Category Archives: Uncategorized

CBD products have exploded in availability and popularity over the last year. Despite their popularity people still have many questions about these products, one being the difference between CBD and THC. 

Both marijuana and hemp come from the cannabis sativa family, but they are significantly different in chemical composition. More than 100 chemical cannabinoids are found in cannabis, but the amount of these cannabinoids differs dramatically between hemp and marijuana. Marijuana’s most common cannabinoid is tetrahydrocannabinol (THC) and reaches levels as high as 30%. Hemps most common cannabinoid is Cannabidiol (CBD) and has levels of THC are less than 0.3%.

Due to their chemical arrangement THC and CBD make your body feel differently. THC is the main psychoactive compound in marijuana, what makes people feel “high.” CBD doesn’t cause that high, instead it is thought to work with other elements in the body linked to feelings of well-being. Thus leading us to another common question, what are the risks and benefits of using CBD for migraines?

Unfortunately, there is a lack of scientific evidence or research on CBD as an effective treatment for migraine. However, it may still be a beneficial option for some migraine patients with associated joint and muscle pain, as well as associated nausea and vomiting. 

There is a concern for lack of regulation of CBD, it’s important to ensure that you are using a pure product. Make sure the product actually has CBD or cannabidiol in it. Many times products will only list hemp seeds, hempseed oil, or cannabis sativa seed oil, these ingredients aren’t the same as CBD. It is also important to look into third party testing and be aware of CBD concentration, how much are you getting per serving. Also, pay attention to possible additional ingredients for preservation or flavor. In conclusion, CBD oil may be beneficial for migraine sufferers but speak to a provider and specialist first before starting treatment. 

Caroline Pruski, NP

Zynex Nexwave

The Zynex Nexwave is an FDA-approved medical device to treat chronic and acute pain. It is non-invasive and nonpharmacological alternative to pain medication.

The device is similar to a TENS unit in which you attach electrodes to the treatment area and start a treatment cycle. It has 3 setting including TENS setting. The NMES setting is great for muscle spasm and neuromuscular rehab and the IFC setting is geared towards pain management. In fact, the IFC setting is 40 times stronger than TENS and may deliver from 1-8 hours of pain relief.

The device is a good option pain treatment because it may help you reduce your use pain medication including prescription and over-the-counter medications and help you return to your normal activities of daily living.

 For more information about this device and to determine if it is right for you, talk to your healthcare provider.

 Brooke Steiger, NP


“Though that was decades ago, today there are still several reasons migraine is poorly controlled for so many people. One is a lack of appreciation by both doctors and the public for what it entails”

This NY Times article discusses migraines and how it affects those individuals that suffer from this condition. A Migraine is described as a headache with body-wide effects that affects those who suffer from the attacks unable to tolerate light, noise, smells or touch. These attacks interfere with the sufferer’s ability to work, interact with others, and perform daily tasks. There are many medications that treat and prevent migraines ranging from wearable nerve stimulating devices that can be activated by your smartphone to biologic drugs, monoclonal antibodies, that can be given once a month or once every three months. CLICK ON THE LINK TO READ THIS ARTICLE AND LEARN ABOUT VARIOUS OTHER MEDICATIONS THAT TREAT MIGRAINES!


The U.S. Food and Drug Administration just approved Ubrelvy (ubrogepant) tablets for the acute (immediate) treatment of migraine with or without aura (a sensory phenomenon or visual disturbance) in adults. Ubrelvy is not indicated for the preventive treatment of migraine. It is the first drug in the class of oral calcitonin gene-related peptide receptor antagonists approved for the acute treatment of migraine.


Yoga is a mind-body practice based ancient Indian philosophical tradition involving physical and mental techniques including exercise, stretching, and relaxation.

One 2014 study, showed that yoga led to a significant reduction in frequency and intensity of migraines. It is thought that it enhances tone of the vagus nerve and decreases overstimulation of the nervous system. A 2015 study, showed the same results with also reports of decrease anxiety and depression among those participants practicing yoga.

For people who suffer from headaches, restorative yoga is recommended. Hot yoga may cause dehydration which may trigger migraines. Additionally, one must be aware of limitations and modify certain poses if necessary to minimize injury. For example, it is best to avoid positions that put increased pressure on the neck including bridging and headstands.

To learn more about yoga for headaches and migraines, talk to your healthcare provider.

Brooke Steiger, NP

Infusion Therapy for Migraines

IV treatments provide fast relief and long term relief up to a month from the pain, nausea and inflammation associated with migraine and headaches. IV infusion treatments include fluids, supplements and medications that target the cascade reaction in the body resulting in migraines and headaches.The infusion of fluids is extremely beneficial with the associated symptom of nausea that commonly occurs with migraine and headache disorders. Nausea can lead to poor oral intake and at times vomiting, resulting in fluid loss. Dehydration worsens migraine and headaches, thus making them harder to treat.
Magnesium is a common supplement that is added to the fluid infusion. Studies show that magnesium can help prevent headaches and that the magnesium levels in a person’s brain may be low during a migraine. Toradol (Ketorolac) is nonsteroidal anti-inflammatory drugs (NSAIDs) that is added during the infusion to help reduce pain and inflammation. Zofran (Ondansetron) or Reglan (Metoclopramide) are both anti-nausea medications that are also added to the infusion, thus helping with associated nausea and vomiting.
In addition to the types of medications offered, IV infusion is the fastest route for absorption in comparison to taking medications orally or in injection form. Drugs delivered through the intravenous route circulate directly to the brain, within 20 to 40 seconds. IV route also has the greatest level of absorption, medications given through IV route have 100% bioavailability. IV route bypasses absorption barriers and first-pass metabolism (the phenomenon of drug metabolism whereby the concentration of a drug, specifically when administered orally, is greatly reduced before it reaches the systemic circulation).

Caroline Pruski, NP

Is Lyme Disease Causing Your Headache?

Lyme disease is caused by the bacterium Borrelia burgdorferi, which is transmitted through the bite of an infected tick. The hallmark sign of Lyme is erythema migrans, also known as the “bull’s eye” rash. This rash has the appearance of a red ring with a clear center. However, not everyone develops this rash, which makes Lyme disease hard to diagnose. Lyme is considered a “Great Imitator” because the features of the disease can result in such nonspecific symptoms and may be confused with a number of other diseases.
Initially symptoms of Lyme disease consist of flu-like symptoms such as fever, chills, swollen lymph nodes, headaches, fatigue, muscle aches, and joint pain. In later stages of Lyme disease, you start to see neurological symptoms such as severe headaches, difficulty with memory, pain, numbness and tingling, facial weakness, visual disturbances, tinnitus, hearing loss, stiff neck, irritability, anxiety, depression, mood swings and sleep disturbances.
Lyme disease is treated with antibiotics under the supervision of a physician. Most individuals with Lyme disease respond well to antibiotics and have full recovery.

Caroline Pruski, NP

LASMIDITAN: New Acute migraine treatment

Lasmiditan is an oral medication for treatment of acute migraines. It is the first of its class of serotonin (5-HT)1F receptor agonists meaning that it acts on the chemical in our body called serotonin.

Two studies of lasmiditan found that patients had higher levels of pain relief compared to placebo after taking the medication and relief of migraine-associated symptoms 2 hours after taking it. There also may be particular benefit for patients who have nighttime migraines that interfere with sleep.

For more information about this medication call The Manhattan Center for Headache & Neurology. We look forward to meeting you!

Brooke Steiger, NP

Stress and Migraines

Stress can cause migraines, migraines can become a form of chronic pain and chronic pain creates more stress. It is an endless cycle that can seem impossible to avoid. Additionally, if your body is accustomed to constant stress, a weekend off can result in a “let down” migraine when your stress levels abruptly lowers. The migraine brain is vulnerable to change and fluctuations in stress, thus managing stress can be a significant aspect in controlling migraines.
Tips on how to manage stress:
Prioritize – Remember what’s most important when planning your week. Consider what is more time sensitive or urgent.
Protect your time – Schedule what is important and learn to say no to events or tasks that are not important to you or could cause more stress.
Make time for relationships – Studies show that by increasing personal interaction and prioritizing the things that make you happy, stress will instantly be minimized.
Make time for yourself – Many times we are too focused on doing things for others that we forget to take time to focus and work on ourselves. Pamper yourself from time to time.
Communicate your wants and needs – If you communicate your wants and needs properly, everyone around you will be on the same page making managing certain tasks and stress easier.
Better sleep – Proper sleep hygiene is key. Sleep hygiene includes daily exercise, avoiding food before bed, waking up and going to sleep around the same time on a daily basis, keeping the bed separate (no eating, catching up on work in bed) and avoiding screens prior to sleep. Recent studies display that approximately 85% of migraine sufferers report clinically significant poor sleep quality.

by Caroline Pruski, NP


Exercise and migraine

Many people with headache and migraine avoid exercise to keep migraines from coming.

Research has shown that women who intentionally avoid physical activity actually have twice as many migraine attacks as women who do not avoid physical activity.

Some scientific studies have shown that physical activity actually reduces the frequency and severity of migraine. It is thought that it may be helpful because exercise reduces stress and helps with sleep. Additionally, it releases endorphins which are the body’s natural pain killers. For this reason, it is important for people with migraines to get regular exercise 2 to 3 times per week.

For more information on the type of exercise that is right for you, speak to your health care provider.

By: Brooke Steiger, NP