What’s New For Migraine Prevention?

A new category of medication for prevention of migraine is in the late stages of clinical trials and is expected to be available by early 2018. This category is called CGRP Monoclonal Antibodies. It will be administered either as a monthly self-administered injection or by IV (intravenous) every 3 months. Four pharmaceutical companies (Alder, Amgen, Lilly and Teva) are all developing CGRP drugs and are competing to be the first to come to market.

The headache community is very excited about this new category of preventive treatment as it is working quite well in clinical trials. This can be a great option for Botox non-responders or others not doing well with their current treatment.

Stay tuned!

What is the difference between a migraine and a cluster headache?

molly_croppedMigraines are characterized by disabling attacks often including throbbing/pulsating pain, nausea, sensitivity to light, and the desire to be in a dark quiet room.  In contrast, cluster headaches are characterized by incredibly severe pain in and around one eye with drooping of the eyelid on the affected side, tearing, nasal congestion, and the sufferer is agitated, pacing, and may even be hitting their head against the wall.  In fact, cluster has often been referred to as the “suicide headache” due to its severity.  Migraine is much more common than cluster and it tends to be recurrent throughout the year.  In contrast, cluster, as the name implies, often clusters together during certain times of the year and may go away for months at a time.  Unlike migraine, cluster is much more common in men.  Treatment is different for migraine and cluster, so proper diagnosis and evaluation is important.  We treat both in our practice.

If you think you are suffering from one of these, call for an appointment 949-861-8717.

Alternatives to the Emergency Room

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When a severe migraine hits, many sufferers end up in the ER. This is not ideal for many reasons including the long wait to be seen, the noise and bright lights in the ER, the attitude of the ER staff often treating the migraine patient as a narcotic seeker, and lastly, the cost. There are several alternatives to the ER including an urgent care center, home rescue, or an infusion center.

Urgent cares are typically open from 8 am to 8-10 pm seven days a week and do not require an appointment. They can give injectable medications like Toradol (Ketorolac) for the pain and if necessary, anti-vomiting injectables. Most don’t provide Intravenous Fluids (IV’s) so if someone is dehydrated, may be better to go to an ER. However, the Hoag Urgent Care near our office does offer IV treatment. The cost and wait time are typically much less in urgent care centers compared to the ER.

Home rescue is ideal and a home rescue plan should be part of every migraine patients’ “tool box.” Examples of home rescue include injectable Sumatriptan, nasal formulations of Sumatriptan, injectable Toradol, rectal suppositories, steroids, and narcotics. When a headache is prolonged and/or severe, it often does not respond to oral medication so non-oral treatment forms are preferred.

An Infusion Center can provide IV fluids and IV medication similar to an ER but in a calm and quiet atmosphere. Trained RN’s start an IV and administer the medication. Orders must be sent to the Infusion Center ahead of time and typically are a “standing order” set for a maximum of 90 days. Once the orders are approved and in the system for the Infusion Center, the patient can call for a same day appointment to be treated. There is a maximum number of visits per month that the patient can go for example 4-6 times. Infusion Centers are an excellent treatment option for migraine patients. They are also much less expensive than the ER setting.

I encourage all migraine sufferers to have an emergency plan in place for those migraines that get out of control. Ideally, home rescue can be successful eliminating the need to leave your home. If not successful, urgent care centers and infusion centers are good alternative options to the ER.

I look forward to reviewing your rescue plan to avoid ER visits as much as possible. When those ER visits are needed, a letter from me or your health care provider legitimatizing that you have migraines and are not a narcotic seeker, can help that experience be more comfortable.

Susan Hutchinson, MD
October 30, 2016


What is the difference between a headache and a migraine?


What is the difference between a headache and a migraine?

Migraines are headaches, but not all headaches are migraines.  So, a migraine is a type of headache.  There are many other types of headaches including:  tension headache, cluster headache, cervicogenic headache, trigeminal neuralgia, occipital neuralgia to name a few.

– Dr. Molly Rossknecht

For more information, call and schedule an appointment at 949-861-8717

How long does it normally take to determine if a treatment isn’t working?


How long does it normally take to determine if a treatment isn’t working?  How patient should I be?

For most headache prevention treatments, it can take up to 4 weeks to see significant benefit (however some patients may see benefit at 1-2 weeks).  If at 4+ weeks there is no real headache benefit and if you are tolerating the medication/treatment well (as far as adverse effects) we would likely discuss adjusting your dosage.  Every patient is different and it’s just a matter of finding out what dosage of medication you respond to.  If you have reached a therapeutic dose for a few weeks and you do not feel it is helping, at that point we would make a change, discuss other options.

– Dr. Molly Rossknecht

For more information, call and schedule an appointment at 949-861-8717

Can Migraines Be Prevented?

molly_croppedNow that I know my headaches are migraines, can they be prevented?

Yes, there are many different treatment options for migraine prevention, it’s just a matter of finding the right one for you.  There are 2 ways we look at treating migraine- prevention (daily treatment to cut down the amount of headache days per month) and abortive therapy (what to do/take when you have the migraine).  If you are only having a few migraines per month and you are headache-free the other days, there isn’t a real need to take something every day to prevent them (you just need an abortive).

However, if you are having many headache days per month, prevention is definitely key to cutting down the number of days (zero would be ideal!).  When you get to a place where you are feeling better and having less headaches, then we can discuss coming off the prevention to see how you do…. preventatives do not have to be a “forever” thing.  In other words, if you are doing really well on a preventative medication I would not want you to think you will have to take it for the rest of your life.  Headaches can change/improve over time. – Dr. Molly Rossknecht

For more information, call and schedule an appointment at 949-861-8717

Introducing Dr. Molly Rossknecht

Dr. Molly Rossknecht

molly_croppedDr. Molly Rossknecht is a neurologist who specializes in headache medicine. She is originally from South Florida and went to college at Florida Atlantic University, graduating with a BS in Biology and MS in Biomedical Science. She then went on to medical school at Nova Southeastern University College of Osteopathic Medicine where she completed the dual degree DO/MPH program. Dr. Rossknecht completed her internship and neurology residency at Garden City Hospital in Michigan, a program through the Statewide Campus System of Michigan State University, followed by a headache fellowship at the University of Michigan. She looks forward to helping patients on their journey to healing at Orange County Migraine & Headache Center

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