Occipital Neuralgia

Occipital neuralgia is an uncommon cause of headache in the occipital region (back of the head). There is jabbing pain in the greater, lesser, and/or third occipital nerves. In most cases, the condition develops spontaneously.
The pain of occipital neuralgia is sudden. It is stabbing, electric, shock-like, sharp, or shooting. Attacks may begin spontaneously or may be provoked by specific maneuvers. A dull occipital discomfort can be present during periods between the stabbing pain. Examination may reveal local tenderness in the territory of the affected nerve.
For patients with occipital neuralgia who have moderate to severe pain or debilitating symptoms, local occipital nerve blocks are recommended. Pain relief may last several weeks or even months. Patients whose pain is not sufficiently managed with occipital nerve blocks may benefit from pharmacotherapy or alternative treatments (eg, botulinum toxin injections). Please call to speak to a provider at MCHN to evaluate and treat.

–Alice Wong, NP
Reference: https://www.uptodate.com/contents/occipital-neuralgia

Abdominal Migraine

Abdominal migraine is a migraine with mostly gastrointestinal-type symptoms. These symptoms include stomach pain or upset, nausea and vomiting, and loss of appetite. Typically, these last between about 2-72 hours in duration with symptoms improving between attacks.

It is thought that abdominal migraines affect 4% of children and some adults. This is more common in children, especially those with a family history of migraine.

These symptoms may be accompanied by headache, sensitivity to light, sound, and smell, and fatigue. Abdominal migraines may be triggered by typical migraine triggers including lack of sleep, stress, or skipping meals.

Treatments for abdominal migraine include medications typically used to treat or prevent migraines in addition to other agents.

The cause of abdominal migraine is unclear due to limited research but is thought to be a childhood manifestation of migraine often evolves to migraine as a child moves into adulthood.

For more information about abdominal migraine, speak with your healthcare provider.

By: Brooke Steiger, FNP


Primary cough headache is typically a benign headache. It is characterized by intense throbbing sensations within seconds of coughing, sneezing, or straining – and subsides within minutes. However, some sufferers may continue to experience a dull achy headache several hours afterward. Typically, this type of headache affects men over the age of 40. Younger patients can experience these headaches as well.
Pain can be localized in the frontal, temporal or occipital aspect of the head. Either bilateral or unilateral. Associated symptoms i.e. (nausea, vomiting, visual disturbances), are usually absent.
A detailed history, through physical examination and possible neuro imaging is needed for diagnosis and treatment.

By: Jordan Shankle, PA

Reversible Cerebral Vasoconstriction Syndrome (RCVS)

Reversible cerebral vasoconstriction syndrome (RCVS) is a group of conditions characterized by reversible narrowing and dilatation of the cerebral arteries. The age of onset of RCVS is approximately 42 years, affecting adult females more often than males. The presentation of RCVS is usually dramatic, with sudden, excruciating headaches that reach peak intensity within seconds. The “thunderclap headaches” tend to recur over a span of days to weeks. Many patients have triggering factors, such as orgasm or physical exertion, acute stressful or emotional situations, or Valsalva maneuvers (eg, straining, coughing, sneezing). A variety of conditions have been associated with RCVS including exposure to vasoconstrictive drugs and medications, other headache disorders, and recent pregnancy. Patients who present with thunderclap headache must be evaluated as a medical emergency. Supportive care is directed toward managing blood pressure, severe headaches, and other complications such as seizures. The time course of vasoconstriction is variable, but most patients show resolution within three months. The clinical outcome is benign in 90 to 95 percent of patients. Recurrence of an episode of RCVS is rare.
–Alice Wong, NP Reference: https://www.uptodate.com/contents/reversible-cerebral-vasoconstriction-syndrome


Oxygen therapy for migraine

Oxygen therapy was first used at the Mayo Clinic in 1939 for migraine. The treatment used was 100% high flow oxygen. It is thought that migraines are in part caused by a low level of oxygen in the blood which is caused by constriction of blood vessels. Oxygen helps relieve migraines and cluster headaches by causing dilation of the blood vessels. It has been found to be helpful for headache and at the time migraines and cluster headaches were not well-differentiated.
There are 2 different ways of delivering oxygen for headache treatment include hyperbaric oxygen chamber treatment and normobaric oxygen delivery. Hyperbaric oxygen chamber treatment involves patient receiving treatment within an enclosed chamber with 100% oxygen that is free-flowing. Normobaric oxygen delivery involves of 100% oxygen through a face mask or nasal cannula at 7-9 for around 10-20 minutes.

Research of oxygen for migraines is limited at this time. A small study by National Institutes of Health, examined participants with episodic migraine with aura that were provided oxygen via a partial rebreather. Among the participants, pain freedom at 2 hours was obtained by 60% receiving 100% oxygen compared to placebo group.

There is more research available regarding oxygen and cluster headaches.

If you would like more information about oxygen therapy for the treatment of headaches, discuss with your health care provider.

By: Brooke Steiger, NP



It’s the most wonderful time of the year! For most – this season embodies gratefulness, family time, sweet memories, and joyful moments! The season of pumpkin spice latte, apple cider and retail sales you can’t beat – is often unsettling to the approximately 45 million Americans suffering from disabling Migraines. Preparing for celebrations filled with sweets, red wine, and aged cheese can be extremely daunting for Migraine or headache sufferers. Excess stress from hectic shopping, changes in barometric pressure (when traveling) and indulging in processed meats can all be triggering to these patients.While others are snapping selfies or under the mistletoe. Migraine sufferers may be experiencing excruciating/throbbing head pain. Associated with nausea, vomiting and light sensitivity. These attacks can be especially overwhelming and discouraging.
Here are a few tips to help prevent a potential episode during this holiday season.
1. Drink plenty of water:
STAY HYDRATED, STAY HYDRATED. During your busy schedule try to drink at least 4-6 ( 8oz) glasses of water per day.
2. Get adequate rest.
Try to maintain a consistent sleep schedule – even during the holidays. Aim for at least 6-8hrs of sleep per night.
3. Reduce Stress by planning ahead and staying organized.
Try your best to reduce prolonged screen time while online shopping. Additionally, refrain from last minute/ hectic shopping.
4. Avoid Migraine Triggers
5.have a Migraine Toolbox
Ensure that you have an adequate supply of preventive and abortive migraine therapies.
Happy Holidays to you all!

CoQ10 & Migraine

Coenzyme Q10 (CoQ10) is an antioxidant that your body produces naturally. Your cells use CoQ10 for growth and maintenance. The body also uses CoQ10 as an antioxidant. Levels of CoQ10 in your body decrease as you age. 

Interest in coenzyme Q10 (CoQ10) for migraine treatment has been sparked by the potential role of mitochondrial dysfunction in migraine. In a small, randomized controlled trial of 42 patients with migraine, CoQ10 was effective for migraine prevention; significantly more patients treated with CoQ10 experienced a ≥50 percent reduction in attack frequency at three months than patients treated with placebo.  

If you are interested in supplementation with CoQ10, speak with your health care provider first. CoQ10 may change the way the body uses warfarin (a drug that prevents the blood from clotting) and insulin. There are also other evidence-based vitamins and minerals that may be recommended as part of your regimen. 

–Alice Wong, NP 

Migraines & Your Personal Life

Migraines can have a deep and far-reaching effect on an individual’s personal life including relationships.

According to a study in The Journal of Headache and Pain, 87% of survey respondents noted that migraines impacted their professional, social, and private lives. Eighty-five percent of participants reported experiencing negative consequences related to long-term migraines including depression and feelings of hopelessness.

Migraines impair an individual’s ability to function in their daily lives. They may have to “sit out” activities including social events, work, and childcare. This also may affect the quality of their relationships with their significant other including interfering with communication and physical intimacy. They may also interfere with a person’s ability to care for their children.

In addition, the anticipation of migraines may influence planning of activities. For example, the individual may avoid scheduling certain activities because they believe that they might trigger a migraine.

If migraines are interfering with your life, it is important to seek treatment from a medical provider. Additionally, to help with the burden of coping with having migraines it is recommended that individuals seek guidance from a mental health practitioner.

For more information on treating your migraines or to pursue mental health counseling, contact our office today.

By: Brooke Steiger, NP

Headache Attributed to Systemic Infection

Headache associated with infection. More often, these headaches are attributed to viral infections ie influenza or COVID 19. Occasionally, infections can be bacterial – originating in the sinuses or even the brain. The ICHD specifics headaches due to viral, bacterial and other systemic infection. This list of diagnostic criteria for headache attributed to systemic infection is listed below.
Headaches are usually on both sides (bilateral), constant and intensity gradually increases. Headaches can be aggravated by straining – and are often accompanied with nausea, green/ yellowish nasal drainage and/or fever. Headaches can develop into abscess, seen on neuroimaging. Immediate antibiotics should be given if suspected brain abscess.

By: Jordan Shankle, PA


Headache is among the most frequent symptoms persisting or newly developing after COVID-19 as part of the so-called long COVID syndrome. Long COVID headache can present in the form of worsening of a preexisting primary headache, or in the form of a new intermittent or daily headache starting during the acute infection or after a delay. It often presents together with other long COVID symptoms like fatigue, insomnia, and depression. Patients with a prior history of headache usually report a worsening of their headache. Interestingly, both tension-type-like and migraine-like headache features can also be seen in patients without a personal headache history or despite not having experienced headache in the acute infection phase. The World Health Organization provides useful advice for patients on self-management after COVID related illness to improve self-rehabilitation and recovery (https://www.who.int/ publications/m/item/support-for-rehabilitation-selfmanagement-after-covid-19-related-illness). The nonprofit Altea Long COVID Network Association, based in Zurich, is also a source of useful information (https://www.altea-network.com/en). The Altea platform includes evidence-based information and helpful tips to cope with and/or overcome symptoms; a directory that helps find health professionals specialized in post COVID-19 condition by location or by symptom; a blog where the latest news and updates about post COVID-19 condition are published. We at MCHN are continually monitoring for new information and guidelines for treatments for our patients. Please make an appointment with one of our providers to evaluate your headache.  

–Alice Wong, NP 

References: Tana, C., Bentivegna, E., Cho, SJ. et al. Long COVID headache. J Headache Pain 23, 93 (2022). https://doi.org/10.1186/s10194-022-01450-8