By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

Chronic migraine is more than “just a headache.” It is a complex neurological condition that can significantly impact work, relationships, and overall quality of life. Research also shows that many patients face barriers to diagnosis and treatment depending on their background or access to care.

A recent study called the COMPEL trial recently explored an important question: Do preventive migraine treatments work similarly for people from different racial and ethnic groups? [1]

Our Medical Director, Dr. Deena Kuruvilla, served as a study author in the post-hoc analysis of this phase-4 COMPEL trial and was recently interviewed by NeurologyLive ® to discuss the findings [2]. 

Here’s what the findings mean for patients.

Why This Research Matters:

Previous studies show differences in:

• Migraine symptoms and severity
• Access to care
• Treatment use
• Quality of life among patients with migraine

However, there has been limited data on whether preventive treatments work equally well across different populations. This study helps address that gap.

What Was Studied?

Researchers analyzed data from a large clinical trial that followed adults with chronic migraine for more than 2 years.

Participants received a preventive treatment called onabotulinumtoxinA every 12 weeks and researchers evaluated:

• Changes in monthly headache days
• Migraine-related disability
• Daily functioning and quality of life 
• Safety and side effects
• Treatment response across racial groups

The study included patients who identified as White, Asian, and Black/African American subgroups.

Key Findings for Patients:

Participants in every group experienced significant reductions in monthly headache days over time.

• Many patients cut their headache days in half or more
• Improvements continued throughout treatment
• Results were similar across different populations

Preventive treatment can be effective for diverse patient groups when access to care is available.

Migraine Disability and Quality of Life

The study looked beyond headache frequency and measured how migraine affects everyday life.

Patients reported improvements in:

• Daily functioning
• Work productivity and activities
• Emotional well-being
• Overall quality of life

Some patients also showed improvements in anxiety and depression symptoms during treatment.

Benefits Increased Over Time

Headache days continued to decrease throughout the 108-week study. Some patients – particularly in certain groups – showed slower early improvement but strong long-term benefit. Overall, preventive migraine care appears to work gradually and requires consistency.

Safety

No new safety concerns for onabotulinumtoxinA were identified. The most common side effects included neck pain, temporary eyelid drooping, muscle stiffness, and injection-site discomfort. Side effects were similar across groups.

Findings About Migraine Care

One important finding was that differences in outcomes may be more related to access to care than differences in how treatment works.

Researchers observed:

• Differences in prior use of preventive treatments
• Challenges staying in long-term care for some patients
• Higher loss to follow-up in certain groups

These findings highlight the importance of removing barriers such as transportation, scheduling, insurance, challenges, and access to specialists.

Conclusion
The COMPEL study helped reinforce several important messages. Preventive migraine treatments can help many patients. Long-term care and follow-up improve results, and access to care plays a major role in outcomes. 

References:

1. Blumenfeld AM, Charleston L, Kuruvilla D, et al. OnabotulinumtoxinA treatment among diverse racial groups: post hoc analysis of the phase 4 chronic migraine onabotulinumtoxinA prolonged efficacy open‐label (compel) trial. Headache. Published online December 15, 2025:head.70007. doi:10.1111/head.70007
2. Meglio M, Kuruvilla D. Chronic Migraine Prevention in Diverse Populations: What the COMPEL Trial Reveals. NeurologyLive. https://www.neurologylive.com/view/chronic-migraine-prevention-diverse-populations-what-compel-trial-reveals

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

As winter progresses, many people notice changes that are difficult to explain but easy to feel.

Energy may be lower. Focus may take more effort. Sleep may feel less restorative. Headaches may become more frequent or more noticeable.

You may often wonder whether this reflects stress, seasonal changes, or simply the pace of daily life. From a brain health perspective, experiences like these are common during late winter and often reflect how the brain responds to changes in routine, environment, and cumulative demands over time.

___

The brain responds to context

The brain does not function in isolation. It continuously integrates signals from the body and the environment to regulate energy, attention, sleep, and stress responses.

As winter continues, several subtle shifts often occur at the same time:

• Daylight exposure remains limited
• Sleep timing may drift
• Physical activity often decreases
• Work and personal demands continue without a natural pause

Individually, these changes may seem minor. Together, they can influence how efficiently the brain functions day to day.

This does not indicate that something is “wrong.” It reflects the brain adapting to its current context.

___

Understanding brain fog

“Brain fog” is a term many people use to describe slowed thinking, difficulty concentrating, or reduced mental clarity. While it is not a medical diagnosis, it is a real and commonly reported experience.

Brain fog can be influenced by sleep quality, stress levels, hydration, physical activity, and routine consistency. Because the brain is highly energy-dependent, even small disruptions in these areas can affect overall cognitive functioning.

Experiencing brain fog during late winter does not necessarily signal long-term cognitive decline. In many cases, it reflects temporary strain on attention and processing systems.

___

Headaches as a signal, not just a symptom

For individuals with a history of headaches or migraine, late winter can be a time when symptoms feel more frequent or more disruptive.

Headache pathways are sensitive to changes in sleep, stress, hydration, and sensory input. When several of these factors shift at once, headache patterns may change as well.

Recognizing headaches as part of overall brain health — rather than isolated events — can help patients approach symptoms with more clarity and less frustration.

___

Why pushing harder often doesn’t help

When symptoms increase, it is natural to respond by trying to push through fatigue or cognitive difficulty.

However, for many people, increased pressure and reduced recovery can make symptoms more noticeable over time. The brain benefits from balance — between activity and rest, focus and recovery.

A gentler, more flexible approach is often more supportive of brain health during periods of increased demand or seasonal change.

___

A supportive way to respond

Rather than viewing late-winter changes as something to overcome, you may consider treating them as information.

Helpful areas to reflect on include:

• Sleep consistency and quality
• Stress levels and opportunities for recovery
• Hydration and regular meals
• Daily movement
• Changes in headache or cognitive patterns

Small, thoughtful adjustments are often more sustainable — and often more effective — than dramatic changes.

___

A seasonal view of brain health

Brain health is not static. It naturally fluctuates with seasons, routines, hormonal changes, and life demands.

Late winter can be a time when the brain requires additional patience, support, and flexibility. Recognizing this can reduce unnecessary self-criticism and encourage a more compassionate response to symptoms.

___

Optional supportive tools

As part of a broader approach to brain health, some patients find it helpful to use tools that support awareness and consistency over time.

Our clinic offers the Brain Health MD app as an optional resource for patients who are interested in reflecting on sleep, stress, and symptoms between visits. Tools like this are not a replacement for medical care, but they may support ongoing self-awareness and communication as part of comprehensive brain health care.

___

In the weeks ahead, we’ll continue sharing clear, patient-centered brain health education and addressing common questions through our Ask the Medical Director series.

Supporting brain health often begins with understanding where you are — and responding with patience.

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

The beginning of a new year often brings a sense of momentum – new goals, new routines, and desire to “reset” everything at once.

From a neurology perspective, however, brain health tends to improve less through dramatic changes and more through patterns that develop dramatically over time. The brain responds best to consistent habits, rather than abrupt overhauls or short-lived resolutions.

Each January, we often notice similar themes in the clinic: disrupted sleep, increase in number of headaches, heightened stress, and frustration when ambitious plans become difficult to maintain.

As the year begins, here are a few perspectives that may be helpful to keep in mind.

—

Brain health doesn’t reset on January 1.

The brain does not operate on a programmed calendar.

Research shows that brain structure and function change gradually across the lifespan, shaped by sleep, stress, physical activity, cardiovascular health, and other daily influences – not by single moments or short-term efforts. Large neuroimaging studies demonstrate that the brain continues to reorganize well into adulthood, responding to cumulative lifestyle patterns rather than isolated events [1].

This is why sudden, extreme changes – especially around sleep, diet, or exercise – can feel difficult to sustain, and in some cases may worsen symptoms such as migraine, chronic headaches, or anxiety.

In many cases, consistency appears to matter more than intensity.

— 

Habits that often support brain health

While brain health is complex, there are several foundational habits that repeatedly show up in both research and clinical practice as supportive of brain function. Rather than thinking of these as rules or requirements, they may be viewed as areas to gently pay attention to over time.

1 – Sleep consistency

Sleep plays a central role in brain function. Irregular sleep schedules may contribute to headaches, difficulty concentrating, and increased sensitivity to stress.

Many patients find it helpful to focus on maintaining relatively consistent sleep and wake times, as regularity supports circadian rhythms and cognitive stability [2].

2 – Stress regulation

Chronic stress affects the brain through sustained cortisol exposure, inflammation, and changes in attention and memory networks.

People often describe themselves as “busy” rather than stressed, but over time, limited recovery can contribute to increased headache frequency, brain fog, and disrupted sleep [3].

3 – Headache awareness

Headaches and migraine are not only pain conditions — they are closely connected to overall brain health.

Sleep disruption, stress, hydration, hormonal changes, and sensory overload can influence headache patterns. Many patients find that simply observing patterns and potential triggers is a helpful first step toward better understanding their symptoms.

4 – Movement

Regular physical activity supports blood flow to the brain, metabolic health, and cognitive resilience.

Research suggests that even moderate activity, such as walking, is associated with healthier aging over time [5].

5 – Hydration and nutrition

The brain is highly energy-dependent. Dehydration, blood sugar fluctuations, and overly restrictive diets can contribute to fatigue, headaches, and difficulty focusing.

Rather than extreme dietary changes, many patients benefit from focusing on adequate hydration and balanced, sustainable nutrition that supports overall health.

—

Why a gentler approach can be helpful

At the start of the year, it is common to place high expectations on oneself – perfect sleep, strict routines, and ambitious exercise plans.

For some individuals, however, this added pressure can inadvertently worsen neurological symptoms. Stress and over-restriction are well-recognized migraine triggers and can impact cognitive flexibility. 

In contrast, gentle structure and realistic goals are often more supportive of long-term brain health. A plan that feels manageable and adaptable tends to be more valuable than one that becomes difficult to sustain.

—

One way to approach the year ahead

Instead of resolutions, you may consider focusing on:

• One habit to strengthen (for example, consistent sleep timing)
• One symptom to better understand (such as headaches or brain fog)
• One question about brain health to explore

This approach reduces pressure while increasing awareness — a combination that supports more sustainable change.

—

Throughout the year, we’ll be sharing clear, evidence-informed brain health education — and answering common patient questions through our upcoming Ask the Medical Director series.

Brain health isn’t about starting over.

It’s about supporting your brain – thoughtfully and consistently – one consistent step at a time.

—

References:

1. Mousley A, Bethlehem RAI, Yeh FC, Astle DE. Topological turning points across the human lifespan. Nat Commun. 2025;16(1):10055. doi:10.1038/s41467-025-65974-8
2. Sletten TL, Weaver MD, Foster RG, et al. The importance of sleep regularity: a consensus statement of the National Sleep Foundation sleep timing and variability panel. Sleep Health. 2023;9(6):801-820. doi:10.1016/j.sleh.2023.07.016
3. Duan S, Ren Z, Xia H, Wang Z, Zheng T, Liu Z. Association between sleep quality, migraine and migraine burden. Front Neurol. 2022;13. doi:10.3389/fneur.2022.955298
4. Ungvari Z, Fazekas-Pongor V, Csiszar A, Kunutsor SK. The multifaceted benefits of walking for healthy aging: from Blue Zones to molecular mechanisms. GeroScience. 2023;45(6):3211-3239. doi:10.1007/s11357-023-00873-8

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

When patients walk into clinic, a common question we hear is:

“Should I be worried about my brain?”

It’s an understandable concern. When most people think about brain aging, they picture memory loss later in life. But research increasingly shows that changes in brain structure and function occur across the entire lifespan, not just in older adulthood.

In fact, large neuroimaging studies demonstrate that the brain continues to reorganize and change through young and mid-adulthood, influenced by factors such as sleep, stress, cardiovascular health, and lifestyle habits [1].

Importantly, early changes in brain health don’t always look like memory problems.

They often show up as:

• Headaches or migraine
• Brain fog
• Irritability
• Trouble sleeping
• Difficulty focusing
• Low energy

These symptoms are commonly dismissed — but they can be early signals that the brain is under strain.

Brain aging starts earlier than most people realize. Cognitive aging does not suddenly begin at age 65. Nor does it begin only in later adulthood.

Research suggests that certain brain pathways begin to change as early as the 30s, with measurable differences in brain organization occurring throughout adulthood [1].

This does not mean that the brain is “declining” in a pathological sense.

Rather, it means the brain is responding to cumulative influences over time — including sleep quality, stress exposure, physical activity, nutrition, and vascular health.

The encouraging part is that these factors are often modifiable.

Stress silently affects brain health — even when you feel “fine.” Chronic stress has measurable effects on the brain.

Sustained stress exposure is associated with:

• Increased cortisol levels
• Neuroinflammation
• Oxidative stress
• Higher migraine frequency
• Changes in memory and attention

Patients often say, “I’m not stressed — I’m just busy.”

But from a neurological standpoint, the brain does not distinguish between busyness and stress.

When demands remain high and recovery time is limited, the brain can remain in a prolonged low-grade stress state. Over time, this can affect sleep, focus, mood, and headache thresholds.

Brain fog isn’t “normal” — it’s communication. “Brain fog” is not a medical diagnosis, but it is a common neurological complaint.

The brain is one of the most energy-demanding organs in the body. When resources are limited — due to dehydration, poor sleep, blood sugar fluctuations, burnout, or unmanaged headaches — cognitive efficiency is often one of the first things affected.

Brain fog is often the brain signaling a need for:

• Hydration
• Rest and sleep
• Movement and blood flow
• Stress regulation
• Migraine prevention or management

It’s not a personality trait.

It’s a signal.

Headaches are a brain health issue — not just an inconvenience. Migraines and recurrent headaches are not random events.

They frequently reflect underlying factors such as:

• Sleep disruption
• Stress overload
• Hormonal changes
• Vascular sensitivity
• Inflammation
• Sensory overstimulation

The good news is that migraine pathways are highly modifiable.

Research and clinical experience show that consistent lifestyle habits — combined with individualized medical care — can significantly reduce headache frequency and severity over time.

The most harmful myth: “There’s nothing I can do to protect my brain”

This misconception discourages people from taking action.

Neurological research consistently shows that lifestyle factors play a meaningful role in long-term brain health, often more than supplements or quick fixes [2, 3].

Protective habits associated with healthier cognitive aging include:

• High-quality sleep
• Regular physical activity
• Adequate hydration
• Stress management
• Anti-inflammatory nutrition
• Migraine management
• Cardiovascular health

You don’t need perfection.

You need consistency.

Supporting brain health doesn’t require dramatic lifestyle changes. Small, sustainable habits make a measurable difference over time.

We often recommend starting with:

• Prioritizing 7–8 hours of sleep
• Taking a daily 10–15-minute walk
• Drinking water consistently throughout the day
• Practicing a few minutes of breathing or mindfulness
• Tracking headaches or symptoms
• Limiting blue-light exposure before bed
• Focusing on whole, nourishing foods

These changes are simple — but their impact can be profound.

A New Era of Brain Health Starts Now

The goal of modern neurology isn’t only diagnosis.

It’s preserving brain function long before symptoms become debilitating.

That’s why our clinic continues to develop tools, including our Brain Health MD app, to support patients in managing cognitive, emotional, and neurological health.

Because brain aging is real.

But it’s not inevitable.

And it’s never too early — or too late — to change your trajectory.

References:

1. Mousley A, Bethlehem RAI, Yeh FC, Astle DE. Topological turning points across the human lifespan. Nat Commun. 2025;16(1):10055. doi:10.1038/s41467-025-65974-8
2. Di Liegro CM, Schiera G, Proia P, Di Liegro I. Physical activity and brain health. Genes (Basel). 2019;10(9):720. doi:10.3390/genes10090720
3. Yau WYW, Kirn DR, Rabin JS, et al. Physical activity as a modifiable risk factor in preclinical Alzheimer’s disease. Nat Med. Published online November 3, 2025:1-9. doi:10.1038/s41591-025-03955-6

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

[1]

A good night’s sleep is about much more than feeling rested — it’s one of the most powerful ways to protect and strengthen your brain. When you drift off, your brain doesn’t shut down; it goes into “repair mode,” cleaning up waste, storing memories, and preparing you for clear thinking and stable emotions the next day. In today’s blog post, we will dive deeper into how sleep affects your mental sharpness, emotional balance, and long-term brain health.

What Happens in Your Brain While You Sleep?

Throughout the day, your brain is constantly active — processing information, controlling movement, and managing emotions. That activity creates byproducts that need to be cleared away.

The glymphatic system is thought to be responsible for clearing these byproducts away. It becomes primarily active during sleep, and there are different components of sleep that may contribute to glymphatic functioning, such as subjective sleep quality and sleep patterns [2].The glymphatic system helps wash out cellular waste from the brain, and dysfunction of the glymphatic system impairs the clearance function and leads to the accumulation of toxic proteins [3]. This process has recently been discussed in the pathogenesis of certain neurological disorders, such as Alzheimer’s disease, Parkinson’s disease, and epilepsy [4, 5, 6].

When sleep is cut short or irregular, this cleaning process doesn’t work as efficiently, which can contribute to problems with focus, memory, and long-term brain function. Sleep quality is a key influencing factor for the functioning of the glymphatic system and overall cognitive functioning [3]. 

How Sleep Affects Cognitive Performance

Sleep influences almost every mental skill we rely on — from learning new things to making quick decisions:

1. Memory and Learning

As we sleep, the brain reviews and strengthens connections formed during the day. This process, known as memory consolidation, helps new information move from short-term to long-term storage. Sleep enhances memory consolidation, especially for complex declarative information [7].

Without enough deep or REM sleep, you may notice you forget details more easily or have trouble learning new material.

2. Attention and Mental Speed

Even small amounts of sleep loss can slow your reaction time and reduce concentration. One study reported that 24 hours of wakefulness caused as much impairment as a blood alcohol content of 0.10% [8].

Thus, poor sleep doesn’t just cause fatigue — it can lead to real safety concerns when driving, studying, or working.

How Sleep Shapes Emotional Health

Sleep doesn’t only affect how we think — it deeply influences how we feel and react.

1. Emotional Control

When you’re sleep-deprived, the brain’s amygdala, which processes emotions like anger or fear, becomes more active. The amygdala appears to function in the regulation of physiological sleep, and may also have effects on spontaneous and stress- and fear-induced alterations in sleep [9]. The prefrontal cortex, which helps manage those reactions, can become less effective during times of sleep deprivation [10]. There may be reduced connectivity between the prefrontal cortex and visual regions, which may cause a disruption in attentional control, increased distractibility, and slower cognitive response.

2. Mood and Mental Health

Chronic sleep difficulties are strongly connected to mood disorders such as depression and anxiety. One study showed that sleep deprivation reduces tension and self-esteem [10]. In addition, mood disturbances were linked to disruptions in connectivity between visual processing regions and areas involved in emotional regulation, such as the lingual gyrus and prefrontal cortex. Overall, this study suggested that sleep has an important role in maintaining a positive psychological state and self-evaluation. 

Over time, consistent, restorative sleep supports emotional resilience and better mental health outcomes.

Practical Steps for Better Sleep and a Healthier Brain

Small lifestyle changes can make a big difference in the quality of your sleep — and how your brain functions the next day.

1. Stick to a regular sleep schedule by trying to go to bed and wake up at the same time every day. 
2. Limit screen time before bed, as the blue light from phones and computers can disrupt natural sleep rhythms. 
3. Keep your room a cool, calm, and quiet environment where your brain can rest.
4. Avoid caffeine and heavy meals in the evening.
5. Wind down with relaxation techniques (i.e. deep breathing, meditation) to signal to your body that it is time to rest.

Healthy sleep is one of the most effective ways to improve focus, boost mood, and protect your brain for the long term.

Conclusion

Overall, sleep is the foundation of brain health. It supports memory, attention, creativity, and emotional balance — all the things that make you feel alert, capable, and centered.

When you make sleep a priority, you give your brain the chance to recover, grow, and perform at its best.

References:

1. Photo by Monica Silvestre: https://www.pexels.com/photo/photography-of-bedroom-1034584/
2. Sangalli L, Boggero IA (2023) The impact of sleep components, quality and patterns on glymphatic system functioning in healthy adults: A systematic review. Sleep Medicine 101:322–349. https://doi.org/10.1016/j.sleep.2022.11.012
3. Ma J, Chen M, Liu G-H, et al (2025) Effects of sleep on the glymphatic functioning and multimodal human brain network affecting memory in older adults. Mol Psychiatry 30:1717–1729. https://doi.org/10.1038/s41380-024-02778-0
4. Reeves BC, Karimy JK, Kundishora AJ, et al (2020) Glymphatic System Impairment in Alzheimer’s Disease and Idiopathic Normal Pressure Hydrocephalus. Trends Mol Med 26:285–295. https://doi.org/10.1016/j.molmed.2019.11.008
5. Scott-Massey A, Boag MK, Magnier A, et al (2022) Glymphatic System Dysfunction and Sleep Disturbance May Contribute to the Pathogenesis and Progression of Parkinson’s Disease. Int J Mol Sci 23:12928. https://doi.org/10.3390/ijms232112928
6. Zhao X, Zhou Y, Li Y, et al (2023) The asymmetry of glymphatic system dysfunction in patients with temporal lobe epilepsy: A DTI-ALPS study. J Neuroradiol 50:562–567. https://doi.org/10.1016/j.neurad.2023.05.009
7. Weighall A, Kellar I (2023) Sleep and memory consolidation in healthy, neurotypical children, and adults: a summary of systematic reviews and meta-analyses. Emerg Top Life Sci 7:513–524. https://doi.org/10.1042/ETLS20230110
8. Lowrie J, Brownlow H (2020) The impact of sleep deprivation and alcohol on driving: a comparative study. BMC Public Health 20:980. https://doi.org/10.1186/s12889-020-09095-5
9. Sanford LD, Adkins AM, Wellman LL (2022) The Amygdala as a Mediator of Sleep and Emotion in Normal and Disordered States. J Integr Neurosci 21:163. https://doi.org/10.31083/j.jin2106163
10. Weng X, Wen K, Guo J, et al (2025) The impact of sleep deprivation on the functional connectivity of visual-related brain regions. Sleep Medicine 125:155–167. https://doi.org/10.1016/j.sleep.2024.11.026

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

[1]

Living with conditions like migraine, post-concussion symptoms, or treatment-resistant depression can be challenging. Many patients try multiple medications or therapies, often with limited relief. Transcranial Magnetic Stimulation (TMS) therapy is an innovative, non-invasive option that has gained attention for its potential to improve brain health.

What Is TMS Therapy?

TMS is a non-invasive brain stimulation treatment that uses gentle magnetic pulses to stimulate specific areas of the brain [2]. Unlike medications, which affect the whole body, TMS directly targets brain activity. The magnetic field is used to penetrate the scalp and skull, while the electric field creates secondary currents leading to the activation of neurons in the brain [2].

The FDA has cleared TMS therapy for:

• Major Depressive Disorder (MDD), especially for patients who have not responded to medications (treatment-resistant depression)
• Migraine with aura
• Obsessive-Compulsive Disorder (OCD)
• Anxious depression (a subset of MDD with high anxiety)
• Smoking cessation

Ongoing research is exploring TMS for concussion recovery, PTSD, chronic pain, and other neurological conditions.

How Does TMS Work?

The brain communicates through electrical signals. When certain regions are underactive or out of balance, symptoms like headaches, depression, or difficulty concentrating can appear.

• During a TMS session, a device is placed on the scalp.
• It delivers focused magnetic pulses that encourage brain cells to reconnect and “re-fire.”
• Over time, this can help restore balance in brain activity and improve symptoms.

Most patients describe the sensation as a light tapping on the head. Sessions are performed in-office, do not require anesthesia, and typically allow patients to return to normal activities immediately.

TMS for Treatment-Resistant Depression

TMS is most widely recognized for treatment-resistant depression—cases where patients haven’t found relief from multiple medications. By stimulating underactive regions of the brain involved in mood regulation, TMS can help improve symptoms of depression and support a better quality of life. Repeatedly administered TMS to the dorsolateral prefrontal cortex is an established treatment for some forms of treatment-resistant major depressive disorder [2]. TMS typically delivers stimulation in daily sessions, 5 sessions per week over a period of 2 to 6 weeks.

TMS for Migraine

Migraine can be disabling, causing intense pain, nausea, and sensitivity to light or sound. TMS offers a drug-free treatment option for patients with migraine with aura. Research shows that stimulating specific brain pathways can reduce the frequency and intensity of attacks, providing relief when medications alone are insufficient. A past study showed that single-pulse transcranial magnetic stimulation (sTMS) can provide rapid relief for migraine with aura, with 39% of patients pain-free within 2 hours compared to 22% with sham treatment [3]. The therapy is non-invasive, well-tolerated, and may offer sustained relief for 24–48 hours after a migraine attack.

TMS for Concussion Recovery

Some studies suggest TMS may help with post-concussion symptoms, such as headaches, brain fog, or difficulty concentrating. By targeting neural networks involved in recovery, TMS may support the brain’s natural healing processes. While this application is still under investigation, early findings are promising. A 2021 systematic review investigating the use of TMS for concussion discussed how repetitive transcranial magnetic stimulation (rTMS) shows promising early results for treating post-concussive symptoms, including depression and headaches, in patients with mild traumatic brain injury or concussion [4]. While the studies to date are small, rTMS is non-invasive and may offer a novel approach for symptoms that are otherwise difficult to manage.

Benefits of TMS

• Non-invasive & drug-free – no systemic side effects
• Targeted stimulation – focuses on specific areas of the brain
• Well-researched – backed by clinical studies and FDA clearance for certain conditions
• Convenient – sessions typically last 20–30 minutes with minimal disruption to daily life

Side Effects and Contraindications

It is important to consider potential side effects of TMS therapy and the populations in which TMS is contraindicated. Although TMS is considered non-invasive, and its side effect profile is rare, there is a possibility that rTMS may induce seizures. Thus, TMS is not recommended for individuals with epilepsy. Pre-existing neurological disease, adolescents, change in medication regime, and active substance use should also be taken into account, as these factors may lower the seizure threshold [5]. In addition, metallic/electronic implants or cochlear implants that are in close contact with the TMS coil are also a contraindication.

TMS is generally well-tolerable; however, there may be the presence of post-treatment headaches, neck pain, or toothache. Muscle twitching may also occur during treatment. 

Key Takeaways

TMS therapy represents a growing field in brain health and neurological care, with FDA-approved applications for depression, migraine, OCD, and smoking cessation. While not every patient is a candidate, it provides an alternative or complementary approach for those who have not found relief with conventional treatments.

References:

1. Photo by Google DeepMind: https://www.pexels.com/photo/an-artist-s-illustration-of-artificial-intelligence-ai-this-image-represents-how-machine-learning-is-inspired-by-neuroscience-and-the-human-brain-it-was-created-by-novoto-studio-as-par-17483869/
2. Eldaief MC, Press DZ, Pascual-Leone A. Transcranial magnetic stimulation in neurology. Neurol Clin Pract. 2013;3(6):519-526. doi:10.1212/01.CPJ.0000436213.11132.8e
3. Lipton RB, Dodick DW, Silberstein SD, et al. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. Lancet Neurol. 2010;9(4):373-380. doi:10.1016/S1474-4422(10)70054-5
4. Mollica A, Safavifar F, Fralick M, Giacobbe P, Lipsman N, Burke MJ. Transcranial magnetic stimulation for the treatment of concussion: a systematic review. Neuromodulation. 2021;24(5):803-812. doi:10.1111/ner.13319
5. Taylor R, Galvez V, Loo C (2018) Transcranial magnetic stimulation (TMS) safety: a practical guide for psychiatrists. Australas Psychiatry 26:189–192. https://doi.org/10.1177/1039856217748249

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena E. Kuruvilla, MD

[1]

At the Brain Health Institute, we understand how disruptive and painful headaches can be. In fact, nearly 16% of the global population experiences a headache each day — so if you’re struggling, you’re far from alone [2].

While over-the-counter medications like ibuprofen and acetaminophen work for some, they don’t help everyone — and frequent use can sometimes make headaches worse. That’s why we’re proud to share expert-recommended, drug-free headache remedies, especially those highlighted in a recent Yahoo Health article, which featured our very own Medical Director, Dr. Deena Kuruvilla (https://health.yahoo.com/general/article/natural-headache-remedies-222223570.html) [3].

Dr. Kuruvilla, a nationally recognized, board-certified neurologist, was cited throughout the article for her expertise in both conventional and natural headache therapies. As the Medical Director of the Brain Health Institute, she regularly helps patients find relief through a holistic approach to brain and neurological health.

Here are 10 natural remedies discussed in the article that may help you find relief:

1. Aromatherapy with Essential Oils.

Essential oils like peppermint and lavender are commonly used for natural headache relief. Dr. Kuruvilla recommends the Migrastil Migraine Stick, an essential oil roll-on made with peppermint, lavender, and spearmint oils. A study conducted in 2019 compared the effects of intranasal lidocaine 4% with peppermint oil drop 1.5% on migraine attacks [4]. In this double blind, parallel, randomized controlled trial, intensity of headache decreased in 40% of the patients in the lidocaine and peppermint oil group. The researchers found that peppermint oil relieved a majority of the patients pain similar to the lidocaine group. A study investigating the effect of lavender essential oil as a prophylactic therapy for migraine found a statistically significant reduction in the Migraine Disability Assessment Scores questionnaire following three months of lavender therapy [5].

2. Blue-light blocking glasses.

Long hours in front of screens can trigger headaches. Blue-light-blocking glasses may reduce eye strain and light sensitivity — two common activators for migraine, especially in patients sensitive to visual stimuli.

3. Magnesium supplements.

Studies comparing people with migraine to those without suggest that individuals with migraine often have lower magnesium levels in their blood, saliva, and even spinal fluid [6, 7]. This has led researchers to consider that magnesium deficiency may play a role in causing migraine. Dr. Kuruvilla notes that 400–600 mg daily may ease migraine attacks, especially those with aura. Be sure to consult your doctor before starting any supplement.

4. Riboflavin.

Riboflavin, also known as Vitamin B2, helps the body produce energy in the mitochondria and reduce inflammation and oxidative stress. Since migraine has been linked to problems like mitochondrial dysfunction, inflammation, and oxidative stress, riboflavin is gaining attention as a possible way to help prevent them [8]. A 2022 review study found that daily riboflavin 400 mg/day for three months had a significant effect on days, duration, frequency, and pain score of migraine attacks [9]. It’s considered safe for most people and can support energy production in the brain.

5. Cefaly.

Featured in the Yahoo article [3], the Cefaly Dual Device is FDA-cleared and sends gentle electrical pulses to the trigeminal nerve – a nerve that can play a role in migraine – in the form of external trigeminal nerve stimulation (eTNS) [10]. Dr. Kuruvilla says it’s effective for both acute treatment and daily prevention. A 2024 report co-authored by Dr. Kuruvilla revealed that eTNS was most effective in relieving migraine-related nausea and photophobia, with significantly better outcomes compared to sham treatment [11]. The findings suggest that eTNS may work better for certain migraine symptoms, and identifying a patient’s most bothersome symptom (MBS) could help guide more personalized migraine treatment.

6. Massage therapy. 

Tension in the neck and shoulders can lead to headaches. Massage — whether professional or at home using a neck massager — can release tight muscles and improve blood flow. A 2024 systematic review and meta-analysis on the effectiveness of myofascial release techniques on the intensity of headache pain and associated disability in patients with tension-type headache, cervicogenic headache, or migraine found that myofascial release can significantly alleviate pain and disability in tension-type headache [12]. However, the results for migraine were inconsistent.

7. Cold therapy.

Cold therapy constricts blood vessels and reduces inflammation. A 2023 meta-analysis reviewed six studies and found that cold interventions—such as cold-gel headbands, cooling caps, and intraoral cooling—can provide short-term relief from migraine pain, with significant improvement seen within 30 minutes [13]. However, evidence for long-term effects and benefits for symptoms like nausea and vomiting was limited and inconclusive. Overall, cold therapy appears to be a helpful immediate relief option, though more research is needed to confirm broader benefits. Dr. Kuruvilla recommends cold packs for migraine relief in addition to mainstream as-needed treatments. Warm compresses on the neck or back of the head may be more effective for tension headaches.

8. Acupressure mat.

Acupuncture is a practice rooted in traditional Chinese medicine that involves inserting thin needles into specific points on the body to stimulate nerves, muscles, and connective tissue. It is believed to help restore balance and promote the body’s natural healing processes, and is commonly used to manage chronic pain conditions, including migraine. Acupuncture is often used to treat migraine because it may help reduce pain and promote healing by stimulating specific points on the body, offering a non-pharmacological alternative with fewer side effects. It’s especially considered for patients with chronic or treatment-resistant migraine who struggle with medication side effects or limited access to effective care.

An acupuncture mat is a cushioned surface covered with small, spike-like stimulators designed to apply pressure to the skin, mimicking the effects of acupressure. While not the same as traditional acupuncture, using the mat may help relax muscles, improve circulation, and reduce stress, which could offer relief for some migraine sufferers by targeting tension and promoting relaxation. A 2024 study reviewing past randomized controlled trials further investigated the relationship between the dose of acupuncture sessions, acupuncture frequency, and acupuncture duration, and its impact on migraine [14]. The researchers found that three sessions of acupuncture a week resulted in a significant decrease in the frequency of migraine attacks. In addition, after two months of acupuncture, the frequency of migraine attacks decreased significantly.

9. Stay hydrated.

Dehydration is one of the most common and overlooked headache triggers. Dr. Kuruvilla notes that drinking 16–32 oz. of water can help manage migraine disease.

10. Replenish electrolytes.

If you’re dehydrated from heat or physical activity, adding electrolytes to your water may help. Just watch for added sugars in commercial drinks — opt for clean, sugar-free hydration options.

At the Brain Health Institute, we believe in integrating science-backed natural remedies with personalized medical care to help patients find lasting relief. Let’s work together to get your brain health back on track.

References:

1. Photo by Tara Winstead: https://www.pexels.com/photo/close-up-photo-of-small-amber-bottles-6694184/

2. Stovner LJ, Hagen K, Linde M, Steiner TJ (2022) The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. The Journal of Headache and Pain 23:34. https://doi.org/10.1186/s10194-022-01402-2

3. (2025) 10 natural headache remedies to help you ease the pain, according to doctors. In: Yahoo! Health. https://health.yahoo.com/general/article/natural-headache-remedies-222223570.html. Accessed 25 Jul 2025

4. Rafieian-kopaei M, Hasanpour-dehkordi A, Lorigooini Z, et al (2019) Comparing the Effect of Intranasal Lidocaine 4% with Peppermint Essential Oil Drop 1.5% on Migraine Attacks: A Double-Blind Clinical Trial. Int J Prev Med 10:121. https://doi.org/10.4103/ijpvm.IJPVM_530_17

5. Rafie S, Namjoyan F, Golfakhrabadi F, et al (2016) Effect of lavender essential oil as a prophylactic therapy for migraine: A randomized controlled clinical trial. Journal of Herbal Medicine 6:18–23. https://doi.org/10.1016/j.hermed.2016.01.003

6. Maier JA, Pickering G, Giacomoni E, et al (2020) Headaches and Magnesium: Mechanisms, Bioavailability, Therapeutic Efficacy and Potential Advantage of Magnesium Pidolate. Nutrients 12:2660. https://doi.org/10.3390/nu12092660

7. Samaie A, Asghari N, Ghorbani R, Arda J (2012) Blood Magnesium levels in migraineurs within and between the headache attacks: a case control study. Pan Afr Med J 11:46

8. Yamanaka G, Suzuki S, Morishita N, et al (2021) Experimental and Clinical Evidence of the Effectiveness of Riboflavin on Migraines. Nutrients 13:2612. https://doi.org/10.3390/nu13082612

9. Chen Y-S, Lee H-F, Tsai C-H, et al (2022) Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis. Nutr Neurosci 25:1801–1812. https://doi.org/10.1080/1028415X.2021.1904542

10. CEFALY – The #1 FDA-Cleared Migraine Treatment Device. In: CEFALY. https://blog.cefaly.com/welcome/. Accessed 29 Jul 2025

11. Panza GA, Johnson MAL, Kuruvilla DE (2025) A post hoc analysis of migraine‐associated symptoms from the phase 3 randomized, double‐blind, sham‐controlled Trial of External trigeminal nerve stimulation for the Acute treatment of Migraine ( TEAM) study. Headache 65:779–790. https://doi.org/10.1111/head.14860

12. Lu Z, Zou H, Zhao P, et al (2024) Myofascial Release for the Treatment of Tension-Type, Cervicogenic Headache or Migraine: A Systematic Review and Meta-Analysis. Pain Res Manag 2024:2042069. https://doi.org/10.1155/2024/2042069

13. Hsu Y-Y, Chen C-J, Wu S-H, Chen K-H (2023) Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis. J Clin Nurs 32:2455–2465. https://doi.org/10.1111/jocn.16368

14. Yang C, Wu M, Luo Q, et al (2024) Acupuncture for migraine: A systematic review and meta-regression of randomized controlled trials. Complement Ther Med 86:103076. https://doi.org/10.1016/j.ctim.2024.103076

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

[1]

At the Brain Health Institute, we are committed to staying at the forefront of research that bridges metabolic and neurological health. A newly published pilot study suggests that liraglutide, a medication originally developed for weight management, may also reduce the frequency of migraine attacks in people with obesity [2].

This discovery represents a potentially important shift in how we understand and treat migraine, particularly among patients who also struggle with metabolic health. Our own Dr. Kuruvilla, Medical Director of the Brain Health Institute, was featured in a recent Health article discussing the implications of this research [3].

In the small, randomized controlled trial, researchers examined the effect of daily liraglutide injections on patients with obesity who also experienced frequent migraine attacks. Participants were monitored over several months for changes in migraine frequency and intensity. At the end of the study, the mean (SD) monthly days with headache decreased from 19.8 (6.7) to 10.7 (7.7) days post-treatment. There was no significant change in BMI. The participants also recorded substantial boosts in quality of life via a tool called the Migraine Disability Assessment Test. While the sample size was limited, this pilot study supports a growing body of evidence that suggests migraine is not just a neurological disorder but also a systemic condition influenced by metabolism, inflammation, and hormone regulation.

Migraine affects more than 1 billion people globally and is one of the leading causes of disability among individuals under 50 [4]. Patients may experience not only the burden of recurrent migraine attacks but also coexisting conditions like obesity, insulin resistance, and metabolic syndrome—all of which may exacerbate the frequency and severity of migraine attacks. Understanding that a medication like liraglutide could potentially treat both weight-related issues and migraine frequency opens up new, integrated treatment options for patients living with these overlapping challenges.

For patients who experience both migraine and obesity, this research opens up new and hopeful possibilities. However, it’s important to keep in mind that liraglutide is not currently FDA-approved for migraine prevention. Its use for this purpose is considered “off-label” and should only be pursued under the guidance of a healthcare professional. In addition, this study was relatively small, and more large-scale clinical trials are needed to confirm these findings and clarify best practices for prescribing. GLP-1 receptor agonists can have side effects, including nausea, vomiting, diarrhea, and, in rare cases, pancreatitis or gallbladder issues [5]. 

To schedule an appointment or learn more about migraine and metabolic health, contact the Brain Health Institute today.

References:

1. Photo by Haberdoedas Photography: https://www.pexels.com/photo/close-up-of-semaglutide-injection-pen-on-surface-32532049/
2. Braca S, Russo CV, Stornaiuolo A, et al (2025) Effectiveness and tolerability of liraglutide as add‐on treatment in patients with obesity and high‐frequency or chronic migraine: A prospective pilot study. Headache head.14991. https://doi.org/10.1111/head.14991
3. Popular Weight Loss Drugs May Help Treat Migraines Too, Study Finds. In: Health. https://www.health.com/liraglutide-glp1-weight-loss-medication-migraine-study-11767637. Accessed 11 Jul 2025
4. Migraine Statistics and Facts. In: Migraine.com. https://migraine.com/migraine-statistics. Accessed 11 Jul 2025c
5. Filippatos TD, Panagiotopoulou TV, Elisaf MS (2014) Adverse Effects of GLP-1 Receptor Agonists. Rev Diabet Stud 11:202–230. https://doi.org/10.1900/RDS.2014.11.202

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

Photo by Jonathan Borba [1]

At the Brain Health Institute, we understand that migraine doesn’t pause for pregnancy—and managing it safely matters more than ever. This week, we’re spotlighting a critical topic in women’s health that directly affects many of our patients: the safety of migraine treatment during pregnancy. Migraine is significantly more common in women—especially during their reproductive years—yet treatment decisions during pregnancy often involve uncertainty and concern [2]. A newly published study in Neurology (May 2025) offers timely, evidence-based insight into the long-term effects of triptan use during pregnancy—specifically its impact on child neurodevelopment. In today’s post, we break down the key findings and what they mean for clinical care [3, 4].

Triptans are a class of medications that are FDA approved as the first-line agents to treat acute migraine episodes with or without aura [5]. They work by targeting serotonin (5-HT) receptors in the brain to constrict blood vessels and reduce inflammation associated with migraine pain. Sumatriptan is the most studied of these medications and has a long track record of efficacy and safety. Triptans are widely prescribed for women of childbearing age, raising important questions about their safety during pregnancy—especially because they can cross the placenta and interact with serotonin pathways in the developing fetal brain. Except for sumatriptan, all triptans are contraindicated in pregnancy and breastfeeding [6]. 

Researchers from the University of Oslo and the University of Milano-Bicocca conducted a nationwide, registry-based cohort study using four comprehensive Norwegian health registries [3]. They followed over 26,000 pregnancies in women with diagnosed migraine from 2008 to 2023. Approximately 21,000 of these women used triptans in the year prior to or during pregnancy. The goal was to examine whether prenatal triptan exposure—alone or in combination with other migraine medications—was associated with an increased risk of neurodevelopmental disorders (NDDs) in children, including ADHD, speech/language delays, and learning disabilities. Children were followed for an average of eight years, with some tracked through age 14.

No significant increase in overall risk for neurodevelopmental disorders was found among children exposed to triptans in utero. When comparing children whose mothers had migraine but used no medication during pregnancy with those who had low or moderate triptan exposure, outcomes were statistically similar. Subgroup analysis revealed no elevated risk for ADHD, speech/language disorders, or learning disabilities. The study is notable for its long-term follow-up, large sample size, and comprehensive outcome tracking across multiple health databases. These findings are encouraging and support the conclusion that prenatal triptan exposure does not substantially increase long-term risks to child neurodevelopment.

During pregnancy, many continue to experience migraine attacks, and avoiding treatment out of concern for fetal safety can lead to undertreatment. This study offers reassuring evidence that, for many patients, the benefits of migraine treatment may outweigh potential risks when managed with thoughtful, individualized care and very close monitoring with your physician.

The authors did describe some limitations to this study. For example, prescription data does not confirm actual medication use. Some patients may have filled prescriptions but chosen not to take the medication. In addition, triptan users were more likely to be prescribed other medications (e.g., opioids or benzodiazepines), which could confound neurodevelopmental outcomes. The timing and dosage of exposure varied, and additional research is needed, especially for high-exposure or first-trimester cases. Thus, clinicians must continue to evaluate migraine treatment on a case-by-case basis, ideally incorporating preconception counseling and collaborative care with maternal-fetal medicine specialists.

If you are pregnant—or planning to become pregnant—and are living with migraine, know that safe and effective treatment options exist. Triptans, particularly sumatriptan, appear to pose no major long-term risk to your child’s neurodevelopment based on the current evidence. That said, always consult with your neurologist and OB-GYN to make personalized decisions based on your specific medical history and treatment needs [4].

At the Brain Health Institute, we’re here to support you with expert, compassionate care—whether you’re managing migraine, planning a pregnancy, or navigating both.

References:

1. Photo by Jonathan Borba: https://www.pexels.com/photo/photo-of-hands-touching-baby-bump-4513731/
2. Rossi MF, Tumminello A, Marconi M, et al (2022) Sex and gender differences in migraines: a narrative review. Neurol Sci 43:5729–5734. https://doi.org/10.1007/s10072-022-06178-6
3. Camanni M, Van Gelder MMHJ, Cantarutti A, et al (2025) Association of Prenatal Exposure to Triptans, Alone or Combined With Other Migraine Medications, and Neurodevelopmental Outcomes in Offspring. Neurology 104:e213678. https://doi.org/10.1212/WNL.0000000000213678
4. Shaw G (2025) Triptan Exposure During Pregnancy Does Not Increase Long-term Neurodevelopmental Outcomes. In: Neurology Today. https://journals.lww.com/neurotodayonline/fulltext/2025/06190/triptan_exposure_during_pregnancy_does_not.5.aspx
5. Nicolas S, Nicolas D (2025) Triptans. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
6. Antonaci F, Ghiotto N, Wu S, et al (2016) Recent advances in migraine therapy. Springerplus 5:637. https://doi.org/10.1186/s40064-016-2211-8

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

Photo by Alex Green [1]

Every June, healthcare professionals, advocates, and patients across the country observe National Migraine & Headache Awareness Month. This annual campaign is more than just a recognition—it’s a call to action. Migraine and chronic headaches affect millions of people, yet they often remain misunderstood, underdiagnosed, and undertreated. At the Brain Health Institute, we believe awareness is the first step toward relief. This month, we are spotlighting the real impact of migraine—and how expert, compassionate care can make all the difference.

Migraine is a complex neurological disorder, not just a “bad headache.” While headache is one of the hallmark symptoms, migraine often come with a wide range of disabling features, including [2]:

• Pulsating or throbbing head pain, often on one side
• Nausea and vomiting
• Sensitivity to light, sound, or smells
• Visual disturbances (commonly known as aura)
• Cognitive fog and fatigue

For some, migraine attacks last only a few hours. For others, they can stretch into days—impacting daily life, work, relationships, and mental health.

Migraine is one of the most common neurological conditions worldwide, affecting over 39 million Americans—yet it remains widely misunderstood. Many patients go years without a formal diagnosis [3]. Others are told their symptoms are stress-related or dismissed entirely. Increasing awareness helps reduce stigma, improve access to care, and empower patients with the knowledge that their pain is real—and treatable.

At the Brain Health Institute, we take a whole-person approach to migraine treatment. Our team provides:

• Thorough neurological assessments to understand your specific migraine patterns
• Evidence-based treatment plans, including medication and non-medication therapies
• Lifestyle guidance, including sleep, nutrition, and stress management
• Trigger identification and tracking tools
• Ongoing support to adjust care as your needs evolve

We understand that no two patients experience migraine the same way. That is why our care is always tailored to each specific patient, never one-size-fits-all.

If you or someone you love experiences migraine, National Migraine & Headache Awareness Month is the perfect time to:

• Start a headache journal to track symptoms and potential triggers
• Talk to your primary care provider or neurologist about a formal evaluation
• Explore treatment options you may not have considered
• Reach out for support—you are not alone

Living with migraine can feel isolating—but help is available. At the Brain Health Institute, we are here to listen, evaluate, and guide you toward better brain health.

Contact us today to schedule a consultation or learn more!

References:

1. Photo by Alex Green: https://www.pexels.com/photo/crop-faceless-overwhelmed-black-man-covering-face-against-wall-5700198/
2. Puledda F, Silva EM, Suwanlaong K, Goadsby PJ (2023) Migraine: from pathophysiology to treatment. J Neurol 270:3654–3666. https://doi.org/10.1007/s00415-023-11706-1
3. Migraine Statistics and Facts. In: Migraine.com. https://migraine.com/migraine-statistics. Accessed 15 Jun 2025