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

GIVE ME SOME OXYGEN ..HYPERBARIC OXYGEN CHAMBER

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!

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

https://www.uptodate.com/contents/estrogen-associated-migraine-headache-including-menstrual-migraine

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 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

Triptans were developed specifically for the acute treatment of migraine. The first clinically available triptan was sumatriptan, which has been marketed since 1991. All of the triptans inhibit the release of vasoactive peptides, promote vasoconstriction, and block pain pathways in the brainstem. Triptans inhibit transmission in the trigeminal nerve, thereby blocking input to neurons; this effect is probably mediated by reducing the levels of calcitonin gene-related peptide (CGRP).  

The available triptans include sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan. Sumatriptan can be given as a subcutaneous injection, as a nasal spray, as a nasal powder, or orally. Zolmitriptan is also available for both nasal and oral use. The others are available for oral use only. The choice of a triptan should be individualized; different pharmacologic properties and delivery routes may help guide the choice. Patients who do not respond well to one triptan may respond to another. Sumatriptan offers the most options for routes of drug delivery, with subcutaneous sumatriptan offering the fastest onset of action. Naratriptan and frovatriptan have the slowest onset of action among the triptans and may have the lowest propensity to cause side effects. 

Triptans have proven to be safe and effective for most patients with migraine. As with all medications, there are concerns, risks, and contraindications. The risks and benefits should be discussed with a provider, and patients should be monitored.  
 
–Alice Wong, NP

https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults 

BOTOX FOR MIGRAINE PREVENTION

Botox is often associated with beauty, but have you ever considered it for migraines? In a study of adults who get chronic migraine headaches, injections of Botox decreased the total number of headache days experienced. In another study, nearly half the participants who had two rounds of Botox injections reported that the number of headache days each month decreased by half. After five rounds of treatment, 70% of the people of the participants experienced a decrease in headache days. Botox is a neurotoxin that blocks the chemicals known as neurotransmitters that send pain signals in the brain. Think of it as a big STOP sign on a road – it stops the signals of pain from getting through to the nerves. Botox treatments are administered every 12 weeks to ensure maximum efficacy. Botox is an excellent tool in fighting migraines

What is Neurofilament Light Chain (NfL)? NfL is a biomarker that is found specifically in neurons. In mature myelinated axons, neurofilaments are the single most abundant protein. When there is neuro-axonal injury, NfL is released into the cerebrospinal fluid (CSF), and then into the blood. The concentration in the blood reflects the rate of neurofilament release from neurons. Testing for levels of NfL may provide valuable data in clinical trials for neurological disorders. It has the potential to help guide treatment decisions, used as a screening tool, monitor disease progression, or assess treatment response. NfL is being looked at for multiple neurological conditions, including Alzheimer’s disease, Multiple Sclerosis, Migraine, and Concussion. NfL testing was previously done testing the CSF and could only be found in highly specialized laboratories but is slowly becoming more accessible to your healthcare providers through serum/plasma testing.

Thebault, Simon, Ronald A. Booth, and Mark S. Freedman. “Blood neurofilament light chain: the neurologist’s troponin?.” Biomedicines 8.11 (2020): 523.

Yuan, A.; Rao, M.V.; Veeranna; Nixon, R.A. Neurofilaments and neurofilament proteins in health and disease. Cold Spring Harb. Perspect. Biol. 2017, 9, a018309.

By: Andrew Chan, PA

Approximately 23% of people with migraine experience one or more focal neurological symptoms in the second phase referred to as Aura or Migraine with Aura. Typical Auras include acute and transient visual disturbances. However, aura can be presented in multiple ways. Two less common auras associated with migraine are Language and Motor Auras.

Language Aura is characterized by transient speech difficulties. Examples are slurred speech, difficulty word finding or dysphasia / paraphrastic errors.

Another type of aura is motor which is often considered the rarest type. Patients with motor aura can experience difficulty walking, falls and or muscle weakness. These symptoms emulate stroke like symptoms – therefore it is imperative to get a proper evaluation.

Neuro imaging is needed to rule out underlying structural abnormalities. In addition, blood work and other neurologic testing may be ordered such as EEGs or Trans Doppler ultrasounds.

The Manhattan Center for Headache and Neurology has exceptional providers to help diagnose and potentially treat your migraines and aura.

By: Jordan Shankle, PA