Category Archives: Uncategorized


Acephalgic Migraine

Migraine without head pain. Also called “Silent migraine”.  This type of migraine can be very alarming as you experience dizzying aura and other visual aura. It is characterized by debilitating symptoms, including upset stomach, dizziness and  visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain. The causes, risk factor, and treatment for all migraines are similar, regardless of whether or not they are silent migraines.


Prodrome phase: Depression, difficulty concentrating, fatigue, food craving, irritability, Sleep disturbance.

Nausea, sensitivity to light and sound.

Acute phase:  People with silent migraine only experience aura symptoms.

Numbness & tingling in part of body

Temporary loss of sight

visual disturbances (appearance of pattern, flashing lights, blind spots)

Diagnosis are determined by blood tests, MRI or CT scan, EEG tests


  • Pain relievers: OTC or Prescriptions
  • Preventative drugs:  Beta blocker, CCBs, antidepressants, anti-seizure meds.
  • Home Remedies: getting enough sleep, dark room, quiet room, ice pack on back of neck, keeping a diary.
  • CGRPs, SPGs, IV therapy, Cefely, Gammacore

By: Rajni Bala, NP, RN


Allergy Season &  Migraine Headaches

Spring is the start of allergy season. This may be a migraine trigger for those who suffer from this condition. Your symptoms may be much more intense during allergy season. Remember, weather is a migraine trigger just like scents and food.  

Migraines and weather triggers that occur during allergy season have a link that is complicated to understand.. The endocrine system, the immune system and the nervous system work together, which contributes to creating that painful migraine. If you get migraines, you have a sensitive nervous system. When there are changes in the environment, people that suffer from migraines, react to to those changes in the environment viewing it is a harmful.  The immune system releases chemicals when exposed to allergens. This may cause inflammation which may trigger your headache.

Contact The Manhattan Center For Headache & Neurology to learn more about migraines triggered by allergies and how to treat them.

Headaches and hormones

The hormones estrogen and progesterone  play key roles in regulating the menstrual cycle and pregnancy and may also affect headache-related chemicals in the brain. Having steady estrogen levels may improve headaches, while experiencing estrogen levels that dip or change can make headaches worse. During menstruation the drop in estrogen just before your period may contribute to headaches. Many women with migraines report headaches before or during menstruation.

Treating menstrual migraines

  • Ice  Hold a cold cloth or an ice pack to the painful area on your head or neck.
  • Relaxation exercises. Try relaxation exercises to lower stress.
  • Biofeedback. Biofeedback may improve your headaches by helping you monitor how your body responds to stress.
  • Acupuncture. Acupuncture may improve your headaches and help you relax.
  • Over-the-counter pain relievers.  Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve) or ibuprofen (Advil, Motrin IB, others).
  • Triptans. Triptans often relieve pain from your headache within two hours and help control vomiting.

Preventive treatment

If your menstrual cycle is regular, it may be most effective to take preventive headache medication starting a few days before your period and continuing through up to two weeks after the start of your period. Preventative  medications may include beta blockers, anticonvulsants, calcium channel blockers, antidepressants or magnesium. Your doctor might also consider monthly injections of a calcitonin gene-related peptide (CGRP) monoclonal antibody to help prevent your headaches, especially if other medications aren’t effective.  Making lifestyle changes, such as reducing stress, not skipping meals and exercising regularly, also may help reduce the frequency, length and severity of migraines. Using hormonal contraception to prevent menstrual-related migraines may be appropriate for women who haven’t been helped by other methods.

By: Rajni Bala, NP


Exertional headache is also called activity-related headache. They are brought on by strenuous physical exercise and can be triggered by: running, jumping, weight lifting, sexual intercourse, bouts of coughing or sneezing

Causes: Increased blood pressure in the blood vessels of brain which is called venous pressure, poor diet, low blood sugar, heat & humidity,high altitudes exercises/activities

Symptoms: Headache usually pops up at the height of exercise and typically fades when the exercise stops, throbbing pain felt throughout the head and are more common in those with a family history of migraine, nausea & vomiting, sensitivity to light & noise.

These headaches are usually very short-lived but can sometimes last up to 2 days.

Treatment: Most attacks can be treated with OTC painkillers. Taking a nonsteroidal anti-inflammatory drug (NSAID) or a beta-blocker before exertion can help prevent the headaches, as can warm-up exercises. Hydration (8 glasses water) when exercising outdoor in hot & humid weather

Reference :

By: Rajni Bala NP


It’s the time of year for drinking green beer

St. Patty’s Day is officially here

But headaches await, if you read this too late

So look through these hints and face the day with no fear!

Many migraineurs already know that alcohol can trigger a headache.  Migraine sufferers are less likely to drink alcohol, studies have shown.  For some people, wine is the main culprit, but other forms of alcohol can trigger, including beer and liquor.  In fact, some studies suggest that alcohol in these other forms is just as often or more often a trigger. Several studies have looked at various ingredients in wine that may be acting as triggers, including tannins, tyramines, histamines and sulfites, but none of these has consistently panned out.

There are 2 main types of migraine triggered by alcohol, acute migraine occurs within 2-3 hours of drinking alcohol, and a second delayed type, which occurs the next day.  Often referred to as a hangover, the delayed type headache is usually much worse in a migraine sufferer than a non-migraine sufferer.

When people drink alcohol, they may get dehydrated, which can possibly lower the threshold for a headache, and if you drink alcohol and skip dinner or eat unhealthier foods while out at that party, these dietary issues may also be the culprit.  

It is likely that a combination of factors surrounding alcohol intake contribute to headaches.  So, before you partake, read through these tips.

  1. Drink plenty of water in between alcoholic beverages
  2. Limit your drinking to 1 or 2 drinks
  3. Eat with your beverage, something healthy
  4. Avoid sugary, and sugary drinks
  5. Before you go out, have a snack, so you don’t go too long without eating
  6. get a good night’s sleep

You should talk to your doctor about how drinking alcohol might affect you, and your headaches.  Review with your doc what treatments are available to you to remedy this type of headache. If dehydrated and nauseous, sometimes IV treatments can help a lot, too.\

By:  Audrey Halpern, MD, BC in Headache Medicine

What Is Neurostimulation For Migraines?

It may sound counter-intuitive… why would I want to stimulate my nervous system if I am having a migraine or suffer from migraines?  Well, headache specialists are not crazy. Stimulation of the nerve can actually cause the brain to settle down, and remain calm.

The migraine brain is a very sensitive brain, and we look for ways to help the brain to stay calm and be less sensitive.  Neurostimulators may actually “stimulate” the areas of your brain that send the calming messages to the rest of the brain or nerves.

There are many different neurostimulators either on the market or currently being researched.  There are devices to stimulate the supraorbital nerve (sits right at your eyebrow), the occipital nerve (back of the head), the SPG or sphenopalatine ganglion (right behind your nose/cheek), and even the vagus nerve in the neck.

Some of the neurostimulators are just applied to the skin and used to get rid of a headache, and others are surgically implanted devices for more intractable and chronic headache disorders.  These devices can be used alone or in combination with other treatments to relieve headaches of various sorts.

By: Audrey Halpern, MD, BC


What is Emgality?

A new kind of drug

Emgality belongs to a new class of drugs called calcitonin gene-related peptide (CGRP) antagonists. CGRP antagonists were designed specifically to prevent migraines. Emgality is a brand-name prescription medication that’s used to prevent migraines in adults. It comes as a prefilled pen or syringe that you use to give yourself a monthly injection.

Emgality can be used to prevent both chronic and episodic migraines. In clinical studies of people with chronic migraines, 28 percent of people who took Emgality for 3 months cut in half their number of migraine days per month. In clinical studies of people with episodic migraines, about 60 percent of people who took Emgality for 6 months cut in half their number of migraine days per month.

Emgality may be an especially effective option for people who’ve been unable to reduce their number of migraine days enough with other therapies. It may also be a good option for people who can’t take other medications to prevent migraines because of drug interactions or difficult side effects.

Side Effects  The most common side effects of Emgality are injection site reactions. This can include the following effects at the site where you inject the drug






Long-term side effects: Emgality is a recently approved medication in a new class of drugs. As a result, there’s very little long-term research on Emgality’s safety. The longest clinical study of Emgality lasted one year, and people in the study did not report any serious side effects caused by Emgality.

Injection site reaction was the most common side effect reported in the year-long study. Other side effects reported included:

respiratory tract infection

back pain

sore throat

sinus infection

Call The Manhattan Center For Headache & Neurology to find out if you are a candidate for Emgality. Learn about the Emgality copay card!

By: Rajni Bala, NP



GammaCore: Device for Headache Treatment


The vagus nerve stimulation device was first approved by the FDA in April 2017 for the acute treatment of episodic cluster headaches.  January 2018, announcement of the new Migraine treatment marks gammaCore’s first approval for Migraine.

  •         gammaCore® (nVNS) is a non-invasive, hand-held medical device that treats the acute pain of a cluster headache attack or a Migraine attack by stimulating the vagus nerve.
  •         The device is held to the neck and mild electrical currents pass through the skin to stimulate the fibers of the vagus nerve, a large nerve system that connects the gut to the brain . gammaCore passed the test in clinical studies as a new Migraine treatment, showing a significant reduction in acute Migraine or cluster headache pain after use of the device.

·         gammaCore is the third neuromodulation device approved by the FDA for acute Migraine treatment. Cefaly ACUTE was approved for acute use in September 2017.  Meanwhile, eNeura’s TMS unit was approved for acute use in December 2013. While each device operates differently, they all offer patients the option of aborting a migraine attack without drugs, and minimal side effects.

Call The Manhattan Center For Headache & Neurology to find out more about this device! We look forward to seeing you!

By: Rajni Bala, NP

Primary Headache Associated with Sexual Activity

This headache disorder is rare. It is previously known as pre-orgasmic (appears during sex and increases during mounting excitement) or orgasmic headache (sudden explosive headache followed by severe throbbing immediately before at the point of orgasm). It is considered a primary headache because there is no other underlying cause.

This headache is usually bilateral and often located to occipital areas. Severe headache due to sexual activity can lasts anywhere from 1 minute to 24 hours. Milder headache can last up to 3 days. This headache may have migrainous features and should be differentiated from a migraine triggered by sexual activity. Can occur in anyone who is sexually activity regardless of age. More common among men than women.

People with new onset headache associated with sexual activity or if never evaluated for this headache should consider seeing a doctor to r/o underlying causes. Imaging studies may be ordered to rule out serious conditions such as subarachnoid hemorrhage, arterial dissection and reversible cerebral vasoconstriction syndrome.

Medications are available for headache associated with sexual activity, and should usually be prescribed after all imaging studies are completed.

American Migraine Foundation (2019)

Tanesha Reynolds, DNP, FNP-BC, Certified in Headache Medicine