Results from clinical trials show high efficacy rates with Qulipta. Qulipta blocks the activity of CGRP as do the injectables. We have many patients who have switched to Qulipta and are doing as well or better than the injectable CGRP mAB’s. To see if Qulipta may be a good option for you, please set up an appointment with one of our providers.
To make an appointment, please call 949-861-8717.
Taking a triptan, like Imitrex, and a gepant, like Ubrelvy, together has not been studied in clinical trials. However, they have different mechanisms of action and are not contraindicated to take together. The combination may work better for some individuals than taking either by itself.
To make an appointment, please call 949-861-8717.
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.
To make an appointment, please call 949-861-8717.
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.
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.
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.
Nurtec received the approval to be taken every other day for the prevention of migraine in adults at the end of May 2021. With this new indication, patients should be able to get 16 tablets per month.
To make an appointment, please call 949-861-8717.
FDA 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.
Relivion 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.