Join The OC Migraine & Headache Center Angels 5K & 1 Mile Fun Run Team!

Orange County Migraine & Headache Center invites you to join our team for the Angels 5K & Fun Run on April 21st, 2018.  All are welcome to walk or run depending on their comfort level.

To register with our team:

  1. Please go here: https://raceroster.com/events/2018/15922/angels-baseball-5k-fun-run
  2. Choose either the 5k or 1 Mile Fun Run
  3. When filling out the form, make sure to select the Orange County Migraine & Headache Center team. (see screen shot below)

 

We look forward to running or walking with you and benefiting the Angels Baseball Foundation (charity)!

Improved Office Environment

In late 2017, Orange County Migraine & Headache Center committed to renovating its office to support a more tranquil and modern environment. This transformation optimizes the patient experience and empowers our physicians with more advanced technology to explain and reinforce communication of critical information. Additionally, employee working conditions are more ergonomic and productive.

Improvements include:

  • Waiting room with a video screen providing latest health care information
  • Patient rooms that allow our physicians to demonstrate, via touch screen video monitor, detailing and visualizing the patient’s condition on both a general and specific level.
  • All patient rooms now have computers and exam tables, allowing for both face-to-face interaction with the patient and performing procedures in the same room.
  • A tranquil design environment with pleasing color combinations and decor
  • New hypo-allergenic flooring
  • The practice have added a certified medical assistant to assist the doctors in basic medical care of their patients – including injections to relieve pain.

Please view photos below.

We look forward to seeing you for your next appointment.




Introducing Aurora Bernal-Renteria

Orange County Migraine & Headache Center is pleased to introduce Aurora Bernal-Renteria to our staff. Aurora is a certified medical assistant that adds a new dimension to our services. She is able to assist the physicians in many aspects of back-office care. Aurora also handles all facets of our Botox process from getting approval by prior authorization to ordering and securing Botox for the patients. Her infectious laughter and positive attitude are a perfect complement to the care and working environment we hold dear.

New Year’s Newsletter 2018

(Download PDF)

Dear Patient,

The beginning of the year allows a “fresh start” including setting goals and for some, a new direction to take in life. For our practice, the new direction for 2018 is to move towards being a narcotic/opioid free practice by the end of 2018. Heightened scrutiny and increasing regulation for prescribing narcotics like hydrocodone has occurred in this county. Some pharmacies now set limits on how many days a narcotic may be dispensed. As prescribers, we are required to regularly monitor controlled medication use on a statewide system called CURES.

Our medical practice is devoted to helping those with headaches and mood disorders. We are not a pain practice and are not set up to do urine drug testing as pain practices commonly do as part of monitoring their patient’s narcotic use. In addition, narcotics can work against good headache control by promoting medication overuse headache. Narcotics can create a condition called opioid hypersensitivity in which medications do not work as well. This is possible even with non-narcotic treatments such as triptans.

We realize this change in our practice will cause some of you to have to begin seeing a pain specialist if you are unable or unwilling to give up your narcotic. Our office will help in this process by referring you to a pain group that will work with you to take over the prescribing of the narcotic. We are actively meeting with pain groups to create a network of providers willing to see our patients.

During this process, we will continue to refill your narcotic as we don’t want our patients to suffer withdrawal symptoms. However, any narcotic/opioid medication will only be filled as part of an office visit and cannot be requested to be mailed or picked up in our office. For most, that will mean a monthly visit and the amount prescribed must last 1 full month. Early refills will not be honored. Activity will be monitored monthly on the CURES data base.

Fortunately, there are many effective non-narcotic treatment options for migraine and other headache disorders. Getting off your narcotic may be one of your goals for 2018 – We can help.

In closing, this change in our practice is not meant to be a punishment for those of you taking narcotics. We are moving our practice in a healthier direction and hope you come with us in this journey.
Respectfully,

Susan Hutchinson                                                                                        MD Molly Rossknecht, DO

Orange County Migraine & Headache Center

Newsletter: Update on Office Policies

(Download PDF)

Same day appointments:  Our office will make every effort to accommodate same day appointments upon request. However, you need to call first to allow us to see where we can fit you in. Please do not show up without an appointment. Also, keep in mind, that what we can provide for a severe headache is limited to non-narcotic injections such as Toradol or Imitrex, trigger point injections, occipital nerve blocks, and SPG blocks. We are not equipped to administer IV fluids, IV meds, or narcotics.

Prescription Refills: Please allow up to 3 business days for refills to be handled. Do not call our office to request a refill. Have your pharmacy fax us the request. In the case of an ADHD medication like Adderall, then email your request to info@ocmigraine.org. Keep in mind that in most cases, if you need a refill you probably are due for an appointment.

Appointments: All patients must be seen a minimum of every 6 months even if you are doing well: NO EXCEPTIONS.  This is Good Medicine! If you are doing well and do not feel you need to be seen this often, then consider having your primary care provider take over future prescription refills.

Completion of Forms/Letters: Keep in mind that there will be a fee to complete forms or to compose letters you request. The fee varies depending on the request and how long it will take the provider to complete. Please allow up to 2 weeks for completion. There could be an additional fee if a faster turn-around is requested. The cost will be determined and payment collected prior to the doctor fulfilling the request.

Email: We provide limited access to email. Emails take up to 5 business days to respond to so DO NOT email us with any urgent requests. Also, keep your emails short and to the point. Long emails will not be answered in full and are best handled by scheduling an office visit. For those living out of the area, phone visits are an option. Our office email is info@ocmigraine.org. If your email response requires specific personal medical information, our office will initiate a secure email protocol using Neo-Certified.  Your email will be responded to with a request to sign up with a password for Neo-certified to keep email correspondence HIPPA compliant and confidential.

After Hours Urgent Needs: Dr. Molly and Dr. Hutchinson rotate after hours coverage. If you have an urgent issue, you may call (not text) the after-hours line (949-514-4429) and the doctor covering will do their best to return your call within 1 hour. If you are experiencing a severe problem it will be better to call “911” or go to the Emergency Room.  Do NOT call the after hours line during regular business hours as it will go unanswered.  During business hours it is better to call our regular office number (949-861-8717) for urgent issues.

Office Hours: Current office hours are as follows:

Mondays: 8:30 am-5 pm

Tuesdays: 8:30 am-5 pm

Wednesdays: 8:30 am-5 pm

Thursdays: 9:30 am-5 pm

Fridays: CLOSED

Saturdays: 9 am-12: 30 pm Two Saturdays per Month (on average)

CLOSED FOR LUNCH FROM 12:30 – 1:45 PM MONDAY thru THURSDAY

 

Holiday Schedule:

Closed Wednesday Afternoon 11/22 to Monday 11/27 Morning

Closed Friday 12/22 to Tuesday 1/02/18

 

Feel free to call us if you have questions about our office policies. We look forward to continuing to provide quality care for our patients.  Suggestions, comments, and criticisms will be taken seriously.

Sincerely,

Susan Hutchinson, MD                                Molly Rossknecht, DO, MPH

 

Orange County Migraine & Headache Center

 

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’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!

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

 

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

Summer Newsletter 2016

(Downlowd PDF version)

Dear Patients,

I’m starting off this newsletter with a little house cleaning.

Quick Reminder regarding Prescription Refills: Please have your pharmacy fax us all prescription requests and allow 3 Business Days to be handled. If your request is for a controlled medication like Adderall or Hydrocodone, it can be requested in writing by sending our office an email request to info@ocmigraine.org.  Verbal requests for prescriptions will not be taken as it creates potential medication errors. For a more complete description of our prescription policy, please go to our website.

 

WHAT’s NEW FOR ACUTE MIGRAINE TREATMENT?

 

Onzetra is a new nasal delivery form of Sumatriptan
Onzetra is a new nasal delivery form of Sumatriptan that just received FDA approval.  It is different than the current Sumatriptan and Zolmitriptan nasal sprays in that it is breath activated.  It provides better delivery than current migraine nasal sprays and in clinical trials was well tolerated. This could be a good non-oral option for some migraine patients. For more information go to www.Onzetra.com

 

The SpringTMS (Transcranial Magnetic Stimulator)
The SpringTMS (Transcranial Magnetic Stimulator) is a device that recently was FDA approved for the acute treatment of migraine with aura. A magnetic pulse is delivered to the back of the head at the onset of aura. It is manufactured by eNeura and is a rental unit shipped once a prescription has been faxed to them. For more information go to www.eNeura.com. It is not yet FDA approved for migraine without aura.

 

Beta-blocker eye drops
Beta-blocker eye drops are showing evidence for acute treatment of migraine.  In a small clinical trial, 7 patients used 1-2 drops of Timolol eye drops as early as possible in their migraine attack. Five of the seven patients reported complete pain relief. The other two reported significant relief of 8 and 9.5 on a 1-10 scale. Eye drops were well tolerated.  Oral Beta-blockers are often used for prevention of migraine but would not work fast enough for acute treatment. The eye drops, in contrast, enter the nasal cavity through the lacrimal duct (passageway from the eye to the nose that drains tears). Once in the nasal cavity, the eye drops are rapidly absorbed into the bloodstream.  This use of eye drops is not FDA approved but looks promising.

 

UPDATE ON PREVENTIVE MIGRAINE TREATMENT

 

CGRP Monoclonal Antibody Treatment
CGRP Monoclonal Antibody Treatment for prevention of migraine looks promising but is not yet FDA approved. Clinical trials are underway with Alder, Amgen, Lilly, and Teva Pharmaceutical. Treatment would be by injection or IV and could be as easy as a subcutaneous injection once a month.  If you have an interest in participating in any current CGRP Clinical Trials, go to www.ClinicalTrials.gov

 

The Cefaly Headband
The Cefaly Headband continues to be helpful for many of our patients for prevention of migraine. It is worn 20 minutes once a day and has been FDA approved. We have 4 rental units for those interested. For more information, go to www.Cefaly.us

 

Clinical trials with the relatively new SpringTMS device
Clinical trials are underway with the relatively new SpringTMS device by having patients with migraine apply 4 pulses twice a day.

 

Trokendi XR
Trokendi XR will be getting FDA approved for prevention of migraine and can be a great option for those who like Topamax for prevention but experience fuzziness or what is sometimes called “Topamax Dopamax” side-effects. Trokendi XR is better tolerated and patients often report being more clear-headed.

 

Supplements called HeadAid
A new line of over the counter supplements called HeadAid is now available. Options include a daytime acute treatment option for migraine, a nighttime acute treatment, and a daily preventive. This line of products could be good for those looking for a more “natural” way to treat their migraines. For more information go to www.HeadAid.com

LASTLY
Lastly, I want to encourage all of you to get out and get moving!  With increased daylight, there is no excuse for not getting out for that early morning walk or jog before or after work. My office staff and I recently participated in the Angels 5K and had some much fun we are planning our next 5 or 10K. Stay tuned as we may begin promoting patient participation with us for future athletic endeavors.

I enjoy putting together these Newsletters and hope you enjoy reading them.  Feel free to suggest topics you would like addressed in future newsletters.

Have a wonderful summer. My office staff and I look forward to seeing you soon for a “tune up” of your migraine management.

Susan Hutchinson, MD Director-Orange County Migraine & Headache Center

Neuromodulation (Transcranial Magnetic Stimulation)

Our clinic is pleased to prescribe the SpringTMS® by eNeura, Inc. sTMS (Single pulse Transcranial Magnetic Stimulation). When TMS is applied to the back of the head, a magnetic field of very short duration passes through the skull and tissue non-invasively and without discomfort. The magnetic field is thought to interrupt the abnormal electrical activity associated with migraine and cortical spreading depression (CSD).

Available in the U.S. since 2015, SpringTMS:

  • is the only non-drug therapy clinically proven to effectively stop or reduce pain associated with migraine aura
  • demonstrates success in offering relief to migraine sufferers for whom traditional therapies have failed

It is safe, effective, portable and easy-to-use option for migraine sufferers.

Summer Newsletter 2015

(Download PDF version)

Hello Everyone,

I hope this finds you enjoying your summer. In this newsletter, I would like to share with you a new treatment we now offer for migraine and cluster headache. In addition, I will review & update current treatment options.

Sphenopalatine Ganglion Block
The SPG is the largest group of neurons (nerve cells) outside the brain and can be reached via the nose. In the past, Q-tips were used and after being soaked with a numbing (anesthetic) medication were inserted far back into the nose to try to reach the SPG. However, this process caused nasal discomfort and was not precise in getting to the SPG. As a result, SPG blocks did not become common in a headache practice.

Dr. Tian Xia, a pain specialist and anesthesiologist, has invented the Tx360. It is a patented device that inserts into each nostril and contains a small, flexible, soft plastic tube that is advanced into the nose and is able to reach the SPG. It delivers a precise amount of anesthetic medication (Bupivacaine .3 cc) to each SPG. It is overall well tolerated and can be performed in 5 minutes in the office setting. By blocking the SPG, the migraine path can be blocked and the patient can get relief from their migraine. To see an animation of the SPG procedure, go to www.tianmedical.com.

It would not be necessary for anyone to drive you to the office. You can drive yourself after the procedure, as it is non-narcotic and non-sedating. This procedure can help to treat a bad headache and can also be done as a preventive treatment. For best results for prevention, it would be necessary to come in 2 times per week for 3-6 weeks.

Eye-Brain Update: For a limited amount of time, the Eye Brain Medical Center has agreed to treat our patients at no charge. Candidates include patients having daily lowgrade headache that worsens as the day progresses and is aggravated by prolonged reading or working on the computer. In addition, dry eyes and sensitivity to light are common symptoms that cause what has been termed “Eye-Graine”. This type of headache is not the same as migraine; the cause is felt to be from the eyes not working well together. If a patient is screened and felt to be a candidate for treatment at the Eye Brain Medical Center (located in Orange, CA), then they are fitted with NeuroLenses (glasses with prisms in them to help the eyes work better together). For more information, go to www.eyebrainmedical.com

CGRP Clinical Trial Available: CGRP Monoclonal Antibodies for migraine prevention appear to be very promising and were discussed in the last newsletter. This treatment is only available through clinical trials until FDA approved. If interested, call the following research coordinators: Mark Gonzalez 714-774-7777 (Anaheim) or Shelly Asbill 562-304-1759(Long Beach)

Cefaly Headband: This FDA-approved device for migraine is working well for many of our patients. We now offer a free 20 minute demo if interested. In addition, we have 3 units available to rent. For more information, see the description in our last newsletter and visit www.Cefaly.us

Treximet: This acute migraine medication is a combination of Sumatriptan and Naprosyn and works better than either medication by itself. Through a special program with Newport Lido Pharmacy, it is now available to most of our patients for $20 or less for 9 tablets. Newport Lido will ship to you at no charge.

Sumavel Dose Pro: Sumatriptan 6 mg injectable needle-free is now available through Newport Lido as well for a reasonable cost for most patients. This needle-free injection is a great way to rescue a severe migraine or cluster headache. Trokendi XR: This name brand Topamax does not cause the mental sluggishness/word retrieval problems that generic Topamax causes. It was discussed in the last newsletter. It is now available through Newport Lido for as low as zero co-pay for many patients.

Wherever your summer travels take you, I wish you a very pleasant rest of your summer. I look forward to seeing you to review your current headache management plan!

Sincerely,
Susan Hutchinson, MD Director-Orange County Migraine & Headache Center

Winter Newsletter 2015

(Download PDF version)

Happy Belated New Year to Everyone,

 

I hope everyone is doing well and as headache free as possible. In this newsletter, I would like to review several treatments I discussed in the last newsletter and to tell you about some exciting new treatments for 2015.

Cefaly Headband Treatment Option Now Available

The Cefaly Headband, as mentioned in the last Newsletter, is the first FDA-approved device to treat migraine. In the United States, it is FDA-approved only for prevention of migraine and the directions are to wear for 20 minutes once a day. However, in European countries, it is used to treat migraine, cluster, and tension headaches both acutely and preventively and at a lower setting for relaxation. Even though there is only one control on the device purchased in the US, I have had many patients adjust the intensity of the electrical stimulation and use for all 3 indications with good results. The Cefaly Headband is a “TENS” (Transcutanous Electrical Nerve Stimulator) unit. At this time, insurance companies are not covering the cost. It is approximately $350 to purchase on-line at www.Cefaly.com; a prescription is needed. There is a 60-day money back guarantee. We have 3 rental units at our office and charge $50/month. The fee is necessary to cover our costs of the adhesive pads with electrodes that are needed. I estimate that at least 50% of our patients who have begun using the Cefaly device are satisfied and continue to use it. It can take up to 3 months to get full benefit. Importantly, it does not need to replace current treatment; rather, it can be used as adjunctive treatment to further help migraine.

 

Eye-Brain Study Opportunity

The Eye-Brain Study was mentioned in my last newsletter. Of those who enrolled in the study and received the Neuro-Lenses with prisms to help their eyes focus images better and “in sync”, some received significant reduction in their headaches. For those interested who were not able to be part of the initial study, you can take a short survey on-line to see if you are an appropriate candidate. Criteria include chronic daily headache (headache > 15 days per month for > 3 months), dry eyes, and sensitivity to light. The survey is available at www.eyebrainmedical.com. You will be contacted within 24 hours after your survey is submitted. A no-charge comprehensive evaluation can then be scheduled in the city of Orange at newly opened location for the Eye-Brain Center. For questions, contact Dr. Ashley Owyang at Ashley@eyebrainmedical.com or 408-504-8411.

 

What are some new treatments emerging in 2015 for Migraine and Cluster Headache?

Two new devices will soon be available. One is a light-weight hand-held device called a vagal nerve stimulator. It is held for 90 seconds over the carotid artery in the neck and is being looked at for both treating and preventing migraine and cluster headache. Studies look promising. To learn more go to: www.electrocoremedical.com

The second device is called an sTMS device (brand name Spring). It is designed to deliver a single transcranial magnetic stimulation pulse. This device is held over the back of the head and a button is pressed delivering the pulse. Some of you may be familiar with the increasing use of TMS for severe depression. TMS for severe depression requires multiple visits whereas this sTMS is used as needed for a migraine attack. It may be particularly useful for migraine with aura. To learn more, go to: www.eneura.com

Neither device is yet available. The cost is unknown but expected to be much more than the Cefaly headband; as a result, they may be available as rental units. I am hopeful I can get at least one of each device for use in the office. Stay tuned!

Perhaps the most exciting new treatment on the horizon will be Monoclonal Antibodies to CGRP. CGRP stands for Calcitonin Gene Related Peptide and is one of the main neurotransmitters that gets released during migraine attacks. These new antibodies will act to help prevent the release of CGRP and thus, help to prevent migraine. Four pharmaceutical companies are competing to be the first to get their product out on the market. Route of administration will be by subcutaneous injection in the office or by Intravenous (IV) treatment. It is expected that these treatments will be expensive and reserved for individuals with chronic migraine who have failed traditional preventive treatment including Botox. Exciting news for Botox non-responders and all those who have given up hope thinking their migraines will never get better! To learn more, go to: www.medscape.com/viewarticle/827838

 

Topamax Without the Drowsiness

A few words about Topamax as I wrap up this newsletter. Topamax is FDA approved for prevention of migraine and is perhaps the most widely used of all the preventives. However, it is sometimes referred to as “Dopamax” since some individuals feel they can’t think as clearly, in particular, they may complain of word retrieval issues or feel cognitively not as sharp. There is now a brand name extended release form of Topamax called Trokendi XR that does not have this same side effect. Additionally, it is time released to last a full 24 hours unlike the current generic forms of Topamax. As a result, it may also be more effective in preventing migraine over a full 24-hour time frame. I have switched at least 20 patients to Trokendi from Topamax and have received great feedback with how much more clear-headed they are. If you think you are a candidate to switch to Trokendi, please schedule an office visit to discuss. We need documentation in order to have Trokendi covered by your insurance.

 

Two New Delivery Forms of Sumatriptan Coming Soon for Acute Treatment of Migraine

For acute treatment of migraine, two new delivery methods of Sumatriptan will be available: a patch delivery with the patch being worn over four hours and a new breath-powered nasal spray potentially more effective and better tolerated than current triptan nasal sprays. For more information, go to: www.zecuity.com (patch) and www.optinose.com (spray)

 

One Word of Advice – Protein!

Lastly, I have one last bit of advice for all of you. It is one word: PROTEIN. Recent studies being done at John Hopkins Medical Center are showing the importance of not just protein in the a.m. but also at night before bed. Ingesting a protein snack before bedtime can prevent the drop in blood sugar that many of us get around 4 a.m. The low blood sugar around 4 a.m. may be linked to waking up with a headache. So, if you are frequently waking up with a morning headache, try a protein snack before bed. My favorite is low-fat vanilla yogurt.

And water, water, water….for daily drinking water needs, The National Institute of Health recommends about 9 cups for women and 13 for men. Water can help prevent headache, can increase energy, and improve our overall health. At my office, we are committed to continuing to cut up those cucumbers and lemons for our water dispenser in our front office. So, come and drink up while waiting for your visit in our comfortable waiting room. You may get hooked on cucumber water!

 

In Closing

In closing, I look forward to seeing each one of you to review your headache management. For those of you seeing me for mood disorders and/or hormonal issues and/or ADHD, I look forward to seeing you also and reviewing new and emerging treatments for those conditions.

Sincerely,
Susan Hutchinson, MD Director-Orange County Migraine & Headache Center

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