sensory disturbances that occur prior to a migraine attack. Aura usually last 20-60 minutes and only affects approximately 25-30 % of people with migraine.

Aura can consist of visual disturbances such as seeing spots, flashes, zig zags, stars, or loss of vision. Aura can also present as sensory changes including tingling or numbness in the face, body, hands, and fingers. Speech or language disturbances can also be a form of aura. For example, being unable to produce the right words, slurring or mumbling words.

Aura is a result of hyper-excited nerves in the brain. When these excited nerves are activated in the visual processing areas of the brain, the patient experiences the visual symptoms of aura. When these excited nerves are activated in other areas of the brain, other symptoms may occur.

The majority of migraines with aura are not due to a worrisome underlying problem but be cautious and aware of certain “red flag” that may indicated seeking additional medical attention. Red flags include an immediate onset of symptoms or symptoms lasting longer than 60 minutes. Additional warning signs include weakness on one side of the body, change in consciousness or level of alertness.

It is also important to be aware of the fact that migraine with aura can increases the risk of stroke. As a result, treating other stroke risk factors and avoiding certain medications (such as estrogen containing birth control) is important and should be discussed with a physician.

Fun Fact: Lewis Carroll the author of Alice in Wonderland had migraine with aura. His aura consisted of visual disturbances which inspired his writing.

– Caroline Pruski, NP

RED FLAG HEADACHES

Patients who live with migraines and chronic headache disorders are, unfortunately, often accustomed to coping with pain and symptoms that may occur. It is important to recognize when to seek immediate treatment for headache.

These signs, known as red flags, may be associated with an underlying condition that would require immediate medical treatment:

New headache in pregnancy

Worsening in severity of headache

Sudden onset of new severe headache i.e. thunderclap headache

New neurological symptoms

Numbness or weakness, especially in limbs

New or sudden vision changes

Difficulty speaking or slurring of speech

Headache associated with severe neck pain

If you have any doubts whether or not to seek treatment, go to the ER. If your symptoms are more gradual, make an appointment to see your healthcare provider

By: Brooke Steiger, NP

GREEN LIGHT THERAPY FOR MIGRAINES

Migraine sufferers are extremely sensitive to light and prefer to be in the dark and in isolation. A new lamp has been designed to help people with light sensitivity emerge from the darkness and get back to doing what they love. Recent research suggests that a specific type of narrow band green light reduces the frequency and severity of migraine attacks. Green light has been shown to reduce the pain and discomfort when exposed to light during a migraine attack.

“Dr. Rami Burstein, a Harvard medical school professor, a world leader in the science of migraine and headache pain, has discovered a precise narrow band of natural light that lets you see and function without the same discomfort of everyday light: the Allay wavelength. In a series of studies in Dr. Burstein’s lab at Harvard Medical School, participants overwhelmingly preferred the Allay wavelength to regular light. They were able to read, write, and get back to their normal activities.”

https://allaylamp.com/pages/science

Here, at The Manhattan Center for Headache & Neurology, we too use the Allay Lamp during different types of therapies like IV treatments. We also use the Allay Lamp for patients who come to the center in pain and need to be in a separate room away from light and noise during their wait time to see one of physicians! The Allay lamp is indeed calm and soothing. The green light emitting from the Allay lamp minimizes the discomfort and pressure felt from regular light during a migraine episode.

CBD products have exploded in availability and popularity over the last year. Despite their popularity people still have many questions about these products, one being the difference between CBD and THC. 

Both marijuana and hemp come from the cannabis sativa family, but they are significantly different in chemical composition. More than 100 chemical cannabinoids are found in cannabis, but the amount of these cannabinoids differs dramatically between hemp and marijuana. Marijuana’s most common cannabinoid is tetrahydrocannabinol (THC) and reaches levels as high as 30%. Hemps most common cannabinoid is Cannabidiol (CBD) and has levels of THC are less than 0.3%.

Due to their chemical arrangement THC and CBD make your body feel differently. THC is the main psychoactive compound in marijuana, what makes people feel “high.” CBD doesn’t cause that high, instead it is thought to work with other elements in the body linked to feelings of well-being. Thus leading us to another common question, what are the risks and benefits of using CBD for migraines?

Unfortunately, there is a lack of scientific evidence or research on CBD as an effective treatment for migraine. However, it may still be a beneficial option for some migraine patients with associated joint and muscle pain, as well as associated nausea and vomiting. 

There is a concern for lack of regulation of CBD, it’s important to ensure that you are using a pure product. Make sure the product actually has CBD or cannabidiol in it. Many times products will only list hemp seeds, hempseed oil, or cannabis sativa seed oil, these ingredients aren’t the same as CBD. It is also important to look into third party testing and be aware of CBD concentration, how much are you getting per serving. Also, pay attention to possible additional ingredients for preservation or flavor. In conclusion, CBD oil may be beneficial for migraine sufferers but speak to a provider and specialist first before starting treatment. 

Caroline Pruski, NP

Zynex Nexwave

The Zynex Nexwave is an FDA-approved medical device to treat chronic and acute pain. It is non-invasive and nonpharmacological alternative to pain medication.

The device is similar to a TENS unit in which you attach electrodes to the treatment area and start a treatment cycle. It has 3 setting including TENS setting. The NMES setting is great for muscle spasm and neuromuscular rehab and the IFC setting is geared towards pain management. In fact, the IFC setting is 40 times stronger than TENS and may deliver from 1-8 hours of pain relief.

The device is a good option pain treatment because it may help you reduce your use pain medication including prescription and over-the-counter medications and help you return to your normal activities of daily living.

 For more information about this device and to determine if it is right for you, talk to your healthcare provider.

 Brooke Steiger, NP

NEW HOPE FOR MIGRAINE SUFFERERS

“Though that was decades ago, today there are still several reasons migraine is poorly controlled for so many people. One is a lack of appreciation by both doctors and the public for what it entails”

https://www.nytimes.com/2020/01/06/well/live/new-hope-for-migraine-sufferers.html

This NY Times article discusses migraines and how it affects those individuals that suffer from this condition. A Migraine is described as a headache with body-wide effects that affects those who suffer from the attacks unable to tolerate light, noise, smells or touch. These attacks interfere with the sufferer’s ability to work, interact with others, and perform daily tasks. There are many medications that treat and prevent migraines ranging from wearable nerve stimulating devices that can be activated by your smartphone to biologic drugs, monoclonal antibodies, that can be given once a month or once every three months. CLICK ON THE LINK TO READ THIS ARTICLE AND LEARN ABOUT VARIOUS OTHER MEDICATIONS THAT TREAT MIGRAINES!

NEW FDA APPROVED TREATMENT FOR MIGRAINES

The U.S. Food and Drug Administration just approved Ubrelvy (ubrogepant) tablets for the acute (immediate) treatment of migraine with or without aura (a sensory phenomenon or visual disturbance) in adults. Ubrelvy is not indicated for the preventive treatment of migraine. It is the first drug in the class of oral calcitonin gene-related peptide receptor antagonists approved for the acute treatment of migraine.

YOGA FOR MIGRAINES

Yoga is a mind-body practice based ancient Indian philosophical tradition involving physical and mental techniques including exercise, stretching, and relaxation.

One 2014 study, showed that yoga led to a significant reduction in frequency and intensity of migraines. It is thought that it enhances tone of the vagus nerve and decreases overstimulation of the nervous system. A 2015 study, showed the same results with also reports of decrease anxiety and depression among those participants practicing yoga.

For people who suffer from headaches, restorative yoga is recommended. Hot yoga may cause dehydration which may trigger migraines. Additionally, one must be aware of limitations and modify certain poses if necessary to minimize injury. For example, it is best to avoid positions that put increased pressure on the neck including bridging and headstands.

To learn more about yoga for headaches and migraines, talk to your healthcare provider.

Brooke Steiger, NP

Infusion Therapy for Migraines

IV treatments provide fast relief and long term relief up to a month from the pain, nausea and inflammation associated with migraine and headaches. IV infusion treatments include fluids, supplements and medications that target the cascade reaction in the body resulting in migraines and headaches.The infusion of fluids is extremely beneficial with the associated symptom of nausea that commonly occurs with migraine and headache disorders. Nausea can lead to poor oral intake and at times vomiting, resulting in fluid loss. Dehydration worsens migraine and headaches, thus making them harder to treat.
Magnesium is a common supplement that is added to the fluid infusion. Studies show that magnesium can help prevent headaches and that the magnesium levels in a person’s brain may be low during a migraine. Toradol (Ketorolac) is nonsteroidal anti-inflammatory drugs (NSAIDs) that is added during the infusion to help reduce pain and inflammation. Zofran (Ondansetron) or Reglan (Metoclopramide) are both anti-nausea medications that are also added to the infusion, thus helping with associated nausea and vomiting.
In addition to the types of medications offered, IV infusion is the fastest route for absorption in comparison to taking medications orally or in injection form. Drugs delivered through the intravenous route circulate directly to the brain, within 20 to 40 seconds. IV route also has the greatest level of absorption, medications given through IV route have 100% bioavailability. IV route bypasses absorption barriers and first-pass metabolism (the phenomenon of drug metabolism whereby the concentration of a drug, specifically when administered orally, is greatly reduced before it reaches the systemic circulation).

Caroline Pruski, NP