Depression and Headaches

Depression can be linked to physical symptoms.  This can include feeling fatigue and a decrease in energy.  You may also have some insomnia and/or early morning awakening.  Conversely you may feel more tired than normal or have excessive sleepiness.  It is also possible to have persistent aches and pains, cramps, headaches, or digestive problems that do not resolve with treatment.  A change in your appetite is possible, and can occur either with an increase or a decrease in appetite.

Without proper treatment depression can have a significant impact on your daily life.  Your career, hobbies, and lifestyle may all be affected. Treatment may consist of prescription management for your headaches, SSRI’s and behavioral therapies.

Call the Manhattan Center for Headache & Neurology to help you treat  your headaches associated with depression. Speak to one of our caring providers to discuss the best treatment option for you!

Adult Attention Deficit Hyperactivity Disorder (ADHD)


Many adult may struggle with ADHD, and do not know that they have it. ADHD is easier to recognize in kids, but the symptoms in adults are more subtle. Indications of adult ADHD may include:

  1. Difficulty with getting organized. Responsibilities such as paying bills, your job, and dealing with children can make organization issues more obvious.
  2. Driving recklessly and frequent accidents. ADHD can affect your attention, so people are more likely to speed and cause accidents.
  3. Marital problems. Adults with undiagnosed ADHD may have poor listening skills and not able to honor commitments leading to arguments with partner.
  4. Being easily distracted, which can lead to underperformance at work.
  5. Being, restless, edgy or tense
  6. Delay in starting tasks that requires a lot of attention.
  7. Not meeting deadlines or being late for events. This is often due to distractions and underestimating the time to finish a task or an assignment
  8. Outbursts of anger. People with ADHD have trouble with controlling their emotions. They may get angry over minor issues, and their anger often fade quicker than before the person involved has gotten over it.
  9. Issues with prioritizing such as spending hours on something minor instead of focusing on bigger obligations.

Adult ADHD can be hard to diagnose, as these symptoms can also be signs of other medical conditions. If you think you have it, call The Manhattan Center For Headache & Neurology to schedule an evaluation.

Tanesha Reynolds, DNP, FNP-BC


Most patients with epilepsy also suffer from headaches. Headaches are common mostly after tonic-clonic seizures, but can also follow simple and complex partial seizures. These headaches are called post-ictal headaches because they occur after seizure activity. Post-ictal headaches are usually generalized, steady/throbbing with a duration from 6 – 24 hours and can be very disabling resulting in loss of time from routine activities.

Though less common, a headache may also occur before a seizure. A headache is sometimes the only symptom of a seizure and is a type of aura as it warns of a coming seizure. These headaches are called pre-ictal headaches, because they occur before the start of any seizure activity. These headaches are usually short-lasting with a throbbing, steady or sharp quality.

A headache can also occur during a seizure episode. This is very rare, but are actually seizure symptoms. Can be pounding, but also sharp and steady. Onset can be sudden or pain can just build gradually. Ictal headaches are seen in all types of epilepsy.

Patients with seizures are twice as likely to have migraine headaches. Migraines and seizures have very common symptoms. They can both be triggered by the same things such as stress, alcohol, hormones, fatigue, dehydration. Also, the aura before a migraine is very similar to the aura before a seizure which may consists of flashing lights, zig-zag lines, distorted images, blind spots, etc.

Don’t be afraid to seek medical treatment if you have both headaches and seizures.

Tanesha Reynolds, DNP, FNP-BC

What is ulnar nerve entrapment?

The ulnar nerve runs the entire length of the arm, there are several places along the nerve that can become compressed or irritated. This compression or irritation is known as ulnar nerve entrapment. Ulnar nerve entrapment is the second most common entrapment nerve pain in the upper body. Ulnar nerve entrapment happens most often at or near the elbow, particularly on the inner part of the elbow. This is known as cubital tunnel syndrome. Ulnar nerve entrapment can also happen less frequently at or near the wrist.


  • Intermittent numbness and tingling in the ring and pinky fingers
  • A weak grip in the affected hand
  • A feeling of the pinkie and ring fingers “falling asleep”
  • Difficulty controlling fingers for precise tasks, such as typing or playing an instrument
  • Sensitivity to cold temperatures
  • Pain or tenderness in the elbow joint, especially along the inner aspect
  • In severe and long-standing cases, muscle wasting of the hand may also occur.


Treatment for ulnar nerve entrapment depends on how severe the entrapment is.

Physical therapy

Initial treatments for ulnar nerve entrapment may include anti-inflammatory medication and physical therapy.

use of anti-inflammatory medications to reduce swelling

elbow braces or splints to keep the joint straight at night

exercises and physical therapy to help the nerve slide through the arm correctly

If the ulnar nerve entrapment is severe or nonsurgical approaches to treatment fail, a doctor may recommend surgery to fix ulnar nerve entrapment.

By: Rajni Bala, NP, RN



Acephalgic Migraine

Migraine without head pain. Also called “Silent migraine”.  This type of migraine can be very alarming as you experience dizzying aura and other visual aura. It is characterized by debilitating symptoms, including upset stomach, dizziness and  visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain. The causes, risk factor, and treatment for all migraines are similar, regardless of whether or not they are silent migraines.


Prodrome phase: Depression, difficulty concentrating, fatigue, food craving, irritability, Sleep disturbance.

Nausea, sensitivity to light and sound.

Acute phase:  People with silent migraine only experience aura symptoms.

Numbness & tingling in part of body

Temporary loss of sight

visual disturbances (appearance of pattern, flashing lights, blind spots)

Diagnosis are determined by blood tests, MRI or CT scan, EEG tests


  • Pain relievers: OTC or Prescriptions
  • Preventative drugs:  Beta blocker, CCBs, antidepressants, anti-seizure meds.
  • Home Remedies: getting enough sleep, dark room, quiet room, ice pack on back of neck, keeping a diary.
  • CGRPs, SPGs, IV therapy, Cefely, Gammacore

By: Rajni Bala, NP, RN


Allergy Season &  Migraine Headaches

Spring is the start of allergy season. This may be a migraine trigger for those who suffer from this condition. Your symptoms may be much more intense during allergy season. Remember, weather is a migraine trigger just like scents and food.  

Migraines and weather triggers that occur during allergy season have a link that is complicated to understand.. The endocrine system, the immune system and the nervous system work together, which contributes to creating that painful migraine. If you get migraines, you have a sensitive nervous system. When there are changes in the environment, people that suffer from migraines, react to to those changes in the environment viewing it is a harmful.  The immune system releases chemicals when exposed to allergens. This may cause inflammation which may trigger your headache.

Contact The Manhattan Center For Headache & Neurology to learn more about migraines triggered by allergies and how to treat them.

Headaches and hormones

The hormones estrogen and progesterone  play key roles in regulating the menstrual cycle and pregnancy and may also affect headache-related chemicals in the brain. Having steady estrogen levels may improve headaches, while experiencing estrogen levels that dip or change can make headaches worse. During menstruation the drop in estrogen just before your period may contribute to headaches. Many women with migraines report headaches before or during menstruation.

Treating menstrual migraines

  • Ice  Hold a cold cloth or an ice pack to the painful area on your head or neck.
  • Relaxation exercises. Try relaxation exercises to lower stress.
  • Biofeedback. Biofeedback may improve your headaches by helping you monitor how your body responds to stress.
  • Acupuncture. Acupuncture may improve your headaches and help you relax.
  • Over-the-counter pain relievers.  Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve) or ibuprofen (Advil, Motrin IB, others).
  • Triptans. Triptans often relieve pain from your headache within two hours and help control vomiting.

Preventive treatment

If your menstrual cycle is regular, it may be most effective to take preventive headache medication starting a few days before your period and continuing through up to two weeks after the start of your period. Preventative  medications may include beta blockers, anticonvulsants, calcium channel blockers, antidepressants or magnesium. Your doctor might also consider monthly injections of a calcitonin gene-related peptide (CGRP) monoclonal antibody to help prevent your headaches, especially if other medications aren’t effective.  Making lifestyle changes, such as reducing stress, not skipping meals and exercising regularly, also may help reduce the frequency, length and severity of migraines. Using hormonal contraception to prevent menstrual-related migraines may be appropriate for women who haven’t been helped by other methods.

By: Rajni Bala, NP


Exertional headache is also called activity-related headache. They are brought on by strenuous physical exercise and can be triggered by: running, jumping, weight lifting, sexual intercourse, bouts of coughing or sneezing

Causes: Increased blood pressure in the blood vessels of brain which is called venous pressure, poor diet, low blood sugar, heat & humidity,high altitudes exercises/activities

Symptoms: Headache usually pops up at the height of exercise and typically fades when the exercise stops, throbbing pain felt throughout the head and are more common in those with a family history of migraine, nausea & vomiting, sensitivity to light & noise.

These headaches are usually very short-lived but can sometimes last up to 2 days.

Treatment: Most attacks can be treated with OTC painkillers. Taking a nonsteroidal anti-inflammatory drug (NSAID) or a beta-blocker before exertion can help prevent the headaches, as can warm-up exercises. Hydration (8 glasses water) when exercising outdoor in hot & humid weather

Reference :

By: Rajni Bala NP


It’s the time of year for drinking green beer

St. Patty’s Day is officially here

But headaches await, if you read this too late

So look through these hints and face the day with no fear!

Many migraineurs already know that alcohol can trigger a headache.  Migraine sufferers are less likely to drink alcohol, studies have shown.  For some people, wine is the main culprit, but other forms of alcohol can trigger, including beer and liquor.  In fact, some studies suggest that alcohol in these other forms is just as often or more often a trigger. Several studies have looked at various ingredients in wine that may be acting as triggers, including tannins, tyramines, histamines and sulfites, but none of these has consistently panned out.

There are 2 main types of migraine triggered by alcohol, acute migraine occurs within 2-3 hours of drinking alcohol, and a second delayed type, which occurs the next day.  Often referred to as a hangover, the delayed type headache is usually much worse in a migraine sufferer than a non-migraine sufferer.

When people drink alcohol, they may get dehydrated, which can possibly lower the threshold for a headache, and if you drink alcohol and skip dinner or eat unhealthier foods while out at that party, these dietary issues may also be the culprit.  

It is likely that a combination of factors surrounding alcohol intake contribute to headaches.  So, before you partake, read through these tips.

  1. Drink plenty of water in between alcoholic beverages
  2. Limit your drinking to 1 or 2 drinks
  3. Eat with your beverage, something healthy
  4. Avoid sugary, and sugary drinks
  5. Before you go out, have a snack, so you don’t go too long without eating
  6. get a good night’s sleep

You should talk to your doctor about how drinking alcohol might affect you, and your headaches.  Review with your doc what treatments are available to you to remedy this type of headache. If dehydrated and nauseous, sometimes IV treatments can help a lot, too.\

By:  Audrey Halpern, MD, BC in Headache Medicine

What Is Neurostimulation For Migraines?

It may sound counter-intuitive… why would I want to stimulate my nervous system if I am having a migraine or suffer from migraines?  Well, headache specialists are not crazy. Stimulation of the nerve can actually cause the brain to settle down, and remain calm.

The migraine brain is a very sensitive brain, and we look for ways to help the brain to stay calm and be less sensitive.  Neurostimulators may actually “stimulate” the areas of your brain that send the calming messages to the rest of the brain or nerves.

There are many different neurostimulators either on the market or currently being researched.  There are devices to stimulate the supraorbital nerve (sits right at your eyebrow), the occipital nerve (back of the head), the SPG or sphenopalatine ganglion (right behind your nose/cheek), and even the vagus nerve in the neck.

Some of the neurostimulators are just applied to the skin and used to get rid of a headache, and others are surgically implanted devices for more intractable and chronic headache disorders.  These devices can be used alone or in combination with other treatments to relieve headaches of various sorts.

By: Audrey Halpern, MD, BC