PRIMARY STABBING HEADACHE


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

NEWS: FDA APPROVES BIOHAVEN’S NURTEC® ODT (RIMEGEPANT) FOR PREVENTION

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

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 IN NUMBERS

• 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

https://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-migraine-in-adults

BLUE LIGHT AND MIGRAINE

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

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

ACUPRESSURE


For some people, stimulating pressure points in the body to relieve muscle tension and promote blood circulation can reduce pain. If you press on the pressure point, it is acupressure; if you use a thin needle to stimulate the point, it is acupuncture. Pressure points are found in the ears, hands, feet, face, and neck. One of the most useful points, of the more than three hundred Chinese acupuncture points, is LI4 (or Hegu). Applying pressure to this dime-sized spot, located between the thumb and forefinger, can help with anxiety and pain. To self-administer acupressure on your Hegu point, put your thumb on top of the point and your forefinger/index finger on the other side of the hand. Press down firmly for about five minutes, moving your thumb in small circular motions. Repeat on the other hand. Do not do this if pregnant as it can induce labor. While more research is needed, a few studies indicate acupressure may also reduce nausea and fatigue associated with migraines.

—Alice N.S. Wong, NP

https://www.healthline.com/health/migraine/pressure-point-for-migraine
https://www.wsj.com/articles/SB10001424127887323893504578559772806704216

MIGRAINE WITH AURA


Aura can manifest as a mixture of positive and negative features. Positive symptoms indicate active discharge from central nervous system neurons. Typical positive symptoms can be visual symptoms for example ( bright lines, shapes, objects), auditory symptoms (eg, tinnitus, noises, music), somatosensory (eg, burning, pain, paresthesia), or motor (eg, jerking or repetitive rhythmic movements). Negative symptoms indicate an absence or loss of function, such as loss of vision, hearing, feeling, or ability to move a part of the body. Auras are most often visual, but can also be sensory, verbal, or motor disturbances.
A visual aura classically begins as a small area of visual loss often just lateral to the point of visual fixation. It may either appear as a bright spot or as an area of visual loss. Over the following five minutes to one hour, the visual disturbance expands margin and develops into geometric shapes or zigzagging lines.
Sensory aura is also common and typically follows the visual aura within minutes, although it may also occur without the visual aura. A sensory aura may be described as a tingling in one limb or on one side of the face. As the tingling sensation migrates across one side of the face or down the limb; it may be followed by numbness lasting up to an hour.
Less common than the visual and sensory auras is the language or dysphasic aura. Language auras cause transient problems for example mild difficulties with word finding to difficulty speaking.
Furthermore, motor aura, the limbs and possibly the face on one side of the body become weak, may also occur during migraine attacks.
Patients may also experience aura without an associated headache. Migraine aura without headache (also known as migraine equivalent and acephalgic migraine) manifests as isolated aura unaccompanied by headache.
The Manhattan Center for Headache and Neurology has competent providers to further evaluate and facilitate acute and extended management.
By: Jordan Shankle, PA

MENSTRUAL MIGRAINE


Migraine may be triggered by a variety of environmental factors but may also be triggered by changes within the body. For women, they may be triggered by changes in levels of hormones that occur throughout the menstrual cycle. These are known as menstrual migraines. About 60% of women with migraine experience menstrual migraines.

These migraines may be particularly persistent and difficult to treat. There are many different ways of addressing these with treatment. One clinical trial found that starting magnesium supplements daily 15 days prior to menses was helpful in treating menstrual migraines. They may also be addressed using typical abortive or rescue medications such as NSAIDs or triptans.

Additionally, oral contraceptives may help to alleviate symptoms by decreasing the drop in estrogen, however the effects may vary from person to person. It is important to discuss this with your provider to assess your stroke risk prior to starting oral contraceptives. In some cases, your gynecologist may work together with your headache specialist to coordinate treatment.

Call the Manhattan Center for Headache & Neurology and speak to one of o ur caring healthcare providers about the right treatment for your menstrual migraines.

By: Brooke Steiger NP