Hormonal Migraine is a subtype of Migraine associated with alternation in estrogen levels. Estrogen is a steroid hormone associated with female reproduction. Fluctuations in estrogen levels can be a result of menstruation, pregnancy, menopause, hormone containing contraceptives and in vitro fertilization.

Menstrual Migraine is the most common type of hormonal headache. It is diagnosed over a minimum of three menstrual cycles. Menstrual Migraine can occur with or without aura; although without aura is most common.

The pathophysiology of estrogen impacting migraine headaches is complex related to numerous changes in the neural networks involved in pain response. Additionally, supporting data include genetics.

Hormonal migraine is mostly a clinical diagnosis – Neuro imaging and blood work may be required to rule out secondary causes of headaches. Treatment varies based on headache severity and frequency.

The Manhattan Center for Headache and Neurology and its sister site, Nervana Neurospa, has amazing providers that will help diagnose and potentially treat hormonal related migraines.

By: Jordan Shankle, PA

Neuroplasticity in Migraine

In the realm of migraine research, the concept of neuroplasticity is emerging as a pivotal player, reshaping our comprehension of the brain’s dynamic responses to pain. Neuroplasticity, the brain’s ability to rewire itself, holds intriguing implications for understanding and treating migraines. As we explore the mechanisms behind this adaptability, it becomes evident that the brain’s structural changes play a crucial role in migraine experiences. The discovery of synaptic pruning, long-term potentiation, and the formation of new neural pathways provides insights into potential therapeutic avenues. Harnessing neuroplasticity could revolutionize migraine management, offering hope for more effective treatments that target the brain’s adaptable nature and alleviate the burden of migraine sufferers. As research progresses, the future promises a deeper understanding of how neuroplasticity influences migraine patterns, leading to innovative strategies for prevention and relief.
Ferrari MD, Klever RR, Terwindt GM, Ayata C, van den Maagdenberg AM. Migraine pathophysiology: lessons from mouse models and human genetics. Lancet Neurol. 2015;14(1):65–80. doi: 10.1016/S1474-4422(14)70220-0.
Wessman M, Terwindt GM, Kaunisto MA, Palotie A, Ophoff RA. Migraine: a complex genetic disorder. Lancet Neurol. 2007;6(6):521–532. doi: 10.1016/S1474-4422(07)70126-6.

Occipital Nerve Blocks and Pregnancy


Primary headaches (tension, migraine, and cluster) are common in the reproductive population. Headache treatment during pregnancy is made more difficult by clinician discomfort with treatment options, concern for masking secondary headaches, and fear of potential fetal effects from headache treatments. As a result, treatment of headache disorders is often delayed during pregnancy.
Occipital nerve block is a well-established treatment for tension and migraine headache in the nonpregnant population with both abortive and prophylactic treatment benefits. Occipital nerve block is a safe, commonly performed procedure that involves a subcutaneous injection of local anesthetic with or without a steroid component bilaterally into the area around the occipital nerves. A recently published randomized trial assessed the efficacy of occipital nerve block compared with standard care of an oral cocktail of acetaminophen and caffeine for the treatment of acute headache in pregnancy.
In this randomized controlled trial of pregnant people, treatment with occipital nerve block resulted in lower visual pain scale scores at 1 hour and more rapid turnaround in maternal emergency room. The study found no difference at 2 hours, but the reduction in visual rating scale scores at 1 hour is encouraging. The study suggests that occipital nerve block is a quick-acting, effective treatment for acute headache in pregnancy. Furthermore, in an emergency care setting or for refractory headache, occipital nerve block has some improved outcome metrics compared with standard care. Given the multiple limitations that pregnant people face in acute headache treatment, occipital nerve block should be considered as a primary, secondary, or alternative acute headache treatment in pregnancy. The trial supports the option of occipital nerve block use for pregnant patients.
At MCHN/Nervana, we have used occipital nerve blocks with success. Call for an evaluation to determine if this treatment is appropriate for you.
–Alice Wong, NP
Reference: Bushman, Elisa T. MD; Blanchard, Christina T. MS; Cozzi, Gabriella D. MD; Davis, Allison M. MD; Harper, Lorie MD, MCSI; Robbins, Lindsay S. MD, MPH; Jones, Benjamin MD; Szychowski, Jeff M. PhD; Digre, Kathleen B. MD; Casey, Brian M. MD; Tita, Alan T. MD, PhD; Sinkey, Rachel G. MD. Occipital Nerve Block Compared With Acetaminophen and Caffeine for Headache Treatment in Pregnancy: A Randomized Controlled Trial. Obstetrics & Gynecology 142(5):p 1179-1188, November 2023. | DOI: 10.1097/AOG.0000000000005386



Zinc is a trace element that is essential to the human body for many functions, including supporting healthy functioning of the immune system. Zinc is also responsible for maintaining healthy skin, healthy eyes, and reducing inflammation in the body.

Deficiencies in zinc may lead to hair loss, fatigue, and frequent infections.

Some studies have found that zinc helps with recovery from upper respiratory infections like the flu and colds.

You can obtain zinc from foods such as fish, beans, eggs, meats, and cheese. You can take zinc via oral and IV supplementation.

If you are interested in zinc for your health, book an IV at our sister office Nervana Neurospa.

By: Brooke Masilak, FNP


Desiderata by Max Ehrmann, 1927 

Go placidly amid the noise and haste, 
and remember what peace there may be in silence. 
As far as possible without surrender 
be on good terms with all persons. 
Speak your truth quietly and clearly; 
and listen to others, 
even the dull and the ignorant; 
they too have their story. 

Avoid loud and aggressive persons, 
they are vexations to the spirit. 
If you compare yourself with others, 
you may become vain and bitter; 
for always there will be greater and lesser persons than yourself. 
Enjoy your achievements as well as your plans. 

Keep interested in your own career, however humble; 
it is a real possession in the changing fortunes of time. 
Exercise caution in your business affairs; 
for the world is full of trickery. 
But let this not blind you to what virtue there is; 
many persons strive for high ideals; 
and everywhere life is full of heroism. 

Be yourself. 
Especially, do not feign affection. 
Neither be cynical about love; 
for in the face of all aridity and disenchantment 
it is as perennial as the grass. 

Take kindly the counsel of the years, 
gracefully surrendering the things of youth. 
Nurture strength of spirit to shield you in sudden misfortune. 
But do not distress yourself with dark imaginings. 
Many fears are born of fatigue and loneliness. 
Beyond a wholesome discipline, 
be gentle with yourself. 

You are a child of the universe, 
no less than the trees and the stars; 
you have a right to be here. 
And whether or not it is clear to you, 
no doubt the universe is unfolding as it should. 

Therefore be at peace with God, 
whatever you conceive Him to be, 
and whatever your labors and aspirations, 
in the noisy confusion of life keep peace with your soul. 

With all its sham, drudgery, and broken dreams, 
it is still a beautiful world. 
Be cheerful. 
Strive to be happy. 

As 2023 draws to a close, I am posting an old inspirational poem for reflection. I wish you health and happiness. —Alice Wong, NP 


Migraine is a common headache disorder characterized by recurrent attacks of mild to severe throbbing – sometimes pulsation sensations. The pain is usually on one side of the head but can occur in any region. Pain can be associated with sensitivity to light, noise and odors. Additionally, patients may experience nausea and/or vomiting. Headaches are often worsened by movement and or physical activity.

The two major types are Migraine with Aura and Migraine without Aura. Subtypes include Basilar Type Migraine, Hemiplegic Migraine and Menstrual Migraine. The prevalence of a migraine in women and in men has been reported as 17% and 6%, respectively.

Etiology of migraine can vary and include genetic factors, cerebral vasodilation, magnesium deficiency, and increase in calcitonin gene-related peptide and neurogenic inflammation. During the acute phase of this disease there may be a release of proinflammatory peptides.

Multiples clinical studies have proved efficacy in use of anti-inflammatory nutrients such as omega-3 fatty acids, EPA and DHA to inhibit the production of inflammatory proteins. These nutrients act to modify immune reactions to reduce inflammation.

In conclusion, Omega – 3 fatty acids, can be considered as an adjunctive therapy for patients with Migraine disorder. Omega 3 – fatty acids can potentially reduce the inflammatory response during a migraine attack which in turn may help alleviate symptoms.

By: Jordan Shankle, PA


Nervana Neurospa, the sister site to The Manhattan Center for Headache & Neurology, is dedicated to the health and wellness of our clients! Among the numerous services we offer, Intravenous Therapy is one of them that is getting increasingly popular. IV fluids can include an array of amino acids, antioxidants, and vitamins and minerals. Calcium is an important mineral in the body for bone development and maintenance and keeping your heart healthy. At Nervana, you can customize your IV fluids to include all the additives you desire. Calcium goes well with Lysine, which helps aid in the absorption of our powerful mineral, Calcium. Join us at Nervana today to receive your proper dose of Calcium!

By: Nick Ames, RN

Vitamin C

Vitamin C, also known as ascorbic acid, is an antioxidant found in foods that helps maintain many processes of the body including building muscles, cartilage, and collagen and is an integral part of wound healing.

As an antioxidant, it protects the body from toxins that form free radicals in the body from things such as UV radiation and pollutants.

It can be part of a healthy diet including fruits and vegetables such as berries, tomatoes, peppers, and citrus fruit. It can also be taken as a supplement in pill or intravenous form.

Research suggests that Vitamin C may be protective against different kinds of cancers including breast and lung cancer.

Studies have found that Vitamin C may reduce the length and severity of the common cold.

Vitamin C is available at our Brooklyn location, Nervana Neurospa, via intravenous infusion.

By: Brooke Steiger, NP

Combination Migraine Treatment: BOTOX + CGRP Monoclonal Antibodies 

OnabotulinumtoxinA (brand name BOTOX) and calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) (brand names Aimovig, Emgality, Ajovy) target different migraine pathways, therefore, combination treatment may provide additional effectiveness for the preventive treatment of chronic migraine (CM) than either treatment alone. A 2022 study collected real-world data to improve the understanding of the safety, tolerability, and effectiveness of adding a CGRP mAb to onabotulinumtoxinA treatment for the preventive treatment of CM. The effectiveness of combination preventive treatment was assessed by the reduction in monthly headache days (MHD). Electronic medical records were collected for 192 patients, of which 148 met eligibility criteria and were included for analysis. After ~12 months of continuous combination treatment, MHD were reduced by 4.6 days/month and 34.9% of patients achieved ≥50% MHD reduction. Most common side effects were constipation and injection site reactions. No serious adverse events were reported. In this real-world study, onabotulinumtoxinA was effective at reducing monthly headache days and the addition of a CGRP mAb was safe, well-tolerated and associated with reductions in monthly headache days for those who stayed on the combination treatment. Of those who discontinued, the majority reported lack of insurance coverage as a reason.  
At MCHN, we have seen the effectiveness of Botox and CGRP mABs as stand-alone treatments. We have also seen a number of patients where either Botox or CGRP did not provide enough control for our patients to live productive lives. In some cases, the combination of Botox and CGRP provided the results we needed. If you continue to struggle with migraines, please call MCHN to schedule an appointment to discuss. Be well. 

–Alice Wong, NP 

Reference: Mechtler L, Saikali N, McVige J, Hughes O, Traut A, Adams AM. Real-World Evidence for the Safety and Efficacy of CGRP Monoclonal Antibody Therapy Added to OnabotulinumtoxinA Treatment for Migraine Prevention in Adult Patients With Chronic Migraine. Front Neurol. 2022 Jan 6;12:788159. doi: 10.3389/fneur.2021.788159. PMID: 35069416; PMCID: PMC8770868.


Selenium is a naturally occurring mineral present in many foods such as Brazil nuts, seafoods (tuna, halibut, sardines, shrimp), Beef, Liver, Eggs, Turkey, Lentils, Rice, Spinach. Once inside the body, selenium regulates important metabolic functions and is capable of fighting oxidative damage caused by free radicals. It can lower susceptibility to illness and is also indicated to support vital bodily functions. While it is plentiful in most western diets, since our body can’t produce its own Selenium, people often seek out oral or IV supplementation to harness some of its health benefits. It has been highlighted to play a role in prevention of cancer, cardiovascular disease, cognitive decline, and thyroid disease. While there are plenty of benefits from this mineral, there is also risk from excessive selenium. Early indicators of excess intake are a garlic odor breath and a metallic taste in the mouth. Hair and nail loss or brittleness are the most common clinical signs of chronically high selenium. Acute selenium toxicity can cause severe gastrointestinal and neurological symptoms, acute respiratory distress syndrome, muscle tenderness, lightheadedness, facial flushing, kidney failure, and in rare cases death. Always speak with a healthcare professional prior to starting selenium supplementation and follow appropriate dosing guidelines.

By: Andrew Chan, PA

Rayman MP. Selenium and human health. Lancet 2012;379:1256-68.

Sunde RA. Selenium. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012:225-37