Nausea is a common complaint in people who suffer from migraine. Nausea is part of the diagnostic criteria for migraine, and various studies have found the prevalence of nausea to be anywhere from 65-90% of migraine patients. Many of these patients will have vomiting as a result.
The good news is there are very effective methods of treating nausea and prevent it from turning to vomiting. Zofran is an antiemetic medication that is often prescribed for nausea. One formulation of Zofran is as a dissolvable tablet, making it easy to take and it can start to work in the first 30 minutes. Talk to your provider if you are interested in this medication.
Nausea can also be managed non-pharmacologically. Ginger is one such method that can be effective in treating nausea. It is available in many different forms – with tea being a popular and easy to find option.

Sana Marzouq, DNP

Lete, I., & Allué, J. (2016). The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. Integrative medicine insights, 11, 11–17. https://doi.org/10.4137/IMI.S36273
Min, Y. W., Lee, J. H., Min, B. H., Lee, J. H., Kim, J. J., Chung, C. S., & Rhee, P. L. (2013). Clinical Predictors for Migraine in Patients Presenting With Nausea and/or Vomiting. Journal of neurogastroenterology and motility, 19(4), 516–520. https://doi.org/10.5056/jnm.2013.19.4.516

Photophobia is a common symptom associated with Migraine. More than 80% of migraine attacks are associated with and exacerbated by light sensitivity. Research by Harvard researcher Dr. Rami Burstein on the neurobiology of photophobia led to the discovery of pain modulating effects of green light. Of all light to which migraine sufferers are exposed, green light at 525 nanometer wavelength worsens migraine significantly less than all other colors of light. Green light can actually reduce pain by about 20%.

The connection between photophobia and migraine is because the same thalamic trigeminovascular neurons that relay nociceptive pain signals from the dura to the cortex during migraine are the same bundle of neurons that transmits information about light from the eye to the brain.

This discovery will hopefully lead to an effective non pharmacological option to help decrease the disability associated with migraines. Current limitations are the high cost of light bulbs that emit this specific narrow band of green light wavelength. Dr. Burstein is working on developing an affordable light bulb as well as sunglasses that block out all light except for the narrow band of pure green light.

Burstein R, Noseda R, Fulton AB. Neurobiology of Photophobia. J Neuroophthalmol. 2019 Mar;39(1):94-102. doi: 10.1097/WNO.0000000000000766. PMID: 30762717; PMCID: PMC6383812.

Martin LF, Patwardhan AM, Jain SV, Salloum MM, Freeman J, Khanna R, Gannala P, Goel V, Jones-MacFarland FN, Killgore WD, Porreca F, Ibrahim MM. Evaluation of green light exposure on headache frequency and quality of life in migraine patients: A preliminary one-way cross-over clinical trial. Cephalalgia. 2021 Feb;41(2):135-147. doi: 10.1177/0333102420956711. Epub 2020 Sep 9. PMID: 32903062; PMCID: PMC8034831.

By: Andrew Chan, PA

Many people who suffer from migraines also have relatives who have them as well. There is an increased chance of developing migraines if you have them in your family history. There are specific genetic variants, or genetic mutations, which are inherited from your parents that lead to migraines. A person with one parent who has migraines has a 50% chance of inheriting the migraine trait. If both parents have migraines, there is a 75% chance that the person will inherit migraines. Genetics are thought to account for about 60% of the cause of migraines with environmental factors also being an influence. A study in 2018 found that there are 40 gene locations where mutations are related to migraine development. There are also certain migraine traits that are linked to family history of migraines, including increased frequency of migraines, migraines starting in childhood, migraines with aura, and migraines requiring medication over a long period of time.

In addition, there are also certain types of migraine that are genetically linked including familial hemiplegic migraine.
If you have questions about migraines and genetics, speak with one our caring providers at The Manhattan Center for Headache & Neurology.

By: Booke Steiger, FNP

Primary exertional headache occurs with exertional efforts. For example, during physical exercise, weight lifting, straining or bending over. While cough and exertional headache are often linked as “Valsalva Maneuver Headache” they remain distinct in entities per ICHD-II classification. The headache is sudden onset and often bilateral in location, the pain is often pulsatile and of longer duration, lasting from 5 min up to 48 hours
Neuro imaging is needed to rule out underlying structural abnormalities. In addition, blood work and other neurologic testing may be ordered i.e. ( EEGs or Trans Doppler ultrasounds) for evaluation.
The Manhattan Center for Headache and Neurology has exceptional providers to help diagnose and potentially treat this syndrome.

By: Jordan Shankle, PA

QULIPTA 60MG FOR CHRONIC MIGRAINE
The U.S. Food and Drug Administration (FDA) has approved expanding the indication of Qulipta (atogepant) for the preventive treatment of migraine in adults. The approval makes Qulipta the first and only oral calcitonin gene-related peptide (CGRP) receptor antagonist approved to prevent episodic AND chronic migraine. People living with chronic migraine experience headaches for 15 or more days per month, with at least eight of those days associated with migraine.
CGRP and its receptors are expressed in regions of the nervous system associated with migraine pathophysiology, and studies have shown that CGRP levels are elevated during migraine attacks. Qulipta blocks CGRP through a once-daily dose and is available in three strengths for the preventive treatment of episodic migraine – 10 mg, 30 mg and 60 mg. Only the 60 mg dose of Qulipta is approved for the preventive treatment of chronic migraine.
The most common side effects of Qulipta are nausea, constipation, and fatigue/sleepiness. These are not all the possible side effects of Qulipta. If you have migraines, please make an appointment to discuss this and other possible treatments with a MCHN provider.
–Alice Wong, NP
https://news.abbvie.com/news/press-releases/us-fda-approves-qulipta-atogepant-for-adults-with-chronic-migraine.htm

Cognitive issues and Migraine

Some patients with migraine experience various cognitive-related issues before, during, or after a migraine. The frequency may increase as the frequency of headaches increases. These symptoms are not uncommon and are temporary and harmless.

These may include difficulty with word finding (aphasia), brain fog, or memory loss.

Some patients report feeling exhausted with brain fog before a migraine, or in the prodromal period, or after a migraine or in the post-dromal period.

Some research suggests that migraines may cause temporary difficulty with cognitive functioning which may lead to attentional deficits, memory impairment, verbal impairment, and brain fog.

Often, if the migraines are treated, the cognitive issues that accompany the migraines resolve.

There are other medical or psychological causes of cognitive issues.

If you feel you’re having cognitive difficulties related to migraines, speak with your provider.

By: Brooke Masilak, FNP

Our brain is an essential organ in the body. The brain controls movement, breathing, memory, recall – thinking and speaking. Therefore it is imperative to understand and implement brain health within your lifestyle.
Here are a few tips for cognitive health:
1. Maintain a healthy diet:
A diet rich in vegetables, whole grails, fruits, Omega – 3 Fatty acid and vitamins. One of the more healthier diet options is the Mediterranean diet which limits sodium and surgery foods.
2. Create a mentally active routine:
We highly encourage stimulating your brain with frequent reading, doing crossword puzzles, playing sudoku or putting together puzzles. Learning new skills and critical thinking helps keep your brain active and reduce risk of cognitive impairment.
3. Physical activity:
Not only does exercise help the cardiovascular system, it also increases blood flow to the brain and reduces further risk for a decline in brain health. A moderate amount of physical activity ie 30 – 60 min, 2-3xs per week is ideal. Ideas for physical activity include swimming, running, weight lifting, or playing sports.
4. Adequate amount of sleep:
Adequate sleep helps your brain reset and refuel! While you are asleep your brain is able to rest and repair itself which improves cognitive function. It is essential to get 7-8 hrs of consecutive, unfragmented sleep.
5. Limit use of alcohol, stop smoking!
Excessive use of tobacco and alcohol have been linked to increased medical problems including cardiovascular issues, liver problems and neuropathy. These comorbidities have been shown to increase risk for cognitive problems as you age.
6. Prioritize Your Mental Health:
Anxiety and depression has been linked to increased risk of developing cognitive problems. Therefore prioritizing your mental health will carry over to help maintain healthy cognitive function. Be sure to stay social with family and friends!
By: Jordan Shankle, PA