Sphenopalatine Ganglion Block

A Sphenopalatine Ganglion Block (SPG block) is a procedure that delivers an anesthetic agent or numbing medicine to a collection of nerves for the purpose of stopping pain signals to the brain.
This is done by inserting a small plastic catheter (tube) with lidocaine, a local anesthetic. The medication baths the nerve endings behind this bony structures in the back of the nose and decreases the inflammatory response that results in pain signals reaching the brain. The procedure is not painful and takes about five minutes. There are few side effects associated with the procedure. Some patients experience tearing of the eyes, bitter taste in mouth, or mild dizziness.

This procedure may be done to stop an active migraine or as a series of 2 per week for 5 weeks to achieve long term relief.

If you have further questions about this procedure or other procedures in our office, call and speak to one of our caring providers.

Brooke Steiger, NP

Is Working From Home Worsening Your Headaches?

Despite New York having the best numbers since the pandemic started, we are still living an altered lifestyle and many of us are working from home until the foreseeable future. Prior to the pandemic approximately 9% of the US population worked completely from home, that number is now greater than 40%. For many of us, this change has resulted in a worsening of headaches and migraines.
This worsening may be a result of increased screen time. Migraine sufferers often have sensitivity to light, particularly the blue light that’s emitted from phones and computers. Considering certain screen protectors or glasses that filter blue light may be helpful. Also being mindful and taking the time to periodically move your gaze elsewhere to reduce eye strain.
A worsening in your headaches and migraines can possibly be due to your work set up. Many of us that are working from home don’t have the ideal office setup resulting in poor positioning and posture. For example, working on a laptop can result in hunching forward more, causing an increase in tension in the neck and shoulders. Optimizing the ergonomics of your home office can go a long way and result in great comfort and better posture. Adjusting your desk space by using books to prop up a laptop can be helpful. It is also important to take breaks and stretch.
Lastly, changes in your normal routine can result in an increase in the number of headaches and migraines. For many people, the pandemic has meant changes in their sleep schedule, diet and exercise routine. Too much or too little sleep, changes in meal schedules, changes in caffeine intake and lack of exercise can all worsen headaches and migraines. It is best to establish a regular routine as much as possible during this time.
The pandemic is a stressful time for many people with headache and migraine. If your headaches or migraines are worsening in severity or frequency, just know that our office is still here for you. Our practice is offering virtual appointments, testing, procedures and in person appointments for initial patients and as needed for follow ups.


There are a variety of triggers for migraines. Some people experience them as a result of lack of sleep, stress, or eating certain foods. Some people find that they are triggered by changes or shifts in the weather.
A recent study shows that 62% of participants were sensitive or triggered by weather conditions and 34% of participants were sensitive to temperature and humidity and 14% were sensitive to changing weather patterns.
When it comes to triggers, it is often the case where one trigger in isolation is not the cause of the migraine but one or more triggers may result in migraine.
To help determine your triggers, try creating a headache journal. You can use an app for this such as Migraine Buddy or simply jot notes in the calendar on your cellphone. Try to write down the circumstances surrounding the migraine such as weather changes , stress levels, or specific foods consumed.
If you have additional questions about migraine triggers, CALL THE MANHATTAN CENTER CENTER FOR HEADACHE & NEUROLOGY!

Brooke Steiger, NP

June is Migraine & Headache Awareness Month (MHAM)

June is National Migraine & Headache Awareness Month (#MHAM). A disease awareness month can increase public knowledge, address stigma and build a stronger community.

If you suffer from headaches or migraines this month provides a lot of great opportunities to connect with others, learn about your disorder, learn about treatments and to educate other about what you experience. This month there are a lot of activities planned and ways to get involved. There are many group discussions online or fundraors such as miles for migraines. There are certain observance days such June 21 which is “Shades for Migraine Day”, where migraine suffers wear their favorite pair of sunglasses. You can also participate by raising awareness on social media by using tags such as #MHAM and #MHAM2020.

As per The World Health Organization, “headache disorders are among the most common disorders of the nervous system. Primary headache disorders, such as migraine, tension-type headache, cluster headache, and the so-called chronic daily headache syndrome, can cause substantial levels of disability”. If you have headache or migraine, know you are not alone. Please seek a healthcare provider like us at the Manhattan Center for Headache and Neurology for proper diagnosis and treatment and utilize what this month has to offer.

Caroline Pruski, NP


Over the past few months, we have all been dealing with the the fallout of the Coronavirus pandemic. Recently, we have been faced with images of graphic violence, police brutality, and injustice on the news and in our streets. Our minds crave certainty and with consequences of the pandemic coupled with these graphic images, we may feel more anxious and depressed. Here are a few coping strategies.

Keep your routines
Make yourself a schedule and try to stick to it. Schedule work, mealtimes, and leisure time. For example, if you are used to exercising in the morning, do your best to continue doing so.

Stay connected
Keep in touch with your friends and family. Call them on the phone or do a video chat. Talking with people you’re close with may help ease anxieties.

Take action
You may be feeling very helpless right now and like there is nothing you can do. Help from the safety of your home by going to Change.org to sign petitions for action against police brutality, justice for Ahmaud Arbery, and George Floyd. If you are in the position to do so, donate to organizations such as the NAACP, Community Justice Action Fund, the ACLU, Black Lives Matter, or The Southern Poverty Law Center.

Speak to someone
Many mental health counselors are available via telehealth appointments. If you do not have insurance coverage and are in the New York area, New York state is providing a service from the NY state Office of Mental Health OMH Emotional Support Helpline: 1-844-863-9314. The city of New York continues to provide a hotline for COVID-19 mental health counseling in addition to texting and chat service 1-888-NYC-WELL (1-888-692-9355) or https://nycwell.cityofnewyork.us/en/

Brooke Steiger, NP


The Manhattan Center For Headache & Neurology is open for TESTING! We offer EEG tests, TCD Tests, EMG tests, Nerve Conduction Studies, and VNG Tests. If your provider has ordered these tests and you can’t find a facility that is open and offering tests, there is no need to look any further. Schedule an appointment at The Manhattan Center for Headache and Neurology. We look forward to seeing you!


Occipital Neuralgia is a condition where the occipital nerves (the nerves that run through the back of the scalp) are irritated. This nerve irritation is commonly the result of head and neck injuries, pinched nerves or muscle tightness in the neck. The nerve irritation results in pain in the upper neck, back of the head and scalp. This pain is characterized by a sharp, shooting pain that is often triggered by things like turning your head or pushing on the affected area.
Migraine and occipital neuralgia are very similar, overlapping conditions. Many times both conditions are present at the same time and it’s not easy to tell what is causing what. Occipital neuralgia is also often misdiagnosed as migraine. If the pain is not accompanied by typical migraine symptoms like nausea, sound sensitivyt or light sensitivity, it is likely occipital neuralgia.
There are many treatment options for occipital neuralgia. Treatments as simple as maintaining a healthy lifestyle with regular exercise, stretching, and yoga can be effective.
Additional treatment options include occipital nerve blocks, neck injections or daily preventive medication. There are also neuromodulation devices, which stimulate or interrupt nerve
impulses and can improve the symptoms.
See a provider like us at the Manhattan Center, we can helped confirma neurological diagnosis like occipital neuralgia and review the right treatment options for you.

Caroline Pruski, NP


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!