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.

Newsletter 2022

(Download PDF)

Dear Patient,

Happy 2022! We were all hoping that COVID-19 would no longer be an issue but it continues to be a part of our daily lives. At our office, we are continuing to practice safe precautions in limiting any potential exposure when entering our office. To that end, please consider converting a recheck appointment into a virtual appointment. For those of you who are coming in physically for an appointment please notify us if you feel ill in any way and we can reschedule your appointment. Your well-being is our highest priority and much can be accomplished in a virtual visit.

Some updates to share with you:

  1. Prior authorizations will no longer be done for generic medications. In many cases, the cash price for generics may be less than the copay amount. To find the best cash price for any generics you may be on, go to either or
  2. For name brand medications, please remember to activate your savings card before going to the pharmacy to pick up your prescription; failure to do so may result in delays in getting your medication.
  3. When you need a refill do not call our office-ask your pharmacy to fax us the request. This lessens the chance of medication error.
  4. All billing will be done by you and your insurance company-we will provide the information you may need to do the billing.

Dr. Hutchinson is on a 6-week Sabbatical to write 2 handbooks on Migraine-one for the individual with migraine and one for the busy PCP. Her passion is now education, teaching, & writing as she moves into semi-retirement. Please know that she has a high degree of confidence in both Dr. Molly Rossknecht, Neurologist with a Fellowship in Headache, and Allison Kennedy, a PA trained in Neurology including headache.

We ask for your patience as the beginning of a new year brings changes in insurance formularies in regards to medications, increased prior authorization requests, and changes in insurance. Please notify us if your insurance has changed as of this New Year.

We wish all of you good health, joyful times with family, and lives free of the burden of migraine & mood disorders.


Dr. Susan Hutchinson & Dr. Molly Rossknecht & Staff


Dr. Susan Hutchinson Contributes to “Migraine Management for the Nurse Practitioner: Acute and Preventive Therapies to Reduce Burden of Disease” Continuing Education

Dr. Susan Hutchinson has contributed to the continuing education webcast “Migraine Management for the Nurse Practitioner: Acute and Preventive Therapies to Reduce Burden of Disease”. The intended audience for this activity is nurse practitioners and other health care professionals involved in the management of patients with migraines. You can learn more by visiting

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

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.

Join Us For Miles For Migraine

Miles for Migraine Event San Diego

Saturday November 6th

Join us for the 3rd Annual Miles for Migraine San Diego Event. Due to COVID, this event has been changed to virtual so we won’t be running along beautiful Mission Bay as we did in 2019. However, our practice has still formed a Team and we plan to join together on Saturday, November 6th, for a walk at Crystal Cove followed by breakfast at the Beachcomber.

Our team is called OC Migraine. Feel to join our team and participate with us in person or virtually by doing an activity on your own that day. All funds raised will be used to raise awareness of migraine and to advance migraine research. To learn more about Miles for Migraine, visit

Donations are welcome and any size donation is appreciated. The link to donate is

In coming weeks, we will be asking for donations in lieu of fees normally charged to complete forms and write letters.

For any questions, feel free to email us at

Thank you!


Orange County Migraine & Headache Center

You can also download and print this info here (PDF)

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.