Category Archives: Uncategorized


Since the start of the pandemic, more people have been working from home and spending more time on the computer. In many cases this includes meetings that are conducted virtually and platforms such as Zoom or Outlook Teams.

For patients who suffer from migraines and headaches, this has been a particularly difficult time as many find that their headaches are triggered by “screentime” or extended computer use

For healthier “screentime” utilize the following tips:

-Practice good screen ergonomics. It is important to keep your monitor at eye-level, adjust the brightness of the screen, and make sure you are sitting 2 feet away from the screen.

-Think 20-20-20. Every 20 minutes make a habit of taking your eyes off the screen and focusing on an item 20 feet away for 20 seconds. This will help to prevent fatigue.

-Invest in a blue-blocking or anti-glare screen cover

-Take breaks. It is important to get up from your desk or workstation and move around every so often.

-Stick to a routine. It is important to continue healthy habits including healthy diet, exercise, and keeping hydrated. Try to avoid skipping meals and keep a water bottle on your desk.

If you still find you are having increased numbers of migraines or headaches speak with a healthcare provider for more treatment options.

By: Brooke Steiger, NP


Trudhesa (formally, INP 104) was first approved for acute treatment of migraine on September 2, 2021. Trudhesa uses nasal delivery of DHE (Dihydroergotamine mesylate), 0.725mg per spray. Dihydroergotamine mesylate is a well-established migraine treatment with more than 70 years of therapeutic use. Trudhesa, is advanced because it bypasses the gastrointestinal absorption to provides a quicker delivery of DHE into the bloodstream through vascular -rich upper nasal space. Trudhesa is not indicated for the preventive treatment of migraine or for the management of hemiplegic or basilar migraine. This approval provides another abortive option for a patient to add to their migraine toolbox. Please call The Manhattan Center for Headache & Neurology to speak with one of our caring providers about questions regarding this new advancement in acute migraine treatment!

Jordan Shankle, PA

Vitamins and Supplements
Deficiencies in vital nutrients from unhealthy diets; excessive alcohol, caffeine, or sugar intake; poor absorption; stress; or long-term intake of certain medications can contribute to headaches and other neurological conditions. Vitamins and mineral supplements that can help relieve migraines include the following:
–Magnesium: This mineral is essential to many cell and bodily functions from immunity and nerves, to bone and muscles. It prevents production of inflammatory chemicals and acts as a natural anticonvulsant and tranquilizer. Only 1% of the body’s magnesium is found in the serum, so testing for magnesium deficiency is not straightforward. It is common to be deficient in magnesium (up to half of migraine sufferers are deficient) and supplementation can be effective in the prevention of migraines. Whole grains, dark leafy vegetables, avocados, and legumes or supplementation of 400mg to 800mg daily of magnesium is recommended, but some people do not absorb magnesium well through diet or get diarrhea from taking oral pills. The Manhattan Center offers IV magnesium to relieve acute migraine attacks and for supplementation. Some people need a few infusions to achieve normal magnesium levels while a few may need monthly infusions.
–CoQ10: This nutrient is necessary for production of energy and is a common deficiency in migraine sufferers. It is an antioxidant that stimulates the immune system and protects the nerves. The body makes less CoQ10 as it ages and excess exercise can also affect levels negatively. Recommended dosage is 100mg a day.
–Vitamins B12: This vitamin plays a role in formation of red blood cells, production of neurotransmitters and energy, and lowers homocysteine levels. Symptoms of B12 deficiency include depression, dizziness, confusion, fatigue, irritability, and memory loss. Recommended
dosage is 400 to 1,000 mg daily, taken twice a day as part of a B-complex supplement. If you have a mutation of the gene MTHFR, it is necessary to take a methylated form of B12, methylcobalamin.
–Vitamin D: Deficiency in this vitamin is associated with a wide variety of diseases and conditions. While the normal range of vitamin D is from 30 to 100mg ng/ml, we recommend levels at least in the middle of this range. Take in the form of vitamin D3 with high-quality fats such as olive oil, flax seeds, or avocado for better absorption. Existing levels will direct the dose of supplementation necessary to achieve optimal levels a

Headaches During Pregnancy

For patients with a history of migraine, pregnancy can actually bring relief after the first trimester. Many women during their second and third trimesters notice a decrease in frequency of headaches if not complete resolution.

Those who continue to get headaches there are few treatments that are safe during pregnancy. Rescue treatments may include acetaminophen, SPG blocks with lidocaine, metoclopramide, and magnesium IV infusions. Most preventative medications for headache are contraindicated with pregnancy.

It is very important to speak with your doctor if you get headaches during pregnancy, especially in the 2nd and 3rd trimester, as they may be a sign of other medical issues including elevated blood pressure that may lead to preeclampsia.

Non-pharmacological treatments for headaches may include meditation, yoga, acupuncture, myofascial release massage, and use of essential oils. With clearance from your OB/GYN you may be able to use neuromodulation devices such as the Nerivio.

In general, it is very important to consult your OB/GYN and your headache specialist prior to taking any medication or treatments including over-the-counter medications during pregnancy. Also, when planning on conception it is important to speak with your provider well in advance of trying to get pregnant. You will need instructions on how to safely discontinue your preventative medication prior to attempting to conceive, in some cases up to 6 months prior.

For more information regarding headaches and pregnancy, call The Manhattan Center for Headache & Neurology and speak with one of our caring providers!

By: Brooke Steiger, NP

Reversible Cerebral Vasoconstriction Syndrome

Reversible cerebral vasoconstriction syndrome (RCVS) represents a medical condition in which reversible multifocal narrowing of the cerebral arteries occur and manifest in intense “thunderclap” headache; oftentimes associated with neurological deficits.
RCVS is usually abrupt in nature, causing very intense, sometimes excruciating pain, which peak within seconds. Unlike Subarachnoid hemorrhage, headaches associated with reversible cerebral vasoconstriction tend to reoccur over a span of days to weeks. Provoking factors include orgasm, physical exertion and acute stressful or emotional events. Valsalva maneuvers such as straining, coughing and sneezing may also trigger these types of headaches.
In addition, some patients may experience focal neurological deficits to include unilateral muscle weakness, tremor, ataxia and aphasia. Visual disturbances ( blurred vision, seeing double) may also be associated with RCVS.
All patients who present with one or more thunderclap headaches must be evaluated and treated as a medically emergency, beginning with an evaluation for potentially serious secondary causes.

By: Jordan Shankle, PA


Tom Zeller Jr., a former reporter, recently wrote an opinion piece for The New York Times. *
A headache sufferer himself, he describes his bouts of intense pain, and the clinical and cultural ignorance that persists around primary headaches. While Mr. Zeller is grateful for the recent advances in treatment with CGRP inhibitors, he discusses how funding for research into headache disorders remain incommensurate with their enormous social costs, and how far too few young doctors enter in this specialty.

“In a world troubled by all manner of disease and unrest, it can seem absurd to complain about headaches. But this, too, is what makes the path of a chronic headache sufferer . . . a uniquely lonely one. The pain won’t kill us, sure, but we can receive prolonged physical beatings, without explanation, at any moment . . . Ask any people who suffer from migraines or similar headaches about the months spent being dismissed or misdiagnosed by unenlightened doctors . . . They are in your family. Or you work with them. No, they won’t die. But they are very often experiencing inscrutable, exhausting bouts of pain — or living in fear that it’s just around the corner, again.”

At The Manhattan Center for Headache and Neurology, we understand. Come in for a consultation. We can help.

–Alice Wong, NP


Diagnostic Testing Spotlight: VNG

Our office offers a variety of tests to address a variety of symptoms.

A VNG, or videonystagmography test, is a test that assesses dizziness and difficulty with balance by measuring involuntary eye movements called nystagmus. By doing this testing, it may be determined whether the symptoms are related to disorders of areas responsible for balance within the brain or the vestibular system which is the balance system of the inner ear.

During the testing, goggles are used to record eye movements. The patient is shown a series of patterns and told to move head and body into certain positions which may induce these involuntary eye movements.

Based on the results of the testing, you may be recommended to have a special type of physical therapy called vestibular therapy or other treatments.

For more information about this test talk to one of our providers at The Manhattan Center for Headache & Neurology

Brooke Steiger, NP


Narcolepsy is a clinical syndrome, and it is one of the most common causes of disabling daytime sleepiness after obstructive sleep apnea.
There are four main clinical features of Narcolepsy to include the following:
1. Excessive daytime sleepiness. Patients with chronic sleepiness may be prone to fall asleep throughout the day, often at inappropriate times. Patients with severe narcolepsy may experience “sleep attacks”; in which they rapidly doze off with little to no warning.
2. Cataplexy, which is defined as emotionally triggered, transient muscle weakness. Most episodes are triggered by positive emotions, for example laughter and excitement. Although, episodes can be triggered by anger and grief.
3. Hypnagogic hallucinations are vivid, sometimes frightening visual, tactile, or auditory hallucinations that occur as the patient is falling asleep.
4. Sleep paralysis, which is defined as complete inability to move for one or two minutes immediately after awakening or just before falling asleep.
Other clinical features include psychiatric manifestations such as anxiety, depression and fragmented sleep.
Narcolepsy is diagnosed based on clinical assessment, specific laboratory studies to rule out electrolyte vs vitamin deficiency and sleep studies.
If you have experienced similar symptoms, please contact The Manhattan Center for Headache and Neurology for further evaluation and treatment options.

Jordan Shankle, PA


Vertigo is a type of dizziness that makes you feel like you are spinning, swaying, or tilting, or like the room is moving around you. These feelings come and go, and might last seconds, hours, or days.
The most common causes of vertigo include:
• Benign paroxysmal positional vertigo (BPPV) – extra calcium deposits form in the inner ear which can lead to episodes of vertigo when you move your head in certain ways.
• Meniere disease – This is a condition in which fluid builds up inside the inner ear.
• Vestibular neuritis – This is sometimes caused by a virus which can affect the inner ear or the nerve in the inner ear.
• Head injury – Even a minor head injury can cause inner ear damage and vertigo.
• Vestibular migraine – People who get migraines, which are a type of headache, can sometimes have episodes of vertigo. This can happen with or without a headache.
• Certain medicines
• Neurological problems, such as stroke or multiple sclerosis

If you have vertigo, please make an appointment for a physical exam and evaluation. You may need testing such as a VNG or MRI. Treatment will be targeted to the cause of the problem. In the meantime, reduce your risk of falling from vertigo: make your home as safe as possible (get rid of loose cords, clutter, and rugs), and make sure you wear non-slip shoes.

–Alice Wong, NP



As restrictions are being relaxed across the country, the Delta variant is quickly becoming the prevalent coronavirus strain. The Delta variant was first identified in India in December of 2020. As of early July, the Delta variant has been found in 96 countries. According to Yale Medicine, it is 50% more contagious than the original SARS-COV-2 virus.

This is very concerning for several reasons. In spite of plenty of vaccines available in the United States, many Americans still remain unvaccinated. The unvaccinated are highly susceptible to infection. When infected, they may become very ill, or even hospitalized, and continue to spread the infection.

Cases of breakthrough infections have been documented. Previously, breakthrough cases were believed to only occur in people who are older or with weakened immune systems. According to the Wall Street Journal, in a recent outbreak of COVID-19 in Israel, about half of the adults infected were fully inoculated with Pfizer vaccine. Last night, a major league baseball game Yankees v. Redsox was postponed due to 3 Yankees pitchers who had been vaccinated testing positive for the coronavirus.

So what can we do to protect ourselves?
First, and foremost, get vaccinated. If you have been vaccinated, continue wearing masks when indoors at gatherings or outdoors in large crowds. Continue to practice good hand hygiene by washing hands frequently and using hand sanitizer. Also, continue to practice social distancing. Keep in mind, not only are you protecting yourself, you are protecting others.

For more information about the Delta variant and COVID-19 please visit the CDC website at:

Enjoy your summer, but most importantly, stay safe!