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

(Download PDF version)

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?

molly_cropped

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?

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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

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