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

Headaches Attributed to Whiplash

Whiplash is a term described as intense cervical spine acceleration and deceleration resulting in injury, mostly of the head and neck. Clinical manifestations include somatic extracervical pain, neurosensory symptoms, and oftentimes cognitive impairment.

Additionally, whiplash often leads to headache syndromes. These types of headaches have no typical characteristics. They can be described as dull/achy, sharp shooting or throbbing sensations. Associated signs and symptoms may include brain fog, light sensitivity, nausea and irritability.

Moreover, this type of headache usually develops within 7 days after an injury and resolves within 3 months.

The Manhattan Center for Headache and Neurology has exceptional providers to help diagnose and potentially treat this type of headache syndrome.

By: Jordan Shankle, NP

Massage for Migraines

Who doesn’t like a nice, relaxing massage?

Massages have been found to be beneficial for people suffering from migraines. A 2006 study found that massages helped to reduce migraine frequency and improve sleep quality.

There are several mechanisms by which massages are thought to help.

Massage releases endorphins and reduces cortisol levels which promotes well-being and relaxation thereby reducing stress levels.

Massage can reduce muscle tension and ease pain at trigger points which play a role in the headache process. They can also decrease muscle spasms which may get triggered during a migraine.

If you think you might benefit from massage therapy for your migraines, call our office to schedule your appointment today!

By: Brooke Masilak, NP



A hyperbaric oxygen chamber, often referred to as an HBOT chamber, is a device that delivers pure oxygen to individuals at pressures greater than atmospheric pressure. It’s a non-invasive treatment that enhances the body’s natural healing process. It also enhances the delivery of oxygen to tissues and organs. HBOT can be used for many different purposes such as brain fog, migraines, long COVID symptoms, injuries, etc. Since the pandemic, many have faced a range of persistent and often debilitating symptoms that continue for weeks or months, after the acute phase of a COVID-19 infection has resolved. Long COVID is characterized by a broad spectrum of symptoms that can affect various organ systems in the body. Common symptoms include fatigue, brain fog, cognitive difficulties, muscle and joint pain, etc. Apart from seeking medical evaluation, receiving a few sessions of HBOT can be both beneficial and therapeutic. Schedule a session at Nervana Neurospa!

Estrogen-associated Migraine

Increases or decreases in estrogen levels can trigger headaches, including migraines. Changes in estrogen levels can result from biologic processes (eg, menstruation, pregnancy, or menopause) or from use of hormones (eg, hormone-containing contraceptives, in vitro fertilization). Migraine is the headache type most affected by estrogen.
The pathophysiology of migraine is likely multifactorial. It is thought to be related to changes in neural networks involved in pain connectivity. Briefly, activation of central pain pathways stimulates the trigeminovascular system causing associated release of vascular inflammatory substances, such as calcitonin gene-related peptide (CGRP), cytokines, and prostaglandins. Estrogen has been shown to modulate this pathway in multiple complex ways, altering these vascular inflammatory substances.
Female physiology is one of the most common risk factors for migraine development. Migraine is up to three times more prevalent in females than males. Before puberty, the prevalence of migraine is similar for females and males. Migraine prevalence in females starts to climb in early adolescence (which coincides with the onset of menses), peaks during the 20s and 30s, and decreases following menopause. Observational studies of females with migraine have reported approximately 18 to 25 percent note a relationship between menses and migraine.
Patients with any type of estrogen-associated migraine have multiple treatment options, including nonpharmacologic lifestyle changes for migraine prevention, targeted treatment for acute symptoms, preventative therapy as needed (mini prophylaxis), or continuous prophylaxis. Please make an appointment with a MCHN provider to discuss.

–Alice Wong, NP

Dangers of Nitric Oxide Toxicity

Nitrous oxide is increasingly being used as a recreational drug. Prolonged use of nitrous oxide can have disabling neurological sequelae due to functional inactivation of vitamin B12.
Patients can present with sensorimotor peripheral neuropathy with demyelinating features with no clinical or imaging evidence of myelopathy, emphasizing that not all patients develop subacute combined degeneration of the spinal cord (the typical presentation of functional vitamin B12 deficiency). Diagnosis is mostly based upon the history of nitrous oxide use. Notable abnormal lab values would be raised levels of homocysteine and/or methylmalonic acid. All patients should be treated with parenteral vitamin B12. Timely diagnosis and treatment is important to prevent long term or permanent disability.

Rosenberg H, Orkin FK, Springstead J. Abuse of nitrous oxide. Anesth Analg. 1979 Mar-Apr;58(2):104-6. PMID: 571232.

By: Andrew Chan, PA


Fertility Treatment and Migraine Frequency

Many women have noticed that their migraines may increase around their menstrual period. This is caused by fluctuation in levels of hormones.

Hormone levels that are stable lead to a reduction of headache frequency and severity. A decrease in estrogren causes migraines in about 60% of women. During fertility treatments, exogenous hormones may be introduced at levels much higher than occur naturally in the body to help create conditions more suitable for pregnancy.

Some studies suggest that, similarly, hormonal shifts caused by fertility treatments may increase headache or migraine frequency.

During the course fertility treatments, the patient may be asked by their specialist to stop migraine medications prior to implantation or after implantation. It is important to discuss your migraine medication regimen with your fertility specialist.

There are medications that may be appropriate during the course of fertility treatments. This should be discussed with your headache specialist prior to starting fertility treatments.

By: Brooke Steiger, NP

Chronic Post Traumatic Headache

Chronic Post Traumatic Headache is any headache that occurs within 7 days of an injury and persists for at least 90 days. Neurological symptoms may include cognitive impairment, irritability and poor concentration. Additionally, patients may report sleep disturbances.

These types of headaches have no typical characteristics and can be diagnosed with or without associated loss of consciousness. Patients may experience post traumatic amnesia for up to 48 hours and extreme fatigue.

Neuroimaging to include brain MRI is often performed to rule out traumatic brain lesions i.e. cerebral hematoma or intracranial hemorrhage. Brain contusions and/or fractures can be seen as well.

The Manhattan Center for Headache and Neurology has exceptional providers to help diagnose and potentially treat chronic post traumatic headache.

By: Jordan Shankle, PA