Bio


Dr. Moskatel is internist with fellowship training in headache medicine and board certification in internal medicine. He is a clinical assistant professor in the Stanford University School of Medicine Department of Neurology, Division of Headache.

His practice at the Stanford Health Care Headache Clinic focuses on the diagnosis and treatment of all forms of headache. Patients come to him seeking relief from migraine, cluster, and tension headaches.

Dr. Moskatel teaches headache medicine to medical students and supervises resident physicians in the Stanford Health Care Headache Clinic.

He conducts research into migraine and diet, medication overuse headache, and long-lasting headache after COVID-19. He has written articles on these and other topics. They have appeared in peer-reviewed journals such as Headache, Current Neurology and Neuroscience Reports, Annals of Headache Medicine, and Pain Medicine.

Dr. Moskatel has reviewed the content of articles written by other doctors for the journals Headache and Pain Medicine. The publication Annals of Internal Medicine awarded him a letter of commendation as outstanding reviewer.

He has co-authored textbook chapters on migraine and diet and on headache treatments. He has presented his research discoveries to his peers at meetings of the World Headache Society and other organizations.

Dr. Moskatel volunteers his time to serve both professional and community organizations. He speaks English and Hebrew fluently and reads French.

Clinical Focus


  • Pain Medicine

Academic Appointments


Professional Education


  • Board Certification: United Council for Neurologic Subspecialties, Headache Medicine (2022)
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2020)
  • Fellowship: Stanford School of Medicine (2021) CA
  • Residency: Mercy Hospital and Medical Ctr (2020) CA
  • Medical Education: University of Southern California Keck School of Medicine (2017) CA

Clinical Trials


  • PArtial REbreathing for Migraine With Aura 1 Not Recruiting

    A prospective, multi-centre, randomized, double-blind, sham-controlled, parallel-group, group-sequential study to investigate safety and effectiveness of the Rehaler partial rebreathing device, in adults suffering from migraine with aura

    Stanford is currently not accepting patients for this trial. For more information, please contact Robert Cowan, MD, 650-723-5184.

    View full details

All Publications


  • Long-Term Epidural Patching Outcomes and Predictors of Benefit in Patients With Suspected CSF Leak Nonconforming to ICHD-3 Criteria. Neurology Carroll, I., Han, L., Zhang, N., Cowan, R. P., Lanzman, B., Hashmi, S., Barad, M. J., Peretz, A., Moskatel, L., Ogunlaja, O., Hah, J. M., Hindiyeh, N., Barch, C., Bozkurt, S., Hernandez-Boussard, T., Callen, A. L. 2024; 102 (12): e209449

    Abstract

    Spinal CSF leaks lead to spontaneous intracranial hypotension (SIH). While International Classification of Headache Disorders, Third Edition (ICHD-3) criteria necessitate imaging confirmation or low opening pressure (OP) for SIH diagnosis, their sensitivity may be limited. We offered epidural blood patches (EBPs) to patients with symptoms suggestive of SIH, with and without a documented low OP or confirmed leak on imaging. This study evaluates the efficacy of this strategy.We conducted a prospective cohort study with a nested case-control design including all patients who presented to a tertiary headache clinic with clinical symptoms of SIH who completed study measures both before and after receiving an EBP between August 2016 and November 2018.The mean duration of symptoms was 8.7 ± 8.1 years. Of 85 patients assessed, 69 did not meet ICHD-3 criteria for SIH. At an average of 521 days after the initial EBP, this ICHD-3-negative subgroup experienced significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health score of +3.3 (95% CI 1.5-5.1), PROMIS Global Mental Health score of +1.8 (95% CI 0.0-3.5), Headache Impact Test (HIT)-6 head pain score of -3.8 (95% CI -5.7 to -1.8), Neck Disability Index of -4.8 (95% CI -9.0 to -0.6) and PROMIS Fatigue of -2.3 (95% CI -4.1 to -0.6). Fifty-four percent of ICHD-3-negative patients achieved clinically meaningful improvements in PROMIS Global Physical Health and 45% in HIT-6 scores. Pain relief following lying flat prior to treatment was strongly associated with sustained clinically meaningful improvement in global physical health at an average of 521 days (odds ratio 1.39, 95% CI 1.1-1.79; p < 0.003). ICHD-3-positive patients showed high rates of response and previously unreported, treatable levels of fatigue and cognitive deficits.Patients who did not conform to the ICHD-3 criteria for SIH showed moderate rates of sustained, clinically meaningful improvements in global physical health, global mental health, neck pain, fatigue, and head pain after EBP therapy. Pre-treatment improvement in head pain when flat was associated with later, sustained improvement after EBP therapy among patients who did not meet the ICHD-3 criteria.This study provides Class IV evidence that epidural blood patch is an effective treatment of suspected CSF leak not conforming to ICHD-3 criteria for SIH.

    View details for DOI 10.1212/WNL.0000000000209449

    View details for PubMedID 38820488

  • Long-term persistence to OnabotulinumtoxinA to prevent chronic migraine: Results from 11 years of patient data from a tertiary headache center. Pain medicine (Malden, Mass.) Moskatel, L. S., Graber-Naidich, A., He, Z., Zhang, N. 2024

    Abstract

    OBJECTIVE: To determine if patients with chronic migraine continue onabotulinumtoxinA (onabotA) long-term.METHODS: We performed a retrospective cohort analysis using aggregated, de-identified patient data from the Stanford Headache Center. We included patients in California who received at least one prescription for onabotA during the years of 2011-2021. The primary outcome was the number of onabotA treatments each patient received. Secondary outcomes included sex, age, race, ethnicity, body mass index (BMI), distance to the treatment facility, and zip code income quartile.RESULTS: A total of 1,551 patients received a mean of 7.60±7.26 treatments and a median of 5 treatments, with 16.2% of patients receiving only one treatment and 10.6% receiving at least 19. Time-to-event survival analysis suggested 26.0% of patients would complete at least 29 treatments if able. Younger age and female sex were associated with statistically significant differences between quartile groups of number of onabotA treatments (p=0.007, p=0.015). BMI, distance to treatment facility, and zip code income quartile were not statistically significantly different between quartile groups (p>0.500 for all). Prescriptions of both triptans and non-onabotA preventive medications showed a statistically significant increase with each higher quartile of number of onabotA treatments (p<0.001; p<0.001).DISCUSSION: We show long-term persistence to onabotA is high and that distance to treatment facility and income are not factors in continuation. Our work also demonstrates that as patients continue onabotA over time, there may be an increased need for adjunctive or alternative treatments.

    View details for DOI 10.1093/pm/pnae020

    View details for PubMedID 38518091

  • Alcohol Use Disorder in Patients with Chronic Migraine: A Retrospective, Observational Study. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques Moskatel, L. S., Zhang, N. 2024: 1-11

    Abstract

    The relationship between migraine and alcohol consumption is unclear. We assessed the association between chronic migraine and alcohol use disorder(AUD), relative to chronic disease controls, and in conjunction with common comorbidities.We conducted a retrospective, observational study. The primary outcome was the odds ratio for AUD in patients with chronic migraine or with chronic migraine and additional comorbidities relative to controls.A total of 3701 patients with chronic migraine, 4450 patients with low back pain, and 1780 patients with type 2 diabetes mellitus met inclusion criteria. Patients with chronic migraine had a lower risk of AUD relative to both controls of low back pain (OR 0.37; 95% CI: 0.29-0.47, p < 0.001) and type 2 diabetes mellitus (OR 0.39; 95% CI: 0.29-0.52, p < 0.001). Depression was associated with the largest OR for AUD in chronic migraine (OR 8.62; 95% CI: 4.99-14.88, p < 0.001), followed by post-traumatic stress disorder (OR 6.63; 95% CI: 4.13-10.64, p < 0.001) and anxiety (OR 3.58; 95% CI: 2.23-5.75, p < 0.001).Patients with chronic migraine had a lower odds ratio of AUD relative to controls. But in patients with chronic migraine, those with comorbid depression, anxiety, or PTSD are at higher risk of AUD. When patients establish care, comorbid factors should be assessed and for those at higher risk, AUD should be screened for at every visit.

    View details for DOI 10.1017/cjn.2024.10

    View details for PubMedID 38268310

  • The introduction of the CGRP monoclonal antibodies and their effect on the prescription patterns of chronic migraine preventive medications in a tertiary headache center: A retrospective, observational analysis. Headache Moskatel, L. S., Graber-Naidich, A., He, Z., Zhang, N. 2023

    Abstract

    OBJECTIVE: To determine the effect of the introduction of the calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) in 2018 on the prescribing of older medications for the prevention of chronic migraine.BACKGROUND: Prior to 2018, the preventive treatment of migraine borrowed from medications intended to treat other illnesses with the last medication, onabotulinumtoxinA, receiving Food and Drug Administration (FDA) approval for the prevention of chronic migraine in 2010. The FDA approval of three CGRP mAbs in 2018 provided the ideal natural experiment to assess how the introduction of these medications, and a fourth in 2020, affected the generally stable migraine preventive medications market.METHODS: We performed a retrospective cohort analysis using the aggregated de-identified data of 6595 patients. The percentage of patients with chronic migraine who had been prescribed one of ten most prescribed oral preventive medications or onabotulinumtoxinA, or any of the four CGRP mAbs, were calculated relative to the total number of patients with chronic migraine who received a prescription for any medication from our clinic during the pre-CGRP mAb years of 2015-2017 and post-approval years of 2019-2021.RESULTS: We observed a statistically significant decrease in the prescription of the top 10 most prescribed medications after the introduction of the CGRP mAbs overall (1456/3144, 46.3%, to 1995/4629, 43.1%, p=0.001), as well as with most individual medications, including large decreases in verapamil (230/3144, 7.3%, to 125/4629, 2.7%; p<0.001), the tricyclic antidepressants (494/3144, 15.7%, to 532/4629, 11.5%; p<0.001), topiramate (566/3144, 18.0%, to 653/4629, 14.1%; p<0.001), and onabotulinumtoxinA (861/3144, 27.4%, to 1134/4629, 24.5%; p=0.001).CONCLUSION: The introduction of the CGRP mAbs during 2018 resulted in a decrease in utilization of most oral medications and onabotulinumtoxinA for the prevention of migraine. Future work should continue to observe how the prescription patterns of these medications evolve with time.

    View details for DOI 10.1111/head.14642

    View details for PubMedID 37882379

  • Comparative prevalence and characteristics of fabricated citations in large language models in headache medicine. Headache Moskatel, L. S., Zhang, N. 2023

    View details for DOI 10.1111/head.14638

    View details for PubMedID 37837216

  • An exploratory, comparative case series of calcitonin gene-related peptide monoclonal antibodies in migraine patients with rosacea. The British journal of dermatology Sia, T., Webb, T., Li, S., Moskatel, L. S., Chang, A. L. 2023

    View details for DOI 10.1093/bjd/ljad277

    View details for PubMedID 37596936

  • The utility of ChatGPT in the assessment of literature on the prevention of migraine: an observational, qualitative study. Frontiers in neurology Moskatel, L. S., Zhang, N. 2023; 14: 1225223

    Abstract

    It is not known how large language models, such as ChatGPT, can be applied toward the assessment of the efficacy of medications, including in the prevention of migraine, and how it might support those claims with existing medical evidence.We queried ChatGPT-3.5 on the efficacy of 47 medications for the prevention of migraine and then asked it to give citations in support of its assessment. ChatGPT's evaluations were then compared to their FDA approval status for this indication as well as the American Academy of Neurology 2012 evidence-based guidelines for the prevention of migraine. The citations ChatGPT generated for these evaluations were then assessed to see if they were real papers and if they were relevant to the query.ChatGPT affirmed that the 14 medications that have either received FDA approval for prevention of migraine or AAN Grade A/B evidence were effective for migraine. Its assessments of the other 33 medications were unreliable including suggesting possible efficacy for four medications that have never been used for the prevention of migraine. Critically, only 33/115 (29%) of the papers ChatGPT cited were real, while 76/115 (66%) were "hallucinated" not real papers and 6/115 (5%) shared the names of real papers but had not real citations.While ChatGPT produced tailored answers on the efficacy of the queried medications, the results were unreliable and inaccurate because of the overwhelming volume of "hallucinated" articles it generated and cited.

    View details for DOI 10.3389/fneur.2023.1225223

    View details for PubMedID 37662036

    View details for PubMedCentralID PMC10469750

  • The Role of Step Therapy in the Treatment of Migraine. Current pain and headache reports Moskatel, L. S., Zhang, N. 2023

    Abstract

    PURPOSE OF REVIEW: This review examines recent evidence and applies bioethical principles to evaluate the benefits and risks of using step therapy in the treatment of migraine.RECENT FINDINGS: With the CGRP mAbs, gepants, and lasmiditan now on the market for up to 5years, new research, including network meta-analyses and long-term use studies, can evaluate the comparative efficacy, tolerability, and adherence of these medications relative to older acute and preventive medications for the treatment of migraine. Deciding how medications are chosen for patients requires accounting for many factors including sustainability, efficacy, tolerability, and preference. Newer research can help give clarity on the appropriateness of gating certain treatment options behind others.

    View details for DOI 10.1007/s11916-023-01155-w

    View details for PubMedID 37542597

  • Real world evidence of changes in CGRP monoclonal antibody and onabotulinumtoxinA prescription practices at the start of the COVID-19 pandemic: An observational, retrospective study. Headache Moskatel, L. S., Graber-Naidich, A., He, Z., Zhang, N. 2023

    View details for DOI 10.1111/head.14585

    View details for PubMedID 37358470

  • "The Impact of COVID-19 on Alcohol Sales and Consumption in the United States: a Retrospective, Observational Analysis". Alcohol (Fayetteville, N.Y.) Moskatel, L. S., Slusky, D. J. 2023

    Abstract

    Understanding the COVID-19 pandemic's effect on alcohol sales and consumption is critical in mitigating alcohol abuse and morbidity. We sought to determine how the onset of the COVID-19 pandemic and changes in viral incidence affected alcohol sales and consumption in the United States. We conducted a retrospective observational analysis regressing National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcohol sales data and Behavioral Risk Factor Surveillance System (BRFSS) survey data for 14 states for 2017 to 2020 with COVID-19 incidence in 2020 in the United States. The onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% Confidence Interval: 0.63 to 3.34, p=0.007). Increases of one COVID-19 case per 100 were associated with lower monthly alcohol sales per capita of 2.98 standard drinks (95% CI: -4.47 to -1.48, p=0.001) as well as broad decreases in alcohol consumption, notably 0.17 fewer days per month with alcohol use (95% CI: -0.31 to -0.23, p=0.008) and 0.14 fewer days per month of binge drinking (95% CI: -0.23 to -0.052, p<0.001). The COVID-19 pandemic is associated with increased monthly average alcohol purchases, but higher viral incidence is linked to lower alcohol purchases and consumption. Continued monitoring is needed to mitigate the effects of higher population alcohol use during the pandemic.

    View details for DOI 10.1016/j.alcohol.2023.05.003

    View details for PubMedID 37230334

  • The Impact of COVID-19 Incidence on Emergency Medical Services Utilization. The Journal of emergency medicine Moskatel, L. S., Slusky, D. J. 2023

    View details for DOI 10.1016/j.jemermed.2023.04.017

    View details for PubMedID 37460386

  • Headache and Dizziness after Roller Coaster Rides: A Case Series of 31 Patients CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES Moskatel, L. S., Smirnoff, L. 2022: 1-4

    Abstract

    Previous literature on roller coaster injuries focuses on catastrophic injuries. We conducted a retrospective study of 31 adults with headache or dizziness after roller coaster rides. Twenty five of 31 (81%) patients presented with new or worsening headache, predominantly migraine (15/25, 60%), including 8/25 (32%) with chronic migraine. Of the chronic migraine patients, 4/8 (50%) already had the diagnosis and presented with an exacerbation. Five of the 25 (20%) were ultimately found to have a cerebrospinal fluid (CSF) leak. While persistent symptoms appear to be relatively rare, patients with chronic migraine and potential CSF leaks should consider skipping these attractions.

    View details for DOI 10.1017/cjn.2022.315

    View details for Web of Science ID 000896788200001

    View details for PubMedID 36329659

  • Protracted headache after COVID-19: A case series of 31 patients from a tertiary headache center. Headache Moskatel, L. S., Smirnoff, L. 2022

    Abstract

    BACKGROUND: Headache can be a prominent feature of Post-Acute Sequelae of SARS-Cov2 infection (PASC) and previous studies have centered around PASC headaches that have resolved within a month of infection.METHODS: We performed a retrospective chart review of 31 adults evaluated at the Stanford Headache Clinic between September 2020 and January 2022 who developed new or worsening headaches after COVID-19 infection that were unresolved at time of evaluation for demographics, medical history, and headache diagnosis.RESULTS: Headache had been present for a mean duration of 7.4±4.8 months after infection. Notably, 25/31 (81%) had a previous history of headache. The specific features of the headache varied considerably, but 23/31 (74%) met International Classification of Headache Disorders, Third Edition (ICHD-3) criteria for migraine, with 20/31 (65%) meeting ICHD-3 criteria for chronic migraine, while only 5/31 (16%) met these criteria before COVID infection. Additionally, full-time employment decreased from 25/31 (81%) to 17/31 (55%). Prior to establishing care at our clinic, 13/18 (72%) of the patients who were started on preventive medications currently indicated for migraine management, reported a decrease in frequency and/or severity of headaches.CONCLUSIONS: Our study presents a group of patients with protracted headache after COVID-19 infection that includes both patients with a previously lower headache burden who largely exhibited chronification from episodic to chronic migraine, as well as patients with no previous history of headache who meet ICHD-3 criteria for headache attributed to a systemic viral illness, mostly with a migrainous phenotype.

    View details for DOI 10.1111/head.14337

    View details for PubMedID 35670231

  • Migraine and Diet: Updates in Understanding. Current neurology and neuroscience reports Moskatel, L. S., Zhang, N. 2022

    Abstract

    PURPOSE OF REVIEW: We explore recent developments in the prevention and treatment of migraine through dietary interventions.RECENT FINDINGS: Healthier diets (defined in multiple ways), meal regularity, and weight loss are associated with decreased headache burden. Specific diets including the ketogenic diet, the low-glycemic index diet, and the DASH diet are supported by modest evidence for the prevention of migraine. Neither a gluten-free diet, in patients without celiac disease, nor elimination diets have sufficient evidence for their routine consideration. Diet remains a crucial, but underexplored, component of comprehensive migraine management. Multiple interventions exist for providers and patients to consider integrating into their treatment plan. Larger studies are needed to support stronger recommendations for utilization of specific dietary interventions for the prevention and treatment of migraine.

    View details for DOI 10.1007/s11910-022-01195-6

    View details for PubMedID 35482279

  • Headache Made SIMPAL: A Simple Mnemonic for the Approach to Headache Evaluation and Migraine Treatment. Pain medicine (Malden, Mass.) Migdal, C. W., Moskatel, L. S., Schuster, N. M. 2021; 22 (3): 754–58

    View details for DOI 10.1093/pm/pnaa429

    View details for PubMedID 33735383

  • Staphylococcus intermedius Brain Abscess as a Complication of Pulmonary Arteriovenous Malformation in a Patient With Hereditary Hemorrhagic Telangiectasia OPEN FORUM INFECTIOUS DISEASES Moskatel, L. S., Vo, J. N., Nayak, K. R., Crum-Cianflone, N. F. 2020; 7 (11): ofaa467

    Abstract

    Staphylococcus intermedius is a rare cause of human infections ranging from skin and soft tissue infections to bacteremia. It is particularly known for its association with exposure to dogs. We report an unusual case of a 73-year-old female with a brain abscess caused by S intermedius who was recently diagnosed with hereditary hemorrhagic telangiectasia and a pulmonary arteriovenous malformation. The patient underwent debridement of the brain abscess followed by a 6-week course of vancomycin and rifampin, after which she made a near complete recovery. This is the first case of a brain abscess in an adult due to S intermedius in the published literature, and we provide a comprehensive review of the literature of all human infections caused by this pathogen and summarize its clinical manifestations, treatment recommendations, and outcomes.

    View details for DOI 10.1093/ofid/ofaa467

    View details for Web of Science ID 000604521300025

    View details for PubMedID 33209954

    View details for PubMedCentralID PMC7652099