What is the difference between a headache and a migraine?
Migraines are headaches, but not all headaches are migraines. So, a migraine is a type of headache. There are many other types of headaches including: tension headache, cluster headache, cervicogenic headache, trigeminal neuralgia, occipital neuralgia to name a few.
– Dr. Molly Rossknecht
For more information, call and schedule an appointment at 949-861-8717
How long does it normally take to determine if a treatment isn’t working? How patient should I be?
For most headache prevention treatments, it can take up to 4 weeks to see significant benefit (however some patients may see benefit at 1-2 weeks). If at 4+ weeks there is no real headache benefit and if you are tolerating the medication/treatment well (as far as adverse effects) we would likely discuss adjusting your dosage. Every patient is different and it’s just a matter of finding out what dosage of medication you respond to. If you have reached a therapeutic dose for a few weeks and you do not feel it is helping, at that point we would make a change, discuss other options.
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– Dr. Molly Rossknecht
For more information, call and schedule an appointment at 949-861-8717
Now that I know my headaches are migraines, can they be prevented?
Yes, there are many different treatment options for migraine prevention, it’s just a matter of finding the right one for you. There are 2 ways we look at treating migraine- prevention (daily treatment to cut down the amount of headache days per month) and abortive therapy (what to do/take when you have the migraine). If you are only having a few migraines per month and you are headache-free the other days, there isn’t a real need to take something every day to prevent them (you just need an abortive).
However, if you are having many headache days per month, prevention is definitely key to cutting down the number of days (zero would be ideal!). When you get to a place where you are feeling better and having less headaches, then we can discuss coming off the prevention to see how you do…. preventatives do not have to be a “forever” thing. In other words, if you are doing really well on a preventative medication I would not want you to think you will have to take it for the rest of your life. Headaches can change/improve over time. – Dr. Molly Rossknecht
For more information, call and schedule an appointment at 949-861-8717
Dr. 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
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
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:
It is safe, effective, portable and easy-to-use option for migraine sufferers.
Dr. Susan Hutchinson will be appearing on Lifetime Channel’s “The Balancing Act” TV show airing June 2nd and 9th, 2016. During the interview, she discusses the experience and management of summer time migraines. Check your local listings for times. For more in The Balancing Act, go here: http://www.thebalancingact.com/migraines-are-not-just-another-bad-headache/
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
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
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.
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