My Botox wears off after 10 weeks but my insurance will only let me come in every 12 weeks. What can I do during the 2 weeks that it is wearing off?

Orange County Migraine & Headache Center

There are several options for this 2-week period. One is to come into our office for a nerve block or for a Toradol injection. Another option is to go on a preventive during that 2-week period-an example would be Nurtec every other day. The best strategy is to call our office and set up an appointment to discuss treatment options to lessen your migraine burden during that wearing off period.

 

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

What is Elyxyb?

Orange County Migraine & Headache Center

Elyxyb is a new oral liquid medication for the acute treatment of migraine in adults. It is an anti-inflammatory, Celecoxib, and is dosed as 120 mg in 4.8 ml (just under 1 teaspoon). Packaged as individual bottles containing 1 dose per bottle, it can be easily swallowed. As with all acute treatment medication, it will work best if taken early in the migraine attack.

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

Can you tell me more about a new form of DHE that will be delivered nasally? I have used before as an injectable. It was quite helpful and the nasal delivery sounds easier.

Orange County Migraine & Headache Center

Impel Pharmaceutical is developing a new nasal delivery formulation of DHE. At the present time, DHE, although highly effective for migraine, can only be delivered intravenously (IV) or intramuscularly (IM) which limits its ease of use. Importantly, DHE has not been associated with medication overuse headache (MOH) and can be used to treat MOH. In addition, many migraine attacks are associated with significant nausea so having this non-oral delivery may be a welcome addition for the rescue of a severe migraine attack in some individuals with migraine. To learn more, go to https://impelnp.com/treatments/migraine-treatment/

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

When should I stop using my Emgality injection if I want to get pregnant?

Orange County Migraine & Headache Center

The injectable CGRP mAB’s including Aimovig, Ajovy, and Emgality should be stopped 5-6 months before trying to get pregnant. All have a long half-life ranging from 27-31 days and complete elimination of any medication is 5 half-lives. Until we have more data about using this category of treatment during pregnancy, it is advisable to have complete elimination before trying to conceive.

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

What is the difference between FDA cleared vs. FDA approved?

Orange County Migraine & Headache CenterFDA approval is a more rigorous process and is required for any prescription medication brought to the market for use in the US. For example: for a new acute medication for the treatment of migraine (examples Ubrelvy, Nurtec, and Reyvow)-efficacy that is statistically significant over placebo has to be demonstrated. Safety also has to be proven in long-term safety trials. In comparison, devices such as Cefaly and Nerivio only need FDA clearance to be available for use in the US.  The standards for getting FDA clearance are not as rigorous. These devices have to demonstrate a good safety profile but the requirements for efficacy over placebo are not as strict.

 

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

I heard a new device was just approved for migraine in the US. Can you tell me more about it?

Orange County Migraine & Headache CenterRelivion was FDA cleared for use in the US for migraine on 3/02/2021. It is a non-invasive, multi-channel neuromodulator system which stimulates 6 branches of the occipital and trigeminal nerves. In one study of 131 patients, 46% using the active device experienced pain freedom at 2 hours compared to only 11.8% in the sham (placebo) group. It is not yet commercially available for our office to prescribe. Hopefully it will be available soon. To learn more go to www.neurolief.com

This is now the fifth non-invasive device FDA cleared for use in the US. The other four are the Cefaly device, sTMS, GammaCore and Nerivio.

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

Should I delay getting Botox or injecting with my CGRP mAB (Aimovig, Ajovy, or Emgalit) before or after receiving the COVID-19 vaccine?

Orange County Migraine & Headache CenterThere is no data available that supports delaying any specific migraine therapy during the time of receiving the COVID-19 vaccine. We encourage all of you to continue with your current migraine treatments AND get the vaccine as soon as it is available to you. To learn more about COVID-19 resources for those with migraine go to https://americanheadachesociety.org/covid-19-resources/

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

What is Vyepti?

Orange County Migraine & Headache CenterVyepti is a recently approved medication approved for the prevention of migraine in adults. It targets CGRP so works it similar to Aimovig, Ajovy and Emgality. However, it is given IV every 3 months instead of being an injectable. Key features include quick onset of action; in fact, some individuals may experience their migraine headache go away during the 30-minute infusion time frame. Vyepti requires approval by the insurance company before it can be initiated. If interested, please schedule a visit.

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