Ask Dr. Molly

What is CBD and can it help my migraines?

CBD (cannabidiol) is one of several cannabinoids found in marijuana and hemp plants. CBD is not psychoactive and has low abuse potential compared to THC that is psychoactive and can cause someone to get “high”. CBD has been used to treat anxiety, insomnia, headaches, and seizures. It is felt to have anti-inflammatory properties. Typically it is dispensed as oil that can be put under the tongue or can be mixed or infused in a number of ways. Significantly, The FDA approved Epidiolex, a CBD-based drug, to treat certain forms of epileptic seizures. The FDA, National Institutes of Health, and the World Health Organization, all feel more research and testing are needed. In short, CBD may help your migraines but it is not FDA approved for migraine treatment.  For more information, go to www.uspainfoundation.org, www.TheMintLeaf.org, and www.projectCBD.org

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

Is the new Ajovy for migraine prevention better than Aimovig?

There have not been any studies comparing Ajovy with Aimovig. This new category of CGRP monoclonal antibodies is an incredible break-through for migraine prevention. Experience in the “real world” apart from clinical trials may help us answer your question. Significantly, both Aimovig and Ajovy have favorable side-effect profiles, are well-tolerated, and quite effective (as early as 1 week in some patients) in clinical trials.

Some patients may feel one works better than another just like some patients prefer Sumatriptan to Rizatriptan vs others prefer Rizatriptan to Sumatriptan. Treatment needs to be individualized to each patient. We are here to help develop your individualized migraine treatment plan.

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

Is there evidence that use of the computer, kindle, and cell phone contribute to migraine? Is the light emitted from these devices troublesome?

Yes, there is evidence that high energy (HEV) blue wave or “blue light” that flickers from our electronic devices can aggravate migraines. This “blue light” can disrupt our sleep patterns at night, can cause eye strain, and cause oxidative stress all of which are associated with migraine.  Treatment includes avoiding use of these devices for 3-4 hours before bedtime, wearing blue light blocking glasses while using these devices, and installing blue light blocking screens.

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

What Is CGRP?

CGRP stands for Calcitonin Gene-Related Peptide.  It is a neuropeptide located in neurons (nerve cells) and smooth muscle throughout the part of the nervous system that is part of the migraine process. When a migraine trigger occurs in a susceptible individual, CGRP levels increase and this increase is felt to be major part of the pathophysiology of migraine. Research has demonstrated elevated CGRP during migraine attacks. In addition, research has demonstrated relief of a migraine attack when a CGRP blocking medication is given. This blocking of CGRP is the mechanism of action of the new category of CGRP Monoclonal Antibodies that are now coming to market for the prevention of migraine. The first one available, Aimovig, blocks CGRP activity at the receptor site. To learn more, go to www.Aimovig.com and www.scienceofmigraine.com

To find out if this new preventive treatment makes sense for you, please schedule a visit at our office. We are very excited about this new treatment.

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

How do I know if the new CGRP preventive injection is for me?

The new category of CGRP Monoclonal Antibodies for migraine prevention is ideally suited for anyone suffering from migraine at least 4 days per month. The first one is now available and is called Aimovig. It is approved for adults 18 and over. It is not recommended in women who are breast-feeding or pregnant. Most likely insurance companies will require failure or intolerance of at least 2 standard oral migraine preventives. The best next step would be to come in for an appointment so we can determine if Aimovig would be a good next step for you.

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

Why shouldn’t I use a narcotic to rescue a severe migraine attack?

Increasing evidence from research shows that narcotics can worsen a headache condition by causing narcotic/opioid hypersensitivity. This means that over a period of time no acute medication will work as well. Narcotics are not migraine specific and are not FDA approved for the treatment of migraine. There are migraine-specific medications, oral and non-oral, that are much more appropriate for the treatment of an acute migraine attack such as the triptan category.

 

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

Why are my headaches worse in the winter?

There can be many reasons for worsening of a headache pattern during winter months. Weather changes can be a factor, especially drops in barometric pressure that can occur before a storm. Turning heaters on can be a trigger if dust or mold has accumulated in the air ducts. For some, Holiday stress can be a trigger either from travel or entertaining. Also, there is a tendency to fall off your exercise program, not eat as healthy, and not have a consistent sleep schedule during the Holidays. Now that the Holidays are over, resuming a healthy life style should help.

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

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.

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.