Summer Newsletter 2016

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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

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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

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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

Summer Newsletter 2014

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Three New Treatments for Chronic Migraine

Dear Patients,

The official day of summer is rapidly approaching. Longer hours of daylight, days at the beach, outdoor BBQ’s, vacations, and a break from the more structured September-May time frame is welcomed by many. But for the migraine patient, the heat of the summer months can be a frequent cause of headache exacerbation. Staying well-hydrated and avoiding being out in the middle of the day are common-sense precautions. Are there some other treatments that may prove helpful for those who dread the summer months and feel “nothing is working” for them?

In this newsletter, I would like to discuss three novel treatment approaches to consider for those frustrated with their current migraine pattern.

  1. The Cefaly Headband: this is the first medical device approved by the FDA for the prevention of migraine headaches. It is a small, portable battery-powered headband that is worn across the forehead and fits over the ears on both sides. This device applies an electric current to the skin in the center of the forehead just above the eyes. This current is similar to that of other transcutaneous electrical nerve stimulators (TENS) that have been used for years in the treatment of pain and are frequently part of physical therapy. The electrical current of the Cefaly device stimulates branches of the trigeminal nerve, which is associated with migraine headaches. There are 3 settings for the device: one for prevention of migraine; one for acute treatment of migraine; and one for relaxation. In the patient satisfaction study of 2,313 Cefaly users in France and Belgium, more than 53% of patients were satisfied with Cefaly treatment and were willing to buy the device for continued use. The device is approximately $350 and requires a prescription to purchase. So far, in my practice, about ½ of patients who have tried the device are satisfied and happy with the results so this is consistent with the findings in the patient satisfaction study.
  2. Myers Cocktail IV Treatment: this is an IV treatment containing calcium gluconate, magnesium, B-vitamins, Vitamin C, and msc. Other amino acids/electrolytes administered in an IV bag of 100 cc solution. It takes about 6 minutes to go in. It is not covered by insurance and costs just under $100 for the basic IV treatment. According to a physician colleague of mine, it is recommended as a monthly treatment for maintenance. It is available at Link Medical in Newport through Dr. Garrett Wdowin who is a Naturopath MD (NMD). The phone number to schedule an appointment and/or IV treatment is 949-465-0770. My opinion is that this IV treatment may benefit some migraine patients who are frustrated with their current treatment and this treatment appears to be quite safe.
  3. California eyeBrain Medical Trial: For some chronic daily headache patients, there may be an imbalance between the patient’s peripheral vision and central vision. This could cause overstimulation of the Trigeminal nerve and be contributing to chronic daily headache and neck pain. For patients who have chronic daily headache (headache 15 or more days a month for over 3 months) and have dry eyes, sensitivity to light, stiffness in shoulders or neck, and/or lethargy (fatigue), then you may be a candidate for a novel treatment for your headaches. There is a clinical trial to evaluate a new treatment to address imbalance between peripheral and central vision; there is no charge to be in this trial. To see if you are a candidate for this eyeBrain free clinical trial, go to http://eyebrainmedical.com/self-evaluation website and take the self evaluation of 12 questions. This should only take about 3 minutes to complete. You will then be contacted in 24 hours to determine your eligibility for this study. The treatment involves a progression or prisms in glasses to address the imbalance contributing to the frequent headaches. The study dates in Orange County are June 23-26th. I have met with the study coordinators and was pleased with their honesty and genuine interest in helping chronic daily headache patients with their approach. Their study appears to be quite safe and non-invasive; I like the fact that patients are screened ahead of time by the on-line self-evaluation. This helps to minimize wasting anyone’s time if they are not a candidate for this study. My advice: check it out and take the on-line self-evaluation; you have nothing to lose.

In summary, I have discussed three novel treatments for migraine patients. If you feel you are a candidate for any of these treatments, please call our office and set up an appointment to discuss them further. For the Cefaly headband, a prescription is required to order the device. This could be a great time to come in and have your migraine treatment plan evaluated and improved. I look forward to seeing you in my office in the near future and in the meantime, have a wonderful summer.

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

Happy New Year 2014, New Policies

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Dear Patients,

Happy New Year to Everyone. I hope 2014 is off to a good start for you and your family. On a personal note, I got married this past November and start off 2014 as a happily married woman! Personal goals including adding Pilates and Yoga to my exercise regimen.

Professional goals for my practice for 2014 include providing you with the very best medical care I can for headaches and mood issues. In order to provide you with quality care, I have decided to not sign any insurance contracts. My practice will continue to be fee-for-service. We will, however, continue to bill your insurance as a courtesy.

For existing patients, we now offer Saturday hours and phone visits. We also have “emergency” slots to better accommodate patients who need timely care.

I want my practice to be “predictably consistent” for patients so certain practice policies will be strictly enforced in 2014. These policies include:

Late Policy

There is a 10 minute grace period. If you anticipate arriving more than 10 minutes late, please call first to see if we can accommodate you. In some cases, we may need to reschedule your appointment.

Prescription Requests

Allow 3 business days for prescription refills. Ask the pharmacy to fax the request to us. In most cases, we will handle the refill electronically. It is very important we have your preferred and correct pharmacy phone number and fax number in our system.

Prior Authorization Requests

Allow 2 weeks for processing all prior authorization requests. Options while waiting include switching to the generic alternative covered by your insurance or paying out of pocket for a 2 week supply. Note: If the prior authorization is for Botox, it can take up to 6 weeks.

Botox

Dr. Hutchinson is a certified Botox injector for chronic migraine. The response rate is 85-90% in our practice. Make an appointment to see if Botox right for you. Visit our websitewww.ocmigraine.org for additional information about Botox for chronic migraine.

New Procedures

New nerve block type procedures and non-invasive stimulators may be treatment options in the future for frequent headache sufferers. Dr. Hutchinson is researching which new procedure options would be the best to start incorporating into her practice.

Emails

Allow 5 business days for response to emails. Remember that email is NOT for prescription issues or to make an appointment or for urgent issues. Email is for non-urgent follow-up questions or for providing a progress report to Dr. Hutchinson.

Urgent Issues

Call our office 949-861-8717 for urgent needs. My staff will help you with making an appointment, coordinating refills, and asking Dr. Hutchinson how to handle your need if of a serious nature. Electronic messages may be put in for Dr. Hutchinson to review and handle as she has time in her schedule.

I look forward to working with you to live a life as free of headache and mood issues as possible. See you soon for your next visit.

Hoping for an excellent 2014 for you,

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

Winter Newsletter 2013

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migrainebook_large

Happy New Year to all! I am happy to announce the release of my new book: The Woman’s Guide to Managing Migraine: Understanding the Hormone Connection to find Hope and Wellness. It has taken me 3 years to write this book and as with any major project, it is a wonderful feeling of accomplishment at last!

I wrote this book to help women who are looking for help with their migraines, including the hormonally driven migraines that are often the most severe. My goal is to give the reader the up-to-date knowledge and insight they need to better understand and mange their migraines. For readers who are my patients, it provides comprehensive information regarding my approach to migraine management. For others it may help to better communicate with their health care providers and receive improved migraine management. My passion to learn as much as I can about migraine diagnosis and treatment to help my patients was the driving force behind the hours and weekends I had to give up to write this book. I hope my book can help minimize the impact of migraines in your life. If the quality of your life improves, my book has served its purpose. At the end of the day, I think we all ask ourselves, “Have I made a difference?” Making a difference in your headaches and your life-that is my passion and my desire.

It has now been six years since I left family medicine to focus on headache and mood disorders in my medical practice. There are times I miss being a family physician but feel I can make a greater impact in alleviating pain (both physical and emotional) by focusing my energy and talent. As many of you may be aware, I am affiliated with Hoag Hospital. Along with Dr. Philip O’Carroll and Dr. Ali Makki, we have formed the Hoag Headache & Facial Pain Program. I still maintain my primary practice location in Irvine but am in Newport Beach at Hoag on Tuesday mornings for those patients who prefer the Newport Beach location. My affiliation with Hoag enables me to partner with Hoag’s resources. Through Hoag, we offer a free monthly headache support group (2nd Wednesday of every month from 6 pm-7:30 pm Hoag Neuroscience Board Room), community presentations, weekend symposiums, and a team approach for headache including psychologists, physical therapists, and nutritionists. My staff privileges at Hoag allow me to admit patients, when necessary, for medication overuse headache, and to arrange for IV Infusion Treatments for treatment of severe headaches.

My New Year’s Resolutions include getting my life in balance with a focus on exercise including swimming, running, and playing golf; in addition, I want to “slow down” and appreciate the day-to-day of all that life offers. What are your New Year’s Resolutions? I hope they include taking care of you and living the quality of life you deserve. If your headaches are robbing you of the quality of life you desire, then I invite you to call and make an appointment to review your headache management. New treatments for acute and prevention of headaches are available and may be an option for you. I look forward to seeing you in 2013!

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

New Needle-Free Sumatriptan Delivery

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Imitrex (Sumatriptan) injectable was launched in 1993 in the United States and quickly became the gold standard for fast & effective treatment of a migraine attack. It was the first “triptan” on the market and was quickly followed by an oral and nasal delivery form of Imitrex. Other triptans followed and there are now 7 triptans available in the United States. They include Imitrex, Maxalt, Zomig, Axert, Relpax, Amerge and Frova. Triptans are the most migraine specific medications we have for the acute treatment of migraine. Imitrex now comes in a generic form called Sumatriptan.

Until 2010, Imitex stat-dose (4 & 6 mg) was the only injectable triptan available. The quick onset of action (10 minutes) and the non-oral route made it ideal for:

  1. Migraines associated with nausea & vomiting
  2. Rapidly escalating migraine attacks
  3. Morning migraines

However, some patients do not like to give themselves an injection and may be “needle phobic”.

SUMAVEL Dose Pro is unique. It is a needle-free system that delivers 6 mg Sumatriptan subcutaneously. It offers the same 10 minute onset of action as injectable Imitrex (Sumatriptan) and the same advantages of a non-oral delivery system.

How does it work? The SUMAVEL Dose Pro is a self-contained injection device with 3 simple steps:

  1. Snap (snap off the cap)
  2. Flip (flip back the lever)
  3. Press (press against the skin)

The device is pressed against the skin of the thigh or lower abdomen. It should not be injected through clothing. The Sumatriptan is delivered into the subcutaneous tissue by the force of compressed nitrogen gas that is released once the unit is activated. There is an audible “whoosh” as the nitrogen gas escapes. Once the “whoosh” sound is heard, the Sumatriptan has been delivered. After administering the Sumatriptan, the entire unit can be disposed of in the regular trash. There is no needle to dispose of. At this time the unit is not recyclable but plans for that are underway.

How is it prescribed? It comes in a 6 mg dose. It can be injected as needed for a migraine attack and may be repeated in 1 hour to a maximum of 12 mg in a 24 hour period. It is FDA approved for the treatment of migraine with and without aura and for cluster headache in adults ages 18 and older.

Can it be combined with oral triptans in the same 24 hour period? It is not recommended to combine different triptans in the same 24 hour period. However, I feel it is OK if the oral triptan is Imitrex, generic Sumatriptan, or Treximet since they all contain the same triptan (Sumatriptan). Please call our office if you are unsure about this issue.

What are the side-effects of SUMAVEL Dose Pro? Side-effects may include a feeling of chest tightness, flushing and warmth. Local injection side-effects can include swelling, redness and bruising. A small drop of blood may be present after delivery. In the majority of patients, SUMAVEL Dose Pro is very well tolerated.

In summary, SUMAVEL Dose Pro is a new & unique non-oral delivery system for Sumatriptan. It offers the quick onset of action and effectiveness of injectable Imitrex but without the needle. To learn more, visit SUMAVELDosePro.com

If you feel you can benefit from this new delivery system and medication please call our office and we can set up an appointment. I look forward to demonstrating this unique needle-free injectable system and teaching you how to get fast, effective and needle-free relief from an acute migraine or cluster headache attack.

Our office phone number is 949-861-8717.

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

Fibromyalgia: What Is It?

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In the course of treating both migraine & depression, my patient population of fibromyalgia has grown. Fibromyalgia often co-exists with migraine and depression. If an individual has migraine headaches, that person is more likely to also have fibromyalgia than the general population. The same is true for depression. This newsletter is devoted to this disabling condition.

Fibromyalgia is a common and very disabling condition that affects 5% of women and 1.6% of men in the general population. It is considered an idiopathic disorder of chronic generalized musculoskeletal pain. The pain is in all 4 body quadrants (i.e. the whole body) as well as in specific soft-tissue tender points often called “trigger points”. A patient with fibromyalgia will be very sensitive when light pressure is applied to these trigger points, often located in the neck and upper back. Other symptoms may include fatigue, sleep disturbance, stiffness, and decreased concentration. I have also been told by some of my patients that they feel “flu like” symptoms, tingling or burning sensations or at times, achy all over.

What causes fibromyalgia? The exact cause is unknown but it appears to be from altered pain processing, creating an increased sensitivity to light touch that normally should not be painful. Similarly, migraine patients have an increased sensitivity to their environment, e.g. to changes in barometric pressure or the drop in estrogen with menses. There are striking similarities between migraine & fibromyalgia.

Treatment includes both pharmacologic and non-pharmacologic options. There are 3 FDA-approved medications for fibromyalgia. They are:

  1. Lyrica (pregabalin)
  2. Cymbalta
  3. Savella

Other medications commonly used for fibromyalgia but not FDA-approved include the following:

  1. Tricyclic Antidepressants such as Elavil and Pamelor. This class of medication has been found helpful in fibromyalgia but side-effects include sedation, dry mouth, constipation and weight gain.
  2. Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac, Zoloft & Lexapro. This class of medication has shown mixed results in helping fibromyalgia and would not be considered first-line therapy.
  3. Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) such as Effexor and Pristiq. This class of medication has shown greater effectiveness than SSRIs and includes 2 of the FDA approved drugs for fibromyalgia: Cymbalta & Savella.
  4. Anti-epileptic Drugs (AEDs) such as Neurontin (gabapentin), Lamictal (lamotrigine), Topamax (topiramate), Tegretol (carbamaxepine), and Depakote (valproate). Lyrica, the first FDA-approved medication for fibromyalgia, is in this class. This class of medication shows good benefit in reducing the pain of fibromyalgia and has established itself as potentially the most effective class of medication for migraine prevention. Two of the medications in this class, Topamax and Depakote, are FDA-approved for migraine prevention.Non-pharmacologic treatment includes cognitive behavioral therapy, biofeedback, acupuncture, physical therapy, chiropractic care, and structured exercise programs. Many fibromyalgia patients claim they are “too tired” to exercise. One study showed benefit in exercising for just 10 minutes several times a day. I encourage all my patients to exercise as much as they are able to.Vitamin, herbal and nutritional supplementation may help. The B vitamins are known to be important in stressful conditions and can increase energy. I offer both B-complex & B-12 injections in my office which can potentially boost energy and help lessen the fatigue associated with fibromyalgia. In some cases I recommend a full vitamin & mineral blood panel called SpectraCell which can identify nutritional deficiencies that can be contributing to fatigue and pain. Once the deficiencies are identified, the patient can be instructed on which supplements are needed. I am presently consulting with a local chiropractor, Dr. Di Siena, who offers an integrative program known as First Line Therapy to help patients optimize their well-being from chronic conditions like fibromyalgia.Promising new treatment includes transcranial magnetic stimulation (TMS). This is done in an out-patient setting, is safe & non-painful, is done in a series of treatments, and has been found to be helpful in treatment resistant depression, anxiety and fibromyalgia. Another new treatment is low dose naltrexone. Naltrexone is a medication that has been used clinically for >30 years to treat opioid addiction. More recently, it has been tested in several clinical trials for fibromyalgia and showed a 30% improvement in symptoms compared to placebo. In addition, it was very well tolerated in these studies and is relatively inexpensive.In summary, fibromyalgia can be a very disabling and frustrating medical condition. However, a good integrative approach that combines traditional pharmacological treatment and non-pharmacologic treatment can be very beneficial even for the most difficult-to-treat patient. I believe that the best treatment for a patient is the one that gives them the greatest relief. I encourage you to set up an appointment to develop a treatment plan that can help you live the quality of life you deserve.Sincerely,
    Susan Hutchinson, MD Director-Orange County Migraine & Headache Center