Exertional headaches are a group of headache syndromes that are provoked by physical activity. This sub-type of headache can become severe with strenuous activity such as weight lifting or sexual intercourse. Exertional headaches can occur either as a secondary headache or primary headache. Exercise headache is characterized by episodes of pulsatile head pain that are brought on by or occur only during or after physical exercise. Primary exercise headaches are more likely to occur during hot weather or at high altitude .
Exercise headaches are bilateral and throbbing in quality. They persist from five minutes to 48 hours, are triggered by physical exercise, and may be prevented by avoidance of excessive physical exertion. Exercise headaches are not usually associated with nausea or vomiting
Most exertional headaches are benign. Although these may occur in isolation, they are most commonly associated with patients who have inherited susceptibility to migraine.
Patients with new or never-evaluated exercise headaches should have an evaluation, including brain imaging and a neurovascular evaluation; blood work may also be indicated.
The Manhattan Center for Headache and Neurology has caring providers to further evaluate and facilitate acute and extended management.
By: Jordan Shankle, PA


As we celebrate reaching mid 2021 with vaccination rates up and cases down in New York, we acknowledge for some, the effects of Covid-19 continue. On June 14, 2021, the CDC published interim guidance for evaluating and caring for patients with post-Covid conditions. The key points include:
The term “Post-Covid Conditions” is an umbrella term for the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection, including by patients who had initial mild or asymptomatic acute infection.

Providers are encouraged to incorporate patient-centered approaches to optimize the quality of life and function in affected patients.

Lack of abnormalities in objective laboratory or imaging findings does not invalidate the existence, severity, or importance of a patient’s symptoms or conditions.

Healthcare professionals and patients are encouraged to set achievable goals and to approach treatment by focusing on specific symptoms (e.g., headache). A comprehensive management plan focusing on improving physical, mental, and social wellbeing may be helpful for some patients.

Understanding of post-Covid conditions remains incomplete and guidance for healthcare professionals will likely change over time as the evidence evolves.

We at the Manhattan Center are seeing patients with aggravation of chronic symptoms as well as new onset symptoms possibly due to post-Covid or even Covid vaccinations. Symptoms may include headaches, dizziness, fatigue, brain fog, impaired concentration, nausea, numbness and tingling.

As data and research continue, and governmental and medical guidance develop, our providers follow what has always been successful at our practice. We listen to our patients: we spend up to an hour with our new patients to listen, examine, diagnose, and discuss plan of treatment. We offer in-house testing (EEG, TCD, VNG, EMG/NCS) and use our extensive expertise to treat a variety of neurological conditions. In additional to pharmacological treatments, we offer IV infusions and IM/SQ injections of fluids/vitamins/magnesium, nerve blocks, trigger point injections, as well as massage and mental health therapy. We are committed to recovering from COVID together. Please call and set up an initial or follow up appointment with one of our caring providers.

By: Alice Wong, NP

Reference: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-index.html


We all look forward to summer when the weather is nice and it is time for vacation.
When you suffer from migraines, you need to keep a few things in mind during the summer months.

As the weather gets warmer, we spend more time outside. When it is very warm, we perspire and may become dehydrated. It is important to keep well hydrated with non caffeinated beverages in order to stave off dehydration related to overheating. For some, the heat itself may trigger headaches so make sure to keep yourself cool by spending time in the shade especially around midday and taking breaks indoors to cool off.

As the days get longer we tend to spend more time in the sun. For those who consider light to be a trigger for their migraines, make sure to wear sunglasses and a hat.

Spending more time outside may include social activities such as picnics and barbeques where alcohol is served. Be mindful of the types of alcohol that trigger your migraines and drink alcoholic beverages only in moderation. For every 1 alcoholic beverage, consume 2 glasses of water.

Along with summer, often comes vacation. If you are traveling, be mindful of changes in your routine such as very early flights or altering your sleep schedule. While on vacation, try to stick to your normal routine when you are able.

Overall, enjoy your summer but make self-care a priority.

By: Brooke Steiger, NP


Stabbing headache is one of multiple headache syndromes that may occur either as a primary headache or secondary headache. Careful evaluation for underlying causes is important for these uncommon types of headache.
Primary stabbing headache is characterized by transient, sharp, jabbing pains. The pain can be localized at any site on the head and frequently causes the patient to wince. They appear suddenly either as single stabs or multiple reocurring, mild to intense stabbing pain. This headache subtype has been diagnosed in both children and adults.
The individual stabs typically last for a few seconds and often occur at irregular intervals ranging from rare attacks to more than one attack each day . The stabbing pains occur in the absence of organic disease of the cranial nerves . However, a structural abnormality must be excluded.
Most patients with primary stabbing headache also have another coexisting primary headache disorder, such as migraine or cluster headache. In these cases, the stabbing usually occurs in areas of the head that are involved in the coexisting headache. This implies that the stabbing pain might result from spontaneous firing in individual nerve fibers sensitized by recurrent activation.
The diagnosis of primary stabbing headaches is based upon a particular criteria. The Manhattan Center for Headache and Neurology has exceptional providers to further evaluate and facilitate acute and extended management. We look forward to treating you!

By: Jordan Shankle, PA


NURTEC ODT 75 mg is an oral CGRP antagonist previously approved for acute treatment in all eligible adult patients with migraine, regardless of the number of monthly migraine days. It is now also approved for preventive treatment in adult patients with less than 15 headache days per month. NURTEC can be taken up to once daily as needed to stop migraine attacks or taken every other day to help prevent migraine and reduce the number of monthly migraine days. This approval represents an important advancement in care for the millions of people living with migraine. For the first time, one medication can treat and prevent migraine attacks. We at the Manhattan Center of Headache and Neurology are pleased and excited to offer this new preventative treatment to our patients. Please contact us for evaluation and discussion.

Alice Wong, NP

Migraine and Headache Awareness Month

June is Migraine and Headache Awareness month!

If you are looking for ways to get involved you can start by spreading the word about the impact of headache on daily life. By doing this, you help to change the stigma around migraine.

You can go to the American Migraine Foundation website and sign the “Move Against Migraine” pledge which is an initiative for migraine patient advocacy.

The American Migraine Foundation has several social media related initiatives during the month of June. They are encouraging patients and patient advocates to follow them on social media including Reddit, Instagram, Facebook, and Twitter and use the hashtag #moveagainstmigraine on social media when talking about migraine. They are also hosting a twitter chat with the Executive Director Nim Lalvani on Monday, June 21 at 3 PM EST.

You can even get involved on a national level by attending the yearly advocacy event called “Headache on the Hill” which a 2-day event in Washington D.C. where patients, headache specialists, and patient advocates meet with Congressional representatives to raise awareness. This year, you can register for “Walk/Run/Relax” which is a virtual fundraiser where you complete a walk, run, or simple relaxation time on your own during the first week of June. You can register on for this on www.raceroster.com

By: Brooke Steiger, NP


Post Concussion syndrome (PCS) is a common sequelae of traumatic brain injury (TBI) and describes a symptom complex that includes headache and cognitive impairment. PCS can occur after a head injury or the brain undergoing an acceleration/deceleration movement without direct external trauma to the head.

The most common complaints in PCS are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration and memory, and noise sensitivity. Over 50 percent of patients report personality change to include increased irritability, anxiety, and depression. Patients may find themselves hypersensitive or intolerant to noise, emotional excitement, and crowds. Family members may report that the patient seems more abrupt, argumentative, stubborn, opinionated, or suspicious. Patients also report impaired memory and concentration; these may be corroborated by objective deficits on neuropsychological testing. In typical cases, these are most prominent immediately after the injury and resolve over the next weeks and months. A significant number of patients (15 to 20 percent) will develop symptoms meeting criteria for psychiatric disease. These include acute stress and posttraumatic stress disorder (PTSD) as well as anxiety, panic disorder, and depression.

The use of testing needs to be individualized for each patient. Referrals to an ophthalmologist or otorhinolaryngologist should be made for patients with persistent complaints of visual symptoms or vertigo. Psychiatric evaluation should be considered for patients with prominent psychiatric symptoms. Further evaluation like Electroencephalography (EEG) and neuroimaging may be indicated, however not always warranted.

The Manhattan Center for Headache and Neurology has competent providers to further evaluate and facilitate acute and extended management.

By: Jordan Shankle, PA


• Migraine is a common disorder that affects up to 12 percent of the general population.
• It is more frequent in women than men: up to 18 percent of women and 8 percent of men each year
• Migraine without aura is the most common type, approximately 75 percent of cases
• Most common in ages 30 to 39
• Although not fatal, it is a major cause of disability: ranked #2 worldwide (after low back pain) among all diseases with respect to life lived with disability
• In a retrospective study of 1,750 patients, approx. 75 percent reported at least one trigger, which included:

● Emotional stress (80 percent)
● Hormones in women (65 percent)
● Not eating (57 percent)
● Weather (53 percent)
● Sleep disturbances (50 percent)
● Odors (44 percent)
● Neck pain (38 percent)
● Lights (38 percent)
● Alcohol (38 percent)
● Smoking (36 percent)
● Sleeping late (32 percent)
● Heat (30 percent)
● Food (27 percent)
● Exercise (22 percent)
● Sexual activity (5 percent)

—Alice N.S. Wong, NP



Blue light is a particular spectrum of light emitted from electronic devices that may exacerbate headaches or even trigger a migraine attack. Additionally, blue light is emitted via fluorescent lighting.

In the current environment of increased dependence on technology due to work-from-home, many patients with migraines are finding that headaches may be occurring more often, especially after extended use of the computer.

There are several ways to mitigate the effects of blue light. You may buy eyeglasses that block blue light. There are also screen protectors you can add to your laptop or desktop screen. Additionally, if possible, taking breaks from computer work is recommended.

For more information about blue light and migraine, call The Manhattan Center for Headache & Neurology.to schedule an appointment with one of our caring providers.

Brooke Steiger, FNP


Foot drop, is a neurological disorder which is defined as inability to lift the forefoot due to weakness of muscles in the ankle/foot also known as the dorsiflexors. This condition may be the result of a muscular, skeletal, or nervous system problem. To develop a treatment plan for foot drop, a full evaluation and determination of the cause must be completed for each patient. Just as foot drop can have many causes, foot drop treatment can take many forms.

There are a plethora of etiologies that can cause foot drop; one of which are compressive disorders. The most common being compression of the peroneal nerve, which is located in a patients lower extremity ( hip, ankle, or leg). Foot drop may also be caused secondary to traumatic injuries to include knee/ hip dislocation, fractures, severe ankle inversions, blunt trauma. Foot drop secondary to iatrogenic causes is seen most frequently due to surgical procedures; more often secondary to protracted positioning in anesthesia, although other causes such as prolonged bed rest, splinting, and even pneumatic compression devices may cause symptoms.

Foot drop, may be partial or complete, developing acutely or over a period of days to weeks. Patients may complain of dragging their toes, problems walking or climbing stairs, or frequent falls.

When foot drop occurs due to peripheral nerve entrapment, the symptoms will differ depending on the affected nerve and site of entrapment. Foot drop caused by entrapment of the peroneal nerve may also result in decreased sensation, tingling, numbness, or burning from the lower lateral leg to the top of the foot.

Foot drop is generally a clinical diagnosis apparent from the history and physical examination. Extremity imaging is useful for ruling out fracture or other anatomic abnormalities, to help identify a likely etiology. Most patients will undergo electromyography (EMG), unless there has been an obvious traumatic nerve transection.

A number of nonsurgical treatment options are available for the management of foot drop. The approach to the patient depends upon the etiology of foot drop and the localization of the lesions. Treatment plans are individualized based upon the evaluation and diagnostic findings.

By: Jordan Shankle, PA