Migraine patients are encouraged to do regular aerobic exercise to reduce frequency and intensity of migraine. Unfortunately, exercise can be a trigger in 22% of patients with migraine leading to a more sedentary lifestyle and an increase in migraine.

Yoga is a form of exercise that combines slow, intentional movements with breathing techniques  and meditation. The benefits from yoga include flexibility, muscle strengthening and both physical and mental benefits.

Besides as an exercise, there are other benefits of yoga  including a reduction of stress that then leads to better sleep, which is extremely important in warding off migraines. Relaxation calms the sympathetic nervous systems (the part of the body that says fight or flight) reducing chemicals that may increase the chances of migraine.

So go grab a mat and get your yoga practice started!

Kisan R, Sujan M, Adoor M, et al. Effect of Yoga on migraine: A comprehensive study using clinical profile and cardiac autonomic functions. Int J Yoga. 2014;7(2):126-32.

Top Migraine Triggers and How to Manage


  • Stress:


    • Stress is a trigger for almost 70% of people with migraines
    • Start by making a list of causes of stress and tension
    • Work towards reducing these triggers in your life
    • Biofeedback
    • Relaxation therapy
    • Meditation
    • Exercise
    • Consistent sleep schedule


  • Changes in sleep schedule


    • Try to go to bed at same time every night and get at least 7-8 hours of sleep
    • Eliminate TV, texting, reading, listening to music while in bed
    • Do not nap during the day


  • Hormones


    • Women are three times more likely to have a migraine then men
    • Some methods of birth control that can stabilize hormone levels and prevent future migraine attacks
    • Headache specialist and gynecologist to find right treatment plan


  • Caffeine and Alcohol


    • Limit and know your limits when it comes to alcohol consumption
    • Warning signs of a migraine attack after drinking alcohol, take your acute medication immediately


  • Changes in the weather


    • Storms, excessive heat and changes in barometric pressure
    • Adjust schedule accordingly
    • Errands in the morning before it gets too hot


  • Diet


    • Try to identify specific food triggers and avoid as much as possible
    • Most common ones being foods with histamine and MSG, chocolate, cheese, dairy products, artificial sweeteners, caffeine, cured meats and anything with a strong smell


  • Dehydration


    • Carry a bottle of water and keep track of fluid intake
    • Limit consumption of diuretics


  • Light


    • Natural light- wear sunglasses when outside
    • Green light is the only light that has been shown to not aggravate migraine


  • Smell


    • Avoid perfumes, strong food smells, chemicals or gasoline


  • Medication overuse


  • Stop taking the medication and clear it out of your system before you can stop the cycle of pain
  •  work with your doctor to learn how to come off certain medications, such as opioids or butalbital containing medications, safely.


The holiday season brings friends and families together and is celebrated with food which can trigger HEADACHES and MIGRAINES. Food is a trigger for migraines and avoiding some of the triggers can cut back on the frequency of the attacks.



  • Aged cheese and meats : The nitrites or nitrates in salami or other aged meat can cause headaches/ migraines.  Aged cheese is very salty and can cause dehydration which can trigger a migraine.
  • Alcohol:  The effect of dehydration and it’s withdrawal the next day can trigger migraines
  • Chocolate: Darker chocolate tends to be more of a trigger than others.
  • Monosodium Glutamate or MSG: Glutamate is an excitatory neurotransmitter found in Chinese food, barbecue sauce and some salad dressing that can trigger migraines.
  • Spicy foods: Spicy food containing chili peppers which interacts with TRP receptors in the brain can trigger migraines.
  • Diet Sodas: They contain aspartame which in turn can trigger migraines.
  • Citrus Fruits: There are high-acid foods that can cause gastric irritation which in turn can trigger a migraine.




  • Keep hydrated, drink plenty of water.
  • Eliminate or minimize food triggers
  • Start a headache/migraine journal
  • Discuss the triggers with your neurologist or dietitian.

By: Rajni Bala, NP



Migraine or Stroke?

Some migraine symptoms are very similar to those of a stroke. For new onset migraines over 40 years old, always assume that it is something serious. It is uncommon to have a first migraine when you are older. People with migraines usually have it for most of their life.

During a stroke, blood supply to a certain part of the brain is cut-off. Cells then begin to die as they do not have enough oxygen. A stroke can be due to either a blocked blood vessel in the brain or a ruptured blood vessel resulting a bleed in the brain. A headache that comes on suddenly and very severe, can be a sign of a stroke. Other symptoms include:

  1. Weakness or numbness on one side of the body
  2. Difficulty speaking or understanding what others are saying
  3. Vision issues in one or both eyes
  4. Abrupt Dizziness, loss of balance or coordination
  5. Confusion

A TIA, Transient Ischemic Attack, is a type of stroke that is often mistaken for a migraine. This is also called a mini-stroke because blood flow to the brain is cut off for a short period of time. Symptoms of a TIA usually resolves within an hour.

Migraine with aura is often confused with a stroke. An aura usually occurs before the headache phase. An aura may include visual or sensory symptoms, such as flashing lights, zig-zag lines, blind spots, or numbness or tingling in your arms, legs or face. Some patients may experience ringing in the ears and difficulty speaking. Sometimes these aura symptoms occur without even a headache.

It can be hard to tell the difference between a TIA and a Migraine with Aura. Stroke symptoms usually occur more suddenly whereas migraines are more gradual.  

If you think there is a slight chance that you are having a stroke, call 911 immediately. Early treatment can decrease damage to your brain and even save your life.


By: Tanesha Reynolds, DNP, FNP, BC in headache medicine


Migraine is among the top 10 most disabling illness in the world leading to lost days of work, unemployment, strains on relations, and problems in a family. Medications are the go-to problem solver when dealing with a migraine but  there are many things you can do to change your lifestyle, including the food you eat, to prevent one from occurring.

The best way to help a migraine is by figuring out what is causing it to happen and what is making it worse. The best place to look is the food you are eating and how you are living your life. Any food can be a trigger for a migraine sufferer to set off a migraine, most commonly, caffeine and alcohol. Your lifestyle can also be a huge trigger including stressors, sleeping habits, exercise, and water intake to name a few.

Every person is unique and reacts to food and changes in lifestyle differently. In addition to figuring out your personal trigger, try the following.

  • Reduce caffeine intake and avoid if possible. When you do get a migraine, taking a medication with caffeine is likely to be more effective due to the lower tolerance your body has.

Make sure you are exercising! If you’re the person who says “exercising makes my headaches worse”, try a yoga class. Yoga is known to reduce stress and anxiety, create awareness and most importantly, it has been shown to reduce migraines.

IV  Treatment  and SPG block for treating acute migraines

Why do you need IV Therapy ?

Acute migraine episode lasting anywhere from 24 to 72 hours, week duration failing  to respond to abortives accompanied by severe pain 8-10/10 intensity, nausea and debilitation.  Migraines tends to become more difficult to treat as it becomes more prolonged and more severe with time.  Nausea is most common with acute migraine which leads to poor oral intake and causes dehydration which further worsens the migraine and is harder to treat.

What is an  SPG Block?

Sphenopalatine Ganglion (SPG) is a group of nerve cells linked to the Trigeminal nerve, which is the main nerve involved during a headache.  SPG is located behind the nose which carries sensation, including pain and also plays a role in autonomic functions (tearing & nasal congestion). An SPG block is an application of a local anesthetics (or numbing medications) to block or partially block the SPG which in turn reduces head and facial pain.

IV Treatment effectively manages the acute pain, nausea, dehydration and in many cases either decreases the pain intensity or renders complete relief from the pain.

Core Principles of IV treatment along with SPG block

  • Ensure adequate hydration through IV fluids
  • Counteract nausea with antiemetic agent
  • Reduction or elimination of the acute pain through IV NSAID / SPG block
  • Reduction or elimination of the pain through application of local anesthetics.

Contact The Manhattan Center for Headache and Neurology is you are experiencing an episode of acute migraine to learn if you are a candidate for IV/SPG treatment.

By: Rajni Bala, FNP

SUNCT-Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing

This is a rare type of headache that is most common in men over 50 years old. This headache is unilateral with a burning, piercing or throbbing quality and of moderate to severe intensity. The pain peaks within seconds of onset, and lasts from 5 seconds to 4 minutes. Attacks are typically during the daytime. Patients can have up to 6 attacks per hour.

During the attacks, patients may experience:

  1. watery eyes
  2. reddish or bloodshot eyes (conjunctival injection)
  3. nasal congestion
  4. runny nose
  5. sweaty forehead
  6. swelling of the eyelids
  7. increased pressure within the eye on the affected side of head

These headaches are not usually responsive to regular treatment for short-lasting headaches, however corticosteroids and anti-epileptic drugs may help to relieve symptoms. There is no cure for this type of headache. It is not fatal, but can be very uncomfortable.

If you are experiencing any of these symptoms, please call us for an evaluation.

By: Tanesha Reynolds, DNP, FNP, certified in headache medicine by The National Headache Foundation

Is your jaw to be blamed for your migraine headaches?

Your temporomandibular joint known as TMJ is the hinge joint that connects your jaw to your skull. The pain created by your jaw as it clenches and grinds especially during stress and during sleep travels to your head, causing headaches and migraines.  A migraine of moderate to severe intensity felt at top or the sides of the head, causative factor may actually start at the bottom of your skull, triggered by TMJ. According to Cleveland Clinic’s center for integrative and Lifestyle medicine, “TMJ muscles, located underneath jaw and in cheeks and on top of and sides of head can generate and be a source of the chronic migraines.  It can also be accompanied by toothache, earaches, both shoulder and neck pain”. In our practice, these are the most common complaints made by patients that suffer from TMJ associated migraines. Call us to schedule a consultation with one of our caring provider!


Tips to ease headache, migraine pain associated with TMJ:

  • chew mint instead of gum, which lessens the stress on the jaw that triggers the migraine by preventing excessive mastication
  • Gently massage your jaw muscles
  • Stretch your neck throughout the day with specific neck exercises
  • Visit a dentist for appropriate fitting mouth guard
  • Behavioral Modifications: stress reduction, exercise, yoga .  

By: Rajni Bala, FNP

New York Times Diagnosis

Did you know that sinus headaches are the number 1 misdiagnosis in migraine? There are many other headache disorders as well that can mimic a sinus infection. The trigeminal autonomic cephalalgias (TACs) are a group of headache disorders in which sinus type symptoms and allergy type symptoms are characteristic.  In the New York Times article written by Lisa Sanders, seen below, an example of this is explored.

By: Audrey L. Halpern, M.D.

Her Allergies Were Getting Better, So Why Were Her Sinus Headaches Getting Worse?

– By Lisa Sanders, M.D.

“It was the pain that woke her that night — the worst pain the 60-year-old woman had ever felt. It was as if a C-clamp were tightened around her head and face, punctuated with pulsations of what seemed like an electrical current.

The feeling eased after 20 excruciating minutes. All that was left was a dull ache. And exhaustion: Her husband found her in a fetal position on the floor of their home in a suburb of Baltimore. He helped her into bed. She had to go to the E.R., he said. “What am I going to tell them?” she answered. “That I had a headache?”

The pain returned many times over the next two weeks, usually when she was asleep. Her eyes would water, her nose would run and then she would get this intense pressure behind her cheekbones and eyes. It felt like the worst sinus headache she’d ever had — and she’d had many since her bout with cancer 30 years before.”

Read More