Can a person experience a migraine without pain?

Yes, they are not uncommon.  Typical symptoms include visual symptoms (flashing lights, zig-zag lines, or the absence of vision in all or part of the visual field).  Other symptoms can include tingling on one side of the body and/or slurred speech, or vertigo.  These types of migraines are often referred to as aura without headache (acephalgic migraine).  Symptoms may last from minutes to days.   Treatment varies but may include migraine specific medication.  These symptoms should always be evaluated by a healthcare provider for a correct diagnosis.

To make an appointment, please call 949-861-8717.

Summer Newsletter: Barometric Pressure Change & Migraine

(Download PDF version)

Many of my migraine patients tell me they don’t even need to listen to the weather report. They can tell when rainy or cloudy weather is coming due to an increase in their migraines.

Why is that?
We don’t know exactly why changes, especially drops, in barometric pressure can lead to migraines but here is what we do know: an approaching storm causes a drop in barometric pressure. This affects the pressure in the external environment including the external ear canal. This can lead to an imbalance between the pressure behind the tympanic membrane (middle ear) and the external barometric pressure. There is a certain air pressure in the sinuses, Eustachian tubes, and inner ear at any given time and if the external pressure drops, that imbalance is thought to trigger a migraine in some migraine sufferers. A change in barometric pressure of as little as .20 millibars impacts the pressure in the ear canal and can lead to migraines.

How can this be treated? 
In addition to taking the usual migraine medication, inserting a pressure regulating device (MigraineX) may be helpful. MigraineX looks like a small set of ear plugs (drug & latex free) and is designed to control the rate of barometric pressure changes in the ear canal adjacent to the ear drum (tympanic membrane). The device can be inserted preventively or at first sign of headache if a drop in barometric pressure suspected as the trigger. This product is best used in conjunction with a free App called MigraineX that can predict changes in weather and barometric pressure.

When I first learned about this device, I requested that a limited number of free samples be sent to my office for use in my patients who report that changes in barometric pressure cause migraine attacks. I have given out the first 8 devices this past week and have asked these patients to give my office feedback in coming weeks.

I am skeptical of new products that come into the marketplace promising too much especially if they are expensive. I was very pleased to see that MigraineX can be ordered online through Amazon for only $11.99. In addition, it retails for about $9.99 at CVS and does not require a prescription.

Grant O’Connell, Digital Marketing Manager, Cirrus Healthcare/MigraineX states “What separates MigraineX from other migraine relief medications is, medication-only focuses on relieving symptoms after a headache starts. The best defense against weather-related migraines is to prevent the pressure before it starts. Utilizing our app for weather event alerts will give you a step ahead to minimize the pressure using the MigraineX plugs. We are confident new customers will find MigraineX to be a great reliever from headaches.”

As I am writing this newsletter, I am wearing them and they are comfortable. They were easy to insert. Also, I easily downloaded the MigraineX app.

In a study of 36 patients who used this device in addition to their usual migraine medications, the majority felt their migraine was better treated and less likely to return. For more information, go to www.migrainex.net

For any of you who feel that changes in barometric pressure and weather are a common trigger for your migraines, I suggest you set up an appointment to review our current treatment plan and see if this new MigraineX device makes sense for you.

In summary, MigraineX may be a welcome addition to your Migraine Toolbox if changes in weather and barometric pressure are triggers for you. I welcome your feedback once you have tried this device.

 

Susan Hutchinson, MD

Director-Orange County Migraine & Headache Center

June 18, 2017

Annual John Graham Lecture Award Winner Thanks Dr. Hutchinson Among Others

Professor Gretchen Tietjen recently received the annual John Graham lecture award from Paul Rizzoli and thanked friends and collaborators including Lynne Osborn Geweke, Dawn Buse, Sheena K. Aurora and Susan Lynn Hutchinson.

“I am so happy for Dr. Gretchen Tietjen to receive this prestigious award. I was happy to be part of our Women’s Issues Section research that contributed to this award.” – Dr. Susan Hutchinson.

What type of doctor is best at treating headache?

In the past, neurologists were the most common type of doctor that patients would see for severe headaches.  Now, headache has become a specialty open to non-neurologists as well as neurologists.  Currently, there are only a little over 500 headache specialists in the United States.  Dr. Susan Hutchinson is a Board Certified Family Medicine Physician with a sub-specialty in headache.  I am a neurologist who completed a full 1 year headache fellowship. Dr. Hutchinson’s 21 years of practicing general family medicine including women’s health can help in recognizing the important role of hormones to headache and she is especially well-suited to treat menstrual migraine.  My background as a neurologist is well-suited to recognizing neurological conditions that may be associated with migraine.  Together, our practice provides an excellent comprehensive approach to the headache patient.

To make an appointment, please call 949-861-8717.

Why does a particular medication work really well for my friend with migraine but not for me?

Medications don’t work the same for everyone.  Your genes can influence the way your body responds to certain medications.  The good news is that gene testing is now available and can be as simple as a cheek swab that’s used to collect cells that contain your DNA.  We have begun using this technology to assist in optimal medication prescribing to better suit the individual patient.

To make an appointment, please call 949-861-8717.

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.

Dr. Susan Hutchinson Featured In FREE Live Online Migraine Event, Register Now!

The Migraine World Summit returns this April 23 – 29, 2017 to bring together over 30 top experts and doctors to provide answers, new treatments, research and best practices for migraine and chronic headache. It’s available to anyone with an internet connection.

Dr. Susan Hutchinson is one of the featured specialists.

 

UPDATE: Link has been removed as the event has passed.

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

 

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