Category Archives: Uncategorized

VESTIBULAR MIGRAINE


A common bothersome neurological symptom is dizziness and vertigo. A person may experience a sensation of spinning that may be associated with nausea.

When dizziness occurs before, after, or during a migraine, a person may be diagnosed with vestibular migraine.

Accompanying symptoms may include sensitivity to light and noise.
Triggers for vestibular migraines may be similar to migraine triggers and may include stress, lack of exercise, bright lights, and loud noises.

There are other disorders that are more common in people with vestibular migraines including motion sickness and anxiety. DIzziness and vertigo may also be the result of other underlying disorders so diagnostic testing including bloodwork and VNG may be indicated.

If you feel you are suffering from vestibular migraines, call The Manhattan Center for Headache and Neurology and speak with one of our caring healthcare providers.

Brooke Steiger NP

MIGRAINE ART

People have been using art to recreate their headache and migraine symptoms. Headache and migraine symptoms can be debilitating, thus inspiring very powerful and beautiful art pieces. A campaign called “Frames of Mind” was a collaboration between Allergan and the American Migraine Foundation. The campaign was created to help bring awareness to the debilitating effects of headaches and migraines. A part of this campaign was selecting and displaying some of these migraine inspired pieces of art. Take a look at some of the pieces selected.

Caroline Pruski, NP

CLUSTER HEADACHES

Cluster headaches are a form of headache that presents as stabbing pain around one eye or temple peaking within a few minutes of onset, typically lasting bout 15 minutes, often occurring the same time each day. These headaches, which are severe, and often referred to as “suicide headaches” and are short in duration, often occurring up to 8 times a day. Accompanying symptoms often include tearing, redness, swelling, or drooping of the eyelid on the affected side, or runny nose on the affected side.

They are associated with changes in the seasons, often around when you re-set your clock for daylight savings time. Experts believe that the disruption in sleep cycles due to changes in amount of sunlight from the longer or shorter days that lead to attacks. For this reason, patients may have cycles of headaches in Spring or Fall. Cluster headaches may also be mistaken for allergy-related symptoms due this timing.

Treatment for cluster headaches may involve a combination of pharmacological therapy and lifestyle changes. In particular, sticking to a strict sleep-wake schedule and avoiding alcohol may help prevent headaches or decrease severity of attacks.

If you think you are suffering from cluster headaches, call The Manhattan Center for Headache & Neurology to speak to one of our caring providers

EMG TESTING

Electromyography (EMG) is a form of testing that is used to study nerve and muscle function. EMG tests display the extent of nerve and/or muscle injury and can also determine the exact location of injury. EMG testing is used to help diagnose conditions such as carpal tunnel syndrome, pinched nerve, radiculopathy, sciatica, neuropathies, muscle diseases, muscular dystrophy, ALS (Lou Gehrig’s disease) and myasthenia gravis. Your physician will likely order an EMG test if you experience symptoms such as numbness, decreased sensation, tingling, “pins and needles” sensation, radiating pain, burning sensation, muscle spasms and muscle weakness.
EMG testing usually takes anywhere from 30 to 90 minutes, depending on the condition being tested and the findings of the study. After the study is completed the results are interpreted and a report is created summarizing the findings of the test.

There are two elements of EMG testing. The first portion of the test is to assess nerve conduction. The nerves are stimulated at different points with small electric shocks, artificially activating them so their function can be measured. The second portion of the test is a needle exam for muscle testing. During this portion of the test very fine needles are inserted into several muscles. Each needle has a microscopic electrode that picks up both the normal and abnormal electrical signals given off by a muscle.
EMG testing is offered at the Manhattan Center for Headache and Neurology. Schedule a appointment today if you are experiencing any symptoms that may indicate a need for this test.

Caroline Pruski, NP

MEDICATION OVERUSE HEADACHE

Providers use 2 different treatment strategies for treating migraines. The first treatment strategy is known as preventative therapy. This treatment’s purpose is to prevent migraines or headaches. The second strategy is called abortive therapy which is used to stop the migraine or headache at the time it is occurring.

Patient’s who are not getting good relief from their preventative therapy may use their abortive medication more frequently, often taking more doses than recommended. This creates a cycle of use that results in rebound headaches as the medication wears off.

Medication overuse headaches often occur daily or almost daily and often occur in the morning. These headaches are associated with the use of certain types of abortive medications including NSAIDS (aspirin, naproxen, ibuprofen), butalbital, combination over-the-counter analgesics (Excedrin Migraine) and triptans.

Call The Manhattan Center for Headache & Neurology, if you think you may be suffering from medication overuse headaches,

Brooke Steiger, NP

SUNCT and SUNA Headaches


Trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral trigeminal distribution pain with ipsilateral cranial autonomic features. Types of TACs include cluster headache, paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache attacks. There are two subtypes of short-lasting unilateral neuralgiform headache attacks: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA).
SUNCT and SUNA are both short-lasting, last 10 minutes or less. Both SUNCT and SUNA are unilateral or one sided. Both result in pain that feels “nerve like” or neuralgiform. Additional symptoms shared between the two headache conditions include conjunctival injection (redness of the eye) and tearing of the eye. Additionally, both SUNCT and SUNA are autonomic or involuntary.
The major difference between the two is that with SUNCT headaches, a patient will have both redness of the eyes and tearing of the eyes. With SUNA headaches, a patient will have either redness of the eyes or tearing of the eyes, but not both symptoms.
SUNCT and SUNA are often confused with primary stabbing headache or other TACs (cluster headache, paroxysmal hemicrania, hemicrania continua). What makes Primary Stabbing Headaches different is that they don’t involve the redness of the eyes, tears, nasal congestion, or runny nose. Cluster Headache attacks differ by lasting at least 15 minutes and can continue for up to three hours. Hemicrania Continua differ by lasting all day, with variable intensity. Paroxysmal Hemicrania attacks differ by lasting up to 30 minutes.
– Caroline Pruski, NP

EEG and Headaches

When discussing your headache symptoms with a provider, the provider will take into account your physical exam and discussion of symptoms and may choose to order diagnostic testing. Diagnostic testing is necessary to rule out concerning causes of your headache.

One diagnostic test used to that may be ordered is an EEG. An EEG is a test that assesses the electrical activity of your brain, or brain waves, specifically looking for abnormalities such as seizure-like signals. The test involves several electrodes that are placed on your head and send a signal to the EEG machine to record a graphical representation of what is going on in the brain. During the test, you will often be asked to perform certain activities such as deep breathing to stimulate certain areas of the brain. This often takes about 45 minutes to 1 hour.

The results are reviewed by a physician. If the EEG is deemed normal and there are still concerning symptoms, your provider may ask you to do an extended EEG called an ambulatory EEG over 72 hours. With this test, you come to the office for the EEG electrodes to be applied and then go home wearing them for the next several days. In this case, you will be asked to press a button to record brain activity each time you experience symptoms.

For more information about EEG and other diagnostic testing for migraine, call The Manhattan Center for Headache & Neurology and speak to one of our caring providers.

Brooke Steiger, NP

VNG Testing and Central vs Peripheral Vestibular Disfunction

The sensation of vertigo or dizziness can be the result of different disorders. The first steps a health care provider takes is to identify a possible cause of the patient’s dizziness. Specifically, if the dizziness the patient is reporting is coming from the peripheral vestibular system (the labyrinth of the inner ear, and the pathways/nerves connecting to the brainstem) or the central vestibular system (the brain and brainstem). Examples of central vestibular disorders include Migraine-Associated Dizziness (vestibular Migraine), Vertebrobasilar Ischemic Stroke and Vertebrobasilar Insufficiency. Examples peripheral vestibular disorders include: Meniere’s Syndrome, Benign Paroxysmal Positional Vertigo, Vestibular Neuronitis, Labyrinthitis, Vestibular Schwannoma, Perilymphatic Fistula, Superior Semicircular Canal Dehiscence Syndrome or Trauma.
Being able to find the vestibular system involved is key in helping the healthcare provider decide on further testing, determine the urgency of the symptoms, and develop treatment plans. This is done by having the patient completing a VNG test or Videonystagmography. VNG is a test that measures a type of involuntary eye movement called nystagmus that occurs when someone is dizzy. Nystagmus is the result of the brain getting conflicting messages from the eyes or the balance system in the ear. These movements can be slow or fast, steady or jerky. Certain movements are consistent with either a disorder of the peripheral or central vestibular system.
During a VNG test, the patient will sit in a dark room and wear special goggles. The goggles have a camera that records eye movements while the patient completes a variety of tasks with the technician. While wearing the goggles the patient will be asked to follow objects with their eyes that jump from place to place, standstill, or move smoothly. The technician will also gently move the patients head and body into various positions and blow cold and warm air in the inner ears. Overall the test is fairly quick and noninvasive. VNG testing is offered at the
Manhattan Center for Headache and Neurology and our staff is knowledgeable in diagnosing and treating different dizziness disorders.

Caroline Pruski, NP

INTRAVENOUS INFUSION FOR HEADACHE & MIGRAINE

Intravenous infusions are a controlled administration of medications or fluid through a catheter inserted into the vein in the arm.

Intravenous infusions may be administered monthly as preventative therapy or during a migraine to relieve acute symptoms. Usually, the duration of therapy is about 30 minutes to 1 hour and is done by a Nurse Practitioner or RN.

Medications administered in our clinic include magnesium, toradol, Reglan, and Benadryl. Fluids are also administered.

As with any invasive procedure, risks include bleeding and infection. Risks of these complications are low as the person administering the infusion takes care to put pressure on the site to make sure bleeding has stopped after removing the catheter and the area is sterilized thoroughly before the catheter is inserted.

Call and speak to one of our caring healthcare providers to discuss if this treatment is right for you.

By: Brooke Steiger, NP

BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. BPPV causes episodes of mild to intense dizziness. This dizziness is often described as if your surroundings are moving, a head spinning sensation, or loss of balance sensation. This sensation can accompanied by nausea and occasionally vomiting.
BPPV is generally triggered by positional changes in your head. For example, BPPV tends to occur when you lie down, when you lean back or forwards, or when you turn over or sit up in bed. The signs and symptoms of BPPV can come and go, with symptoms commonly lasting minutes at a time.
Often, there’s no known cause for BPPV. When the cause is unknown this is called idiopathic BPPV. When a cause can be determined, BPPV can be associated with head trauma, damage to your inner ear or migraines.
BPPV can be very uncomfortable, thus seeing a specialist like us at the Manhattan Center for Headache and Neurology can get you the proper treatments to manage your symptoms. It also important to rule out that your dizziness isn’t a sign of a more serious problem.
Caroline Pruski, NP