Category Archives: Uncategorized

CoQ10 & Migraine

Coenzyme Q10 (CoQ10) is an antioxidant that your body produces naturally. Your cells use CoQ10 for growth and maintenance. The body also uses CoQ10 as an antioxidant. Levels of CoQ10 in your body decrease as you age. 

Interest in coenzyme Q10 (CoQ10) for migraine treatment has been sparked by the potential role of mitochondrial dysfunction in migraine. In a small, randomized controlled trial of 42 patients with migraine, CoQ10 was effective for migraine prevention; significantly more patients treated with CoQ10 experienced a ≥50 percent reduction in attack frequency at three months than patients treated with placebo.  

If you are interested in supplementation with CoQ10, speak with your health care provider first. CoQ10 may change the way the body uses warfarin (a drug that prevents the blood from clotting) and insulin. There are also other evidence-based vitamins and minerals that may be recommended as part of your regimen. 

–Alice Wong, NP 

Migraines & Your Personal Life

Migraines can have a deep and far-reaching effect on an individual’s personal life including relationships.

According to a study in The Journal of Headache and Pain, 87% of survey respondents noted that migraines impacted their professional, social, and private lives. Eighty-five percent of participants reported experiencing negative consequences related to long-term migraines including depression and feelings of hopelessness.

Migraines impair an individual’s ability to function in their daily lives. They may have to “sit out” activities including social events, work, and childcare. This also may affect the quality of their relationships with their significant other including interfering with communication and physical intimacy. They may also interfere with a person’s ability to care for their children.

In addition, the anticipation of migraines may influence planning of activities. For example, the individual may avoid scheduling certain activities because they believe that they might trigger a migraine.

If migraines are interfering with your life, it is important to seek treatment from a medical provider. Additionally, to help with the burden of coping with having migraines it is recommended that individuals seek guidance from a mental health practitioner.

For more information on treating your migraines or to pursue mental health counseling, contact our office today.

By: Brooke Steiger, NP

Headache Attributed to Systemic Infection

Headache associated with infection. More often, these headaches are attributed to viral infections ie influenza or COVID 19. Occasionally, infections can be bacterial – originating in the sinuses or even the brain. The ICHD specifics headaches due to viral, bacterial and other systemic infection. This list of diagnostic criteria for headache attributed to systemic infection is listed below.
Headaches are usually on both sides (bilateral), constant and intensity gradually increases. Headaches can be aggravated by straining – and are often accompanied with nausea, green/ yellowish nasal drainage and/or fever. Headaches can develop into abscess, seen on neuroimaging. Immediate antibiotics should be given if suspected brain abscess.

By: Jordan Shankle, PA


Headache is among the most frequent symptoms persisting or newly developing after COVID-19 as part of the so-called long COVID syndrome. Long COVID headache can present in the form of worsening of a preexisting primary headache, or in the form of a new intermittent or daily headache starting during the acute infection or after a delay. It often presents together with other long COVID symptoms like fatigue, insomnia, and depression. Patients with a prior history of headache usually report a worsening of their headache. Interestingly, both tension-type-like and migraine-like headache features can also be seen in patients without a personal headache history or despite not having experienced headache in the acute infection phase. The World Health Organization provides useful advice for patients on self-management after COVID related illness to improve self-rehabilitation and recovery ( publications/m/item/support-for-rehabilitation-selfmanagement-after-covid-19-related-illness). The nonprofit Altea Long COVID Network Association, based in Zurich, is also a source of useful information ( The Altea platform includes evidence-based information and helpful tips to cope with and/or overcome symptoms; a directory that helps find health professionals specialized in post COVID-19 condition by location or by symptom; a blog where the latest news and updates about post COVID-19 condition are published. We at MCHN are continually monitoring for new information and guidelines for treatments for our patients. Please make an appointment with one of our providers to evaluate your headache.  

–Alice Wong, NP 

References: Tana, C., Bentivegna, E., Cho, SJ. et al. Long COVID headache. J Headache Pain 23, 93 (2022). 

Tracking Migraines

What is migraine tracking? It is the practice of recording information about your migraine attacks.

It is helpful to include several pieces of information including timing of attacks, severity of attacks, what medication or treatment was used to stop the attack, weather patterns, exercise habits, sleep habits, and accompanying symptoms. This information may help you to determine triggers for the attacks and what treatments to use in the future.

This information may be helpful in determining how to prepare or modify lifestyle in the future to help prevent episodes. For example, if you see that you have had multiple migraine attacks after several nights of disrupted sleep, you may use this information to work on sleep hygiene. Do you see that eating certain food tends to lead to migraine episodes, you may choose to avoid eating those foods.

You may use an old-fashioned notebook or download an app on your cell phone or device.

If you have any additional questions about tracking your headaches, speak with your healthcare provider.

By: Brooke Steiger, NP

Giant cell Arteritis (GCA)

Giant cell Arteritis (GCA), also known as temporal arteritis, is the most common systemic vasculitides. It is described as inflammation of the cranial arteries, and is generally very painful. It involves the large and medium sized arteries and produces a wide spectrum of cranial manifestations.
GCA should be considered in a patient over the age of 50 with a new onset headache. Associated symptoms may include jaw pain, abrupt visual disturbances, night sweats, unexplained fever and joint pains.
Definitive diagnosis can be seen with positive biopsy.
Treatment with oral steroids is to be considered immediately to prevent potential sequela of blindness. Steroid can be initiated prior to a biopsy if GCA is suspected.
A detailed history, through physical examination and blood work is needed to diagnosis and/or treatment.

By: Jordan Shankle, PA

In Memoriam: Dr. Eric Cassell

On October 1, 2022, family, friends, and colleagues gathered in New York to celebrate the life and work of Dr. Eric Cassell, who died on September 24, 2021, at the age of 93. There was tears, joy, and inspiration as one after another dedicated professional in medicine, nursing, education, and research, from across generations and countries, spoke of how Dr. Cassell had influenced and supported their lives and work.
Dr. Cassell was a pioneer in patient-centered care who urged his fellow doctors to shift priorities beyond curing their patients’ diseases to caring for their overall well-being. The author of hundreds of articles and multiple books, Dr. Cassell devoted his career to helping providers understand how people experience illness and pain.
Among Dr. Cassell’s 11 books were “The Healer’s Art: A New Perspective on the Doctor-Patient Relationship” (1976; revised in 1985) and “The Nature of Suffering” (1991). In “The Nature of Healing: The Modern Practice of Medicine” (2013), Dr. Cassell argued that a key role of medicine should be to return patients to a sense of well-being, where well-being is based on achieving goals and purposes in life. He believed that listening to patients and determining how they define their own well-being was vital, and that “the spoken language is the most important tool in medicine.”
We are grateful for Dr. Cassell’s contributions to the practice of patient-centered care. We encourage you to make an appointment with one of our dedicated providers at MCHN to talk. Take care and be well.
–Alice Wong, NP


Riboflavin, also known as B2, is a B vitamin that is derived from food sources and used by our body for various functions including energy production. It is especially important in certain medical conditions including migraine and headache. Food sources of riboflavin include eggs, meats, milk and dairy products, fortified cereals, and green leafy vegetables.

Some studies have shown that taking a riboflavin supplement has been associated with a reduction in the number of migraine episodes per month.

The supplement is considered generally safe with the possible side effect of bright yellow urine.

If you are interested in supplementation with riboflavin or other natural supplements, speak with your health care provider first. There are other evidence-based vitamins and minerals that may be recommended as part of your regimen.

By: Brooke Steiger, NP


Untreated Sleep Apnea is often accompanied with headaches. These headaches occur in about 10 to 30 percent of patients diagnosed with Obstructive Sleep Apnea.
These headaches are usually described as squeezing, pressure-like sensations localized in the bifrontal (forehead) region. They are recurrent, happening at least 15 days per month or more. This headache subtype is not accompanied by typical migraine symptoms. For example, no associated nausea, vomiting, light or noise sensitivity. Typically, these headaches resolve within 30 minutes to an hour after waking up.
Symptoms of Sleep Apnea include excessive daytime sleepiness – snoring, coughing, or gasping during sleep, morning brain fog or nighttime restlessness.
According to ICHD -II diagnostic criteria, sleep apnea must be demonstrated on overnight sleep study and headaches must be resolved within 72 hours with no recurrence after effective treatment of sleep apnea.
A detailed history in addition to a thorough physical examination is needed to diagnose and/or treat these headaches.

To learn more about your migraines, contact The Manhattan Center for Headache & Neurology and speak to one of our caring providers!

By: Jordan Shankle, PA


Dizziness can originate from a problem in the nervous system (the inner ear, vestibulocochlear nerve, the brainstem, or the cerebellum) or from systemic causes. Dizziness can be neurological, but it can also be caused by cardiovascular disease, anemia, endocrine issues (i.e. hypoglycemia or thyroid disease), or medications affecting the nervous system. The practitioner can try to determine from a patient’s description whether the symptom can be categorized as one of the following:
Vertigo, a sensation of room spinning or tilting movement, is generally neurologic in origin
Light-headedness can be more cardiovascular in origin
Imbalance can be a gait disorder, which may be neurologic or orthopedic
Other/nonspecific dizziness can psychogenic

Other aids in diagnosis include a history of timing, triggers, and associated symptoms, and whether the dizziness is acute or chronic, continuous or episodic. Possible diagnosis can include stroke, vestibular neuritis, lesion (tumor, Chiari malformation), Meniere’s disease, vestibular migraine, transient ischemic attack, benign paroxysmal positional vertigo. Please call MCHN to make an appointment for a thorough evaluation with one of our caring providers.

–Alice Wong, NP

Berkowitz A.L.(Ed.), (2017). Clinical Neurology and Neuroanatomy: A Localization-Based Approach. McGraw Hill.