Why Neurology + Vascular Integration Matters
Headaches, numbness, dizziness, and memory lapses often seem unrelated—until you discover that the brain, its blood supply, and peripheral nerves form a single electrical-plumbing network. NYMVCare’s Neuro-Vascular Service Line brings board-certified neurologists, vascular-medicine physicians, and in-house imaging together so Brooklyn and Queens residents can move from “What’s wrong?” to “Here’s the plan” in days, not weeks.
1. Conditions We Treat Every Day
| Symptom Cluster | Common Diagnoses | Quick Notes |
| Headache & Face Pain | Migraine (with/without aura), tension-type, cluster, trigeminal neuralgia | CGRP monoclonal antibodies now recommended up front for frequent migraine (migrainedisorders.org) |
| Numbness, Tingling, Weakness | Carpal-tunnel syndrome, diabetic polyneuropathy, radiculopathy | Nerve-conduction studies (NCV) clarify nerve vs. spine source (aan.com) |
| Seizures / Spells | Focal & generalized epilepsy, syncope vs. seizure | 72-hr ambulatory EEG catches rare events |
| Dizziness & Balance | Vestibular migraine, BPPV, vertebrobasilar insufficiency | Neuro-otology + extracranial Doppler in one visit |
| Brain Fog & Stroke Risk | Transient ischemic attack (TIA), small-vessel disease | Same-day carotid duplex + MRI prevents ER bounce backs |
2. Our Diagnostic “Toolbox” Explained
A. Electroencephalography (EEG)
- Routine 30-minute EEG —maps cortical electrical activity; identifies interictal spikes.
- Ambulatory 24- to 72-hour EEG —portable device records real-world events; patients mark sensations via phone app.
- When we order: Unexplained blackouts, atypical migraines, new cognitive decline.
B. Nerve-Conduction Velocity & Electromyography (NCV/EMG)
Gold-standard for peripheral-nerve disorders. AAN 2024 course emphasizes pattern-based interpretation to avoid misdiagnosis (aan.com).
- Measures speed & amplitude of signals in sensory and motor nerves.
- EMG needle portion tests muscle electrical activity to pinpoint radiculopathy.
C. Neuro-Vascular Imaging
| Modality | What It Shows | Location |
| Carotid Duplex Doppler | Plaque, stenosis, flow direction | NYMVCare vascular suite |
| Transcranial Doppler (TCD) | Intracranial flow velocities—good for vasospasm, PFO bubbles | Same session as carotid |
| MR Angiography (MRA) / CT Angio | Aneurysms, dissections, venous sinus thrombosis | In-house 3 T MRI & low-dose CT |
D. Structural & Functional Brain Imaging
- 3 T MRI with migraine & epilepsy protocols (FLAIR, SWI, DWI).
- Functional MRI for pre-surgical mapping.
- CT Perfusion when stroke suspected.
E. Headache-Specific Work-Ups
- Vitamin D & B-12 panel (deficiencies mimic migraine).
- Hormonal profile for menstrual migraine.
- Visual-evoked potentials if optic-nerve inflammation on MRI.
3. The Patient Journey—From First Twinge to Tailored Plan
- Day 0 | Neuro-Symptom Clinic
15-minute nurse triage + detailed history. Headache diaries or smartphone symptom trackers uploaded to EHR. - Day 2 | Diagnostics Block
Morning EEG → coffee break → NCV/EMG or Doppler as indicated. Results reviewed same afternoon in our multidisciplinary huddle. - Day 5 | Results & Treatment Visit
You meet your neurologist + vascular specialist together. Expect a printed roadmap covering lifestyle tweaks, medications, and follow-up imaging schedule. - Day 20+ | Interventional Options
- Migraine: CGRP mAbs, onabotulinumtoxinA injections, or the new ACP-endorsed triptan + NSAID combo for acute attacks (acponline.org).
- Neuropathy: Gabapentinoids, sodium-channel blockers, B-vitamins, and physical therapy.
- Venous sinus stent or carotid PTA/stent when vascular bottlenecks drive headaches or TIAs.
4. Spotlight on Headache Care—2025 Updates
CGRP Inhibitors as First-Line Preventives
The American Headache Society’s 2024 position statement elevates CGRP mAbs (erenumab, fremanezumab, galcanezumab) to first-line for ≥4 migraine days/month (migrainedisorders.org). NYMVCare now offers same-day prior auth & first injection.
Combination Therapy for Acute Migraine
March 2025 ACP guideline: add a triptan to NSAID or acetaminophen if monotherapy fails (acponline.org). We stock rapid-dissolve rizatriptan for patients with vomiting.
Neuro-Vascular Headache
20 % of refractory headaches stem from vascular issues—PFO, carotid stenosis, or venous hypertension. Our integrated screening (TCD + MRA) detects these red-flag causes on the first pass.
5. When to Seek Immediate Care
| Red-Flag Symptom | Possible Cause | Action |
| “Thunderclap” headache, worst of life | Subarachnoid hemorrhage, venous sinus thrombosis | Go to ER, call 911 |
| Vision loss + scalp tenderness | Giant-cell arteritis | Same-day ESR/CRP & temporal-artery US |
| New facial droop, slurred speech | TIA/stroke | EMS, stroke code |
| Progressively worsening daily headache in pregnancy | Cerebral venous thrombosis | Urgent Doppler/MRI |
6. Insurance & Cost Snapshot
| Service | CPT | Typical Charge | Coverage |
| Routine EEG | 95816 | $375 | Medicare, most PPOs |
| Ambulatory EEG (72 h) | 95953 | $1 650 | Prior auth needed |
| NCV/EMG (4 limbs) | 95912/13 + 95886 | $900 | Covered with neuro dx |
| Carotid Duplex | 93880 | $350 | Covered if symptoms |
| CGRP mAb inj. | J3035 etc. | List $550/mo | Copay card ↓ to $0–$50 |
Financial counselors help with authorizations and foundation grants.
7. Frequently Asked Questions
Is EEG painful?
No—just sticky scalp electrodes. You may feel mild skin tug removing them.
What’s the difference between NCV and EMG?
NCV measures signal speed along nerves; EMG looks at muscle electrical activity. Together they pinpoint lesion site.
Will insurance cover CGRP antibodies?
Most plans approve if you’ve tried 2–3 oral preventives. We manage paperwork.
I’m claustrophobic—can I skip MRI?
We offer open MRI slots and mild anxiolytics; ultrasound or CT can help if MRI is impossible.
8. Action Steps for Patients
- Track symptoms—download our free Headache Diary app (iOS/Android).
- Book a Neuro-Vascular Evaluation online or 877-877-1118.
- Bring prior imaging & med list—speeds diagnosis.
- Wear loose clothing for NCV/EMG electrode access.
- Ask about lifestyle modules—sleep hygiene, stress CBT, anti-inflammatory diet.
Conclusion
Headaches, nerve pain, and dizzy spells don’t live in silos—and neither should your care. At NYMVCare, neurologists, vascular doctors, and imaging techs share the same hallway, giving Brooklyn and Queens residents a one-stop path from symptom to solution. Whether you need a 20-minute EEG, a Doppler scan of neck vessels, or the latest CGRP migraine injection, we’ve got you—brain, vessels, and nerves—under one roof. Book your comprehensive evaluation today and step into clearer, calmer days ahead.
