Category Archives: Uncategorized


“When the crowded Vietnamese refugee boats met with storms or pirates, if everyone panicked all would be lost. But if even one person on the boat remained calm and centered, it was enough. It showed the way for everyone to survive.”

— Thich Nhat Hanh, Buddhist monk

We live in troubling times. Using mindfulness and other meditative techniques to find balance can help us regulate our emotions, and perhaps also allow us to pay attention and care for those around us. Starting in 2005, Harvard neuroscientist Sara Lazar began to publish findings that meditation can change the structure of your brain. By 2014, follow-up studies showed that meditators’ brains tend to be enlarged in multiple regions, including the insula (involved in emotional self-awareness), parts of the cingulate cortex and orbitofrontal cortex (involved in self-regulation), and parts of the prefrontal cortex (involved in attention). Studies also indicated that meditation can change your neural circuitry in ways that make you more compassionate, as well as more inclined to see things from another perspective.

There are so many meditation online courses, apps and podcasts available now. One of my favorite podcasts to listen to is by Tara Brach, an American psychologist and a widely respected teacher of Buddhist meditation. Her teaching blends Western psychology and Eastern spiritual practices, mindful attention to our inner life, and a full, compassionate engagement with our world. Take care and be well.

–Alice Wong, NP


Nervus Intermedius Neuralgia

Nervus intermedius neuralgia is a very rare disorder characterized by brief paroxysms of pain felt deeply in the auditory canal. Middle-aged females are predominantly affected.

Clinical Manifestations:

brief (usually lasting seconds, rarely minutes)

severe paroxysmal pain

felt within the depths of the ear

Sometimes associated with a trigger-zone in the posterior wall of the ear canal.

Altered taste perception, such as a sense of bitter taste, can occur in some individuals, as can disorders of lacrimation or salivation

It is necessary to rule out other neurologic, otolaryngologic, and infectious causes of ear pain in cases of suspected nervus intermedius neuralgia. 

A detailed history, a physical examination, blood work and possibility of neuro imaging is needed to diagnosis and/or treat Nervus Intermedius Neuralgia.

By: Jordan Shankle, PA


Also known as ocular migraine, ophthalmic migraine is a type of migraine used to describe migraine with characteristics including visual symptoms such as visual floaters, blind spots in the field of vision, and transient loss of vision. This may occur either with or without head pain.

Another similar type of migraine is a retinal migraine. This type is characterized by symptoms that affect only one eye versus both eyes in ophthalmic/ocular migraine and is considered less common. If you are experiencing these symptoms, is it important to contact your provider for further guidance and evaluation.

Call The Manhattan Center for Headache & Neurology for more information about ophthalmic migraines.

By: Brooke Steiger, NP


The NexWave from Zynez Medical is a multiple-mode stimulator with three modalities–transcutaneous electrical nerve stimulation (TENS), interferential current (IFC), and neuromuscular electrical stimulation (NMES)–to help patients manage pain.

• TENS is the process of administering voltages or electrical stimulation to superficial nerves for the purpose of pain relief.

• IFC takes advantage of low frequency instead of superficial nerve stimulation, and it is known for its deeper penetration. IFC works like a TENS unit but can yield better results from a more intense effect. 

• NMES is the use of electrical current to stimulate muscle contractions. It mimics the stimulating action of the central nervous system. 

All three modalities use electrical stimuli or impulses to deliver their impact within the body. These three treatments have been used for over 30 years for pain management. The NexWave is a portable device offering the choice of three treatments for home use, delivering impulses from electrodes (adhesive pads with wire attached). It cannot be used with pacemakers, pregnancy, or heart conditions. Please discuss with your provider at The Manhattan Center to see if the NexWave device can help you better manage your pain.

–Alice Wong, NP 

June is Migraine and headache awareness month

June is National Migraine and Headache awareness month.
Every year during the month of June, the AMF provides a platform for education and patient advocacy.

This year’s theme for the American Migraine Foundation’s Migraine Headache Awareness month is “Advocate for Treatment Access”. This theme centers around barriers to treatments like medications, including step therapy. This is a method used by insurance company health plans to reduce costs by forcing patients to choose a cheaper option before gaining access to a more expensive, newer treatment.

Throughout the entire month, there are days dedicated to different topics regarding migraine awareness and education. There will be opportunities for discussion on social media platforms such as Twitter, Instagram, and Facebook.

There will also be a ‘Migraine the State of the Union’ webinar led by migraine specialist and chair of the Board of Directors of AMF, Dr. Larry Newman.

For more information about Migraine and Headache Awareness visit

By: Brooke Steiger, NP


Extensive evidence-based studies and trials have been completed to support the role in botulinum toxin-based medications, helping to alleviate and prevent migraine attacks. Evidence suggests that these medications interfere with the pathway of pain transmission between the central nervous system and the peripheral nervous system.
A migraine attack can be described as a multifactorial neuronal dysfunction which results in releasing substances called neurotransmitters and molecules associated with pain. Botulinum toxin interferes with the transmission of these substances, typically where the nerves and muscles meet. Moreover, injecting Botulinum into the muscles around the face, head and neck, it is taken up by the nerves and interferes with pain-associated neurotransmission.
Xeomin is a type of botulinum toxin type A, similar to Botox. However, it is incobotulinum type A, so it doesn’t have the binding proteins that stabilize the molecule, resulting in potentially fewer side effects.
Xeomin is indicated for chronic pain and spasticity, we often use Xeomin to treat Chronic Migraine as well. Contact The Manhattan Center for Headache and Neurology to learn more about Xeomin!

By: Jordan Shankle, PA


Status Migrainosus is a continuous debilitating migraine attack that lasts 72 hours or longer. It is an episode that is not responsive to your usual abortive medications and can cause loss of sleep and severe dehydration due to nausea and vomiting. Your provider will check for “red flag” symptoms such as vision changes, numbness, weakness, and changes in speech to rule out a more serious condition, such as a stroke. You may then be offered a combination of abortive treatments which can include the following, typically through IV or injections:
Non-steroidal anti-inflammatory drugs
Triptans or dihydroergotamine
IV Fluids
Anti-nausea medications
Nerve block
If you have a migraine episode that persists, please call for an evaluation and abortive treatment at the Manhattan Center for Headache and Neurology.

–Alice Wong, NP


A migraine is associated with many different accompanying symptoms including sensitivity to light and noise and nausea. Another very common symptom is sensitivity to odors, also known as osmophobia. In some cases, odors may even trigger migraine attacks. This may include but is not limited to perfumes, air fresheners, car exhaust, cleaning products, nail polish, and cigarette smoke.

For some people, olfactory hallucinations, or smelling odors that are not present, or part of their migraine pattern. This may include smells of something burning, metallic scent, or even rotten meat.

At times, it may be difficult to avoid these odor related triggers however there are a few things you can do to adapt. Be observant and aware of your environment – if you notice strong scents do what you can to modify the environment such as opening a window or step outside. Also, be aware of your premonitory symptoms such as fatigue, neck pain, dizziness which may signal an impending migraine. By doing so, you can take the steps to avoid strong odors if possible or adjust your environment.

If you would like more information about migraine and osmophobia, speak with your healthcare provider.

By: Brooke Steiger, NP


New daily persistent headache (NDPH) is a type of chronic daily headache that typically does not subside or remit. NPDH can persist for many years and may be refractory to multiple treatment modalities. Triggering factors most identified with NDPH include increased life stressors, suppressed immunity, and/or post-operation.

The International Classification of Headache Disorders, 3rd edition (ICHD-3), published in 2018, describes NDPH as a persistent and continuous headache with a clearly remembered onset. The pain lacks characteristic features and may be migraine-like or tension type–like or have elements of both.

The following are the ICHD-3 diagnostic criteria for NDPH:
●(A) Persistent headache fulfilling criteria B and C
●(B) Distinct and clearly remembered onset, with pain becoming continuous and unremitting within 24 hours
●(C) Present for longer than three months
●(D) Not better accounted for by another ICHD-3 diagnosis

A detailed history in addition to a thorough physical examination is needed to diagnose and/or treat NDPH. Call The Manhattan Center for Headache & Neurology to set up an appointment with one of our caring providers.

By: Jordan Shankle, PA


Nonsteroidal antiinflammatory drugs, also called “NSAIDs,” are medicines that relieve pain and reduce inflammation. More than 20 different nonsteroidal antiinflammatory drugs (NSAIDs) are available commercially. You can buy many NSAIDs without a prescription, including aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). The choice of NSAID depends upon different factors and individual patients differ in their response to different NSAIDs. Diclofenac can be useful for joint pain and indomethacin is prescribed for certain types of headaches. Meloxicam has slow onset but longer effect and a more appropriate choice in some situations. IV ketorolac (Toradol) is usually a part of the abortive “migraine cocktail” we administer.

NSAIDs can help people who have conditions that cause ongoing pain, but NSAIDs can cause problems of their own, such as ulcers and bleeding. It is important to take the lowest dose you need for the shortest time, and discuss frequent use of NSAIDS with your medical provider. NSAIDs are avoided or used with caution, in older adults and patients (regardless of age) with existing or increased risk for cardiovascular, GI, or kidney disease.

–Alice Wong, NP