Neurologist Anne Constantino, MD, on Migraines

What causes a migraine?

Migraines have a strong genetic component with 70 percent of patients having a first degree relative with a history of migraines. More women than men suffer migraines, and many associate their migraines with factors such stress, hormonal changes, contraceptive use, pregnancy, ovulation, lack of sleep, head trauma, changes in weather, smoking, ingesting red wine and exposure to computers or bright lights.

What are the treatments you offer?

If you experience the worst headache of your life, you should not delay going to the ER for evaluation. If you experience a headache that is likely triggered by the components mentioned above, it is likely a migraine attack. There are numerous medications that can help, from aspirin to much stronger drugs, including antidepressants, anti-seizure medications or calcium blockers. If a headache cannot be stopped, IV medications may be needed and the patient may need to be hospitalized. Narcotics are never a good treatment for a headache. New innovations in treatment include occipital nerve stimulation, external trigeminal nerve stimulation and the Gammacore handheld device, which all work to relieve migraines by sending electrical stimulation to the brain. New medications for migraines include new drugs and antibody therapies.

What else should we know?

Sleeping in a dark, quiet room, doing relaxation exercises, yoga, acupressure treatment and short courses of steroids have proven helpful to some individuals. Lifestyle change can also help patients with migraines, including avoiding or learning how to deal with stressful situations, eating healthy, and sleeping at least eight hours per night. Of course, avoiding the inciting agent is key. If you have a headache from constant computer exposure, relax your eyes and your brain to prevent progression of the headache. A headache diary may be helpful in documenting what activities/ food/etc. triggers the headache.

For more information visit or call 301-877-4540 to schedule an appointment with Dr. Constantino.

MedStar Southern Maryland Welcomes New Neurosurgeon Steven Spitz, MD

spitzMedStar Southern Maryland Hospital Center welcomes new neurosurgeon, Steven Spitz, MD.  Dr. Spitz joins doctors Anaizi, Sandhu and Voyadzis in a neurosurgery practice that treats the full spectrum of brain and spine cases.  Dr. Spitz will perform procedures that include spine oncology, minimally invasive spine surgery, nerve decompression surgery, nerve reconstruction surgery, cervical disc arthroplasty and laminoplasty and cervical, thoracic and lumbar surgeries. 

Prior to joining MedStar Southern Maryland Hospital Center, Dr. Spitz completed a Spine Fellowship at Emory University Hospital, Atlanta, Georgia, where he honed his treatment philosophy.

“I believe healthcare decisions should be a collaboration between myself and the patient,” said Dr. Spitz.  “I’m not here to tell a patient what to do, but to make a plan with them.  I make sure they have the information they need to make informed decisions.”

Dr. Spitz earned two undergraduate degrees, a bachelor of science in biology from the University of Georgia in Athens, GA, and a bachelor of science in medical technology from Medical College of Georgia in Augusta, GA.  He also earned his medical degree at Medical College of Georgia in Augusta, GA.  His residency in neurosurgery took place at MedStar Georgetown University Hospital, Washington, DC.  Dr. Spitz became a Post Doctorate Fellow at Johns Hopkins University Hospital, Baltimore, Maryland and is a member of the American Medical Association and the Congress of Neurological Surgeons.

“MedStar Southern Maryland Hospital Center is thrilled to welcome Dr. Spitz onto our team of gifted neurosurgeons,” said President Christine Wray.  “He earned impressive accolades during his education and has also been the recipient of teaching awards at MedStar Georgetown.  His expertise is in demand and patients here will appreciate his warm demeanor and collaborative approach to care.  Dr. Spitz will be a great addition to our hospital.”

To refer a patient or make an appointment, please call 301-856-2323.


Cheryl Richardson
Director of Marketing and Community Relations
[email protected]

About MedStar Southern Maryland Hospital Center:

MedStar Southern Maryland Hospital Center, a 192 bed full-service hospital serving the Washington, D.C., metro and Southern Maryland areas, was founded in 1977 and joined MedStar Health in December, 2012.  Throughout the hospital’s history, it has remained a community leader, a strong supporter of health care education and a dedicated advocate for quality health care services.

Stroke Program Wins Gold Plus Achievement Award

Strokes are all too common; in fact, they are the third leading cause of death among Americans. Strokes are related to heart disease, which affects a disproportionate number of people in our community. So it’s no surprise that last year our hospital treated almost 1,000 people for strokes.

Because this is such an important medical problem in our community, MedStar Southern Maryland Hospital Center (MSMHC) has made stroke care a high priority. Our ongoing efforts led to the American Heart Association (AHA) awarding our stroke program their Gold Plus Achievement Award and naming us to the Target: Stroke Honor Roll. This is the third year that we have received these honors, which are part of the AHA’s Get With the Guidelines–Stroke program.

The Get with the Guidelines–Stroke program places a high priority on shortening the time to treatment. “We know that every 15 minutes that we treat faster, 5 percent fewer patients die from their strokes,” says Mary Jobson-Oliver, MSMHC stroke program coordinator. Furthermore, nearly two million brain cells die every minute during an acute stroke.

Effective care requires speedy and careful coordination among many departments throughout the hospital. Physicians, nurses and associates from the emergency department, radiology, laboratory, pharmacy, critical care, physical therapy, speech therapy and occupational therapy are among the departments that have a key role in extending patients’ lives while preserving function.

“It’s a huge team effort to make this happen for our patients and our community,” says Deborah Oncale-Guthrie, who served as interim stroke coordinator in 2015 and is currently the hospital’s core measures coordinator. "Everyone has made a sustained, concerted effort to provide quality stroke care."

Learn more about our Stroke Center.

Hospital’s Award-Winning Stroke Center Expands Services

Offering Quality Care Before, During, and After a Stroke 

When every minute counts, we’re ready and waiting. MedStar Southern Maryland Hospital Center is proud to welcome two stroke experts to our hospital, expanding our hospital’s award-winning stroke center’s services with full-time, on-site specialized care for people suffering an acute stroke and those recovering from a stroke.

On-site specialists means better stroke care

“When it comes to stroke, the most important thing is time,” Dr. Shah said. During a stroke, the brain’s oxygen supply is disrupted. With every minute that passes, more of the brain is damaged. There are effective stroke treatments available, including the “clot-busting” drug tPA, but patients must receive them within a narrow window of time in order for them to work.

With a stroke specialist on site full time, patients can expect timely evaluation and treatment for acute stroke, giving patients the best possible chance for a meaningful recovery and good quality of life. For complex stroke cases, an on-site neurologist can expedite a patient’s transfer to one of MedStar’s tertiary care facilities.

By your side during recovery

Dr. Constantino’s goal is to reduce the long-term disability that stroke can cause through a coordinated approach to rehabilitation that starts well before the patient leaves the hospital. “Rehabilitation is crucial to a patient’s improvement after a stroke,” she said. “The earlier rehabilitation can be started, the better the outcome for the patient, and the better quality of life the patient can have.”

Working in partnership with the rehabilitation center and the hospital’s occupational, speech, and physical therapists, Dr. Constantino helps patients navigate their recovery and rehabilitation after a stroke.

With Drs. Shah and Constantino aboard, the hospital plans to deepen the stroke center’s services and add complementary programs, including clinical trials, stroke prevention community education, and support for caregivers. Be sure to visit the hospital’s online newsroom for updates.

Know the warning signs of stroke

Check the National Stroke Association’s list of stroke symptoms, or just remember the acronym FAST to check for stroke warning signs:

F- Face: Ask the person to smile. Does the face droop?
A- Arm: Ask the person to raise both arms. Does one arm drift downward?
S- Speech: Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?
T- Time: If you observe any of these signs, then it's time to call 911.

If you or someone you know is having stroke symptoms, call 911 right away. 

For more information about stroke rehabilitation services or to make an appointment at the outpatient clinic, call patient services manager Valerie Stewart, MS, MBA, at (301) 877-4540.

Aabha Shah, MD, and Anne Constantino, MD

Aabha Shah, MD
Medical Director of Stroke Services, MedStar Southern Maryland Hospital Center, and Assistant Professor of Neurology, MedStar Georgetown University Hospital

Dr. Shah attended medical school at India’s D. Y. Patil Medical College, Maharashtra University of Health Sciences. She completed an internal medicine residency at Flushing Hospital Medical Center and went on to complete a neurology residency at Albert Einstein College of Medicine, Beth Israel Medical Center. She is a board certified neurologist and is currently a vascular neurology fellow at the National Institutes of Health/National Institute of Neurological Disorders and Stroke.

Anne Constantino, MD
Neurologist, MedStar Georgetown University Hospital, based at MedStar Southern Maryland Hospital Center

A board certified neurologist and movement disorder specialist, Dr. Constantino earned her medical degree from University of the East Ramon Magsaysay Memorial Medical Center in the Philippines. She completed her residency in neurology at the State University of New York at Syracuse and New York-Presbyterian Hospital-Weill Cornell Medical College before taking a movement disorders fellowship at Columbia University College of Physicians and Surgeons. Dr. Constantino has worked as a medical officer with the U.S. Food and Drug Administration and has served on the academic medical faculty at several institutions, including the University of Louisville and New York University School of Medicine. 

Stroke Is No Joke


Just as a lack of blood flow to the heart causes a heart attack, a lack of blood flow to the brain causes a brain attack, or stroke. Typically a stroke occurs when an artery that supplies the brain with blood is either blocked or bursts. Brain cells die when they no longer receive oxygen and nutrients from the blood, or when there is sudden bleeding into or around the brain.

Although all strokes happen in the brain, there are two different types of strokes: hemorrhagic and ischemic. During a hemorrhagic stroke, blood vessels rupture and allow blood to leak into the brain. During an ischemic stroke, a blood clot stops the flow of blood into the brain.

Risk factors

Strokes are caused by the same risk factors that cause heart attacks, including high blood pressure, diabetes, high cholesterol, cigarette smoking and obesity.

How to recognize a stroke

 A stroke can happen to anyone, at any time and in any place. Knowing the signs and symptoms of a stroke is the first step to ensuring immediate medical help. Learn as many of these stroke symptoms as possible so you can recognize a stroke FAST and save a life!

F – Face droops on one side
A – Arm drifts down on one side
S – Speech sounds strange
T – Time is critical, so get help quickly!

A medical emergency

For each minute that a stroke goes untreated, a person loses about 1.9 million neurons. This loss of brain cells can affect a person’s speech, movement, memory and so much more. Immediate stroke treatment may save someone's life and enhance his or her chances for successful rehabilitation and recovery.

If you observe any stroke symptoms, call 9-1-1 immediately. Secondly, try to note the exact time of the first symptom and the exact time when you saw the person without those symptoms. In addition, find out all of the medications the person currently takes (for any condition), and which medications the person has taken today. This information can affect treatment decisions.

How Genetic Counseling is Empowering Those at Risk for Inherited Cancers


For all that we still don’t know about cancer, we are certain of two facts:

  • Five to ten percent of cancers—including some breast, ovarian, endometrial, colon, thyroid, and pancreatic cancers—are due to an inherited gene mutation, and
  • The earlier you catch cancer, the easier it is to treat.

The goal of genetic testing is to identify genetic abnormalities, called gene mutations, which increase an individual’s risk to develop certain cancers. But who should get tested? Does a positive result guarantee that you’ll get cancer? And does a negative result ensure that no future screening is necessary?

This is where genetic counseling comes in. Genetic counseling is a comprehensive approach to assessing and managing an individual’s cancer risk. Genetic counselors help patients understand how mutations contribute to cancer risk and can be passed down through families; who can benefit from testing; how test results are interpreted; the probability that an individual will develop cancer or a secondary cancer; the likelihood of relatives inheriting the mutation; and appropriate screening and risk-reduction strategies, and also provides resources for support.

Chloe Farkas, MGC, CGC is a certified genetic counselor, based at the Lombardi Comprehensive Cancer Center at MedStar Georgetown University Hospital. She also sees patients at MedStar Southern Maryland Hospital Center’s Breast Health Program and the Washington Cancer Institute at MedStar Washington Hospital Center.

“I feel strongly about making medical and scientific information available to everyone,” Chloe says. “Genetics is an emerging science and it is changing rapidly. Something new is discovered almost every week.”

In the general population, the risk of having a gene mutation associated with a hereditary cancer syndrome is low. But if you have a family history of early-onset and/or rare cancer, were diagnosed with cancer before the age of 50, or have a known mutation in a cancer risk gene such as BRCA1 or BRCA2 in your family, you are a candidate for genetic testing.

Chloe’s job starts before the testing begins. “I provide information and context for the patient,” she says. “After we talk, some patients choose to have genetic testing and some don’t. For most individuals at high risk to carry a mutation, we encourage testing because a positive result may inform options for increased cancer screening and/or risk reducing surgeries. Individuals at high risk to carry a mutation are generally patients who have been diagnosed with a cancer suggestive of a hereditary cancer syndrome (i.e. an individual diagnosed with breast cancer diagnosed before age 50) or it may be a person who has not developed cancer, but whose relative carries a known genetic mutation.  We try not to test individuals without a personal history of cancer who do not have a known genetic mutation in the family because it is much harder to interpret the meaning of a negative result and because it is difficult to obtain insurance coverage for genetic testing for unaffected individuals.”

It all starts with the genes. Genes tell our bodies how to function and develop. We all have two copies of each gene; one copy inherited from mom and one copy inherited from dad. A small percentage of people are born with an inherited gene mutation in a cancer risk gene, which means they have only one working copy of that gene. Because specific cancer risk genes prevent the growth of tumors or the development of cancers, people with only one working gene are not as well protected as those with two working copies of the gene, putting them at higher risk to develop cancer.

So the first step for a genetic counselor is to gather the patient’s medical and family histories, which will indicate the probability that she or he may have a mutation in a cancer risk gene. If a patient does not have cancer, Chloe assesses his or her risk of carrying a gene mutation, helps identify the best candidate in the family to undergo genetic testing, and estimates an individual’s cancer risk based on the patient’s personal and family history using risk modeling. If there is a personal history of cancer, Chloe explains possible inherited causes of the cancer and assesses the risk that the patient may develop a secondary cancer. She then helps the patient decide whether genetic testing is appropriate and whether he or she wants to pursue it.

Genetic tests are more affordable and accessible than ever before. Inherited breast and ovarian cancers are primarily caused by mutations in two genes: BRCA1 and BRCA2; Chloe provides genetic testing for those and others that are not as common.

Results are available within two to six weeks, depending on the test, and Chloe then contacts the patient to discuss the result and answer questions.

“Genetic counseling helps patients put all this information in perspective, because the details can be confusing or scary at first,” she says.

Although genetic testing accurately detects the vast majority of known mutations, no test can be 100% accurate. An individual may still carry an undetected mutation, even with a negative result; patients who are at risk based on personal and/or family history are encouraged to have regular cancer screenings to ensure that if a cancer does develop, it’s caught early. Conversely, receiving a positive result does not guarantee a person has an 100% chance to develop cancer. Genetic counselors help patients and their physicians understand the meaning of a genetic testing result.  Physicians and patients can then use the information to appropriately tailor a cancer screening program.

Chloe’s interest in genetics started in college, and eventually drew her into the healthcare field. She earned a B.A. degree in chemistry and English from Case Western Reserve University, and a master’s in genetic counseling from the University of Maryland. She is one of only two cancer genetic counselors in the MedStar system in the Washington, D.C. area.

“We’re very excited to have Chloe here at MedStar Southern Maryland Hospital,” says Katerina Tsiapali, MD, a surgical oncologist and medical director of the MedStar Breast Health Program. “With genetic counseling, patients are educated and given context in which to understand the test results, so they’re prepared for all eventualities.”

Chloe Farkas, MGC, CGC