Winter Newsletter 2021

Dear Patient,

Happy New Year 2021! Many of us were glad to say good-bye to 2020 but admittedly, 2021 has had its challenges with ongoing COVID-19 cases, vaccination glitches, political unrest, and financial stress. Our practice is committed to being there for you during this time.

All of us have now been vaccinated and continue to take special precautions in sanitizing our office and limiting the number of you that come in at any one time. Many of you have appreciated the convenience of virtual phone visits for follow-up and we will continue to offer that option for existing patients.

We are very excited to announce the addition of two new staffmembers to Orange County Migraine & Headache Center. Jamie Kolak is our new front office receptionist and works from 8:15 am-1 pm Monday-Thursdays. She brings 14 years of medical front office experience with her and has great communication skills. Aurora continues to work full-time as our certified medical assistant (CMA) and will now be able to devote more time to back office responsibilities, Botox approvals, and prescription refills. Bailey, our other receptionist, is completing her dental hygiene training and has had to reduce her hours; however, she still devotes time to non-Botox prior authorizations and billing. We are proud of all three of them. They make a great team.

Our other new addition is Allison Kennedy, a Physician Assistant (PA), who is available to see headache patients on Wednesday afternoons. She has over 5 years of experience seeing headache patients and is skilled with Botox injections for migraine patients, nerve blocks, and evaluation of headache. We anticipate her hours to increase over time.

Dr. Hutchinson and Dr. Molly Rossknecht continue to provide care for headache and mood disorders. We continue to strive to provide compassionate and state-of-the-art treatment for headache and mood disorders. A patient survey will be offered in the near future providing valuable feedback on how we are doing and what we can do better. Your feedback is greatly appreciated.

And behind the scenes is our hard-working office and business manager, Norma Colgan. She continues to be our “silent hero.” Our practice could not run without her.

We look forward to continuing to service you, our patient, in 2021, and welcome your feedback. May 2021 be a year of renewal and healing for us as individuals, for our country, and for our world.

Drs. Susan Hutchinson, Molly Rossknecht & staff

Should I delay getting Botox or injecting with my CGRP mAB (Aimovig, Ajovy, or Emgalit) before or after receiving the COVID-19 vaccine?

Orange County Migraine & Headache CenterThere is no data available that supports delaying any specific migraine therapy during the time of receiving the COVID-19 vaccine. We encourage all of you to continue with your current migraine treatments AND get the vaccine as soon as it is available to you. To learn more about COVID-19 resources for those with migraine go to

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

Holiday Message December 2020

Dear Patient,

We want to say goodbye to 2020 filled with COVID-19 invading our lives, economic and political unrest, and just the uncertainty of daily life. We have all had to adapt in ways that have adversely affected our life and caused undue anxiety, stress, and unhappiness. For many of you, your migraine pattern may have worsened.

Our practice has remained open to take care of your needs. We are very grateful that most of you have been receptive to us practicing virtual medicine by reviewing your medical issues over the phone. We anticipate many of you may want to continue handling follow-up visits by phone even after vaccinated for COVID-19. Phone visits can be convenient and still provide a thorough review of how you are doing with your headache and/or mood disorder issues.

For those choosing to come in person we can accommodate you. This has been important for those of you needing a Botox procedure, a nerve block procedure, a Toradol injection, or simply a preference for an in-person visit. We will continue to take your temperature and screen for COVID-19 prior to entering our office. Disinfecting the exam rooms in between patients and disinfecting all office surface areas will continue to be a top priority to help you feel safe in our office.

On an optimistic note, new migraine-targeted treatments have become available in 2020 including Ubrelvy, Nurtec, and Reyvow for the acute treatment of migraine attacks. Vyepti, an IV CGRP targeted treatment for the prevention of migraine, has also become available and is helping many of our patients who like the convenience of an IV medication administered over 30 minutes every 3 months at a local Infusion Center in Irvine that we are affiliated with.

May you & your loved ones have a safe & joyous Holiday Season. We look forward to 2021 and helping you towards improved health.

Warm regards,

Dr. Susan Hutchinson & Dr. Molly Rossknecht

Orange County Migraine & Headache Center

What is Vyepti?

Orange County Migraine & Headache CenterVyepti is a recently approved medication approved for the prevention of migraine in adults. It targets CGRP so works it similar to Aimovig, Ajovy and Emgality. However, it is given IV every 3 months instead of being an injectable. Key features include quick onset of action; in fact, some individuals may experience their migraine headache go away during the 30-minute infusion time frame. Vyepti requires approval by the insurance company before it can be initiated. If interested, please schedule a visit.

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

Is Botox safe during pregnancy?

Orange County Migraine & Headache Center

In any individual patient, the risk of a medication needs to be weighed against the benefits and this is especially true in pregnancy. Fortunately, most women note migraine improvement during pregnancy and can stop getting Botox. For those in whom migraines continue to be disabling, a clinical decision can be made between the provider and pregnant patient. Fortunately, a published study in 2016 looked at 232 outcomes in women receiving Botox during pregnancy. This review showed the prevalence of fetal defects (2.7%) comparable to the rate in the general population for pregnancy in the US. More recently, an additional number of cases was been reviewed bringing the total up to 397 and this shows the prevalence of fetal defects to be 2.6% once again comparable to the general population for pregnancy. In general, it is wise to avoid as much medication as possible during pregnancy. However, in some select cases, the disability of frequent migraine attacks in a pregnant woman may warrant consideration of Botox treatment to prevent migraine.

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

How much Sumatriptan can I take in a 24 hour period?

Orange County Migraine & Headache Center

For oral Sumatriptan the maximum total daily dose is 200 mg in adults typically taken as a 100 mg tablet and then repeated 2 or more hours later. For injectable Sumatriptan the maximum total mg in adults is 12 mg and can be broken up as 3 mg, 4 mg or 6 mg spaced 1 hour apart. For generic Sumatriptan nasal spray, the maximum adult dose in 24 hours is 40 mg and taken as 1 spray 1 nostril of 20 mg and may be repeated 2 or more hours later. For the Tosymra form of Sumatriptan nasal spray the total adult dose is 30 mg taken as 1 spray of 10 mg in 1 nostril and may be repeated every hour to a maximum of 3 sprays or 30 mg. For the Onzetra breath-powered nasal delivery of Sumatriptan, the maximum total adult dose is 44 mg/4 nosepieces with the initial dose of 22 mg (2 nosepieces) followed by 2 more nosepieces (1 in each nostril) 2 or more hours later.

An oral and a non-oral form of Sumatriptan can be safely taken in a 24-hour period. Often individuals may choose to use a non-oral for a morning migraine then later in the day take an oral form of Sumatriptan. Alternatively, an individual may start with an oral tablet of Sumatriptan then choose to rescue with a non-oral route of delivery if the headache escalates.


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

Summer Newsletter 2020

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Summer Newsletter 2020

Orange County Migraine & Headache Center

Today is July 4th, a day we celebrate our country and our freedom. Due to COVID-19, this is a July 4th unlike any we have ever had in our country. The good news is that we will eventually have a vaccine and life can return to somewhat of a new “normal”.

Today can also be a time to celebrate freedom from migraine. Migraine still can not be “cured” but can be much more manageable due to new treatments for both acute & prevention of migraine attacks. These new treatments are target specific for what is happening during migraine and are better tolerated & more effective than prior treatments. New preventive treatments include the injectable CGRP monoclonal antibodies: Aimovig, Ajovy, and Emgality. Recently, the first CGRP monoclonal antibody for IV infusion every 3 months got approved; it is called Vyepti. Many of our patients feel as if they have their life back with this new category for prevention.

In addition, there are new medications for the acute treatment of migraine with or without aura and these include Ubrelvy, Nurtec, and Reyvow. All are target specific and good options if the triptan category (Sumatriptan, Rizatriptan, etc.) are not well-tolerated, not effective enough, or for those for whom the triptans are contraindicated due to coronary artery disease or peripheral vascular disease. Unlike the triptans, the new oral medications do not cause vasoconstriction and do not show any evidence of medication overuse headache.

Also, the newest device to come to the market for migraine is called Nerivio and is helping many patients with their migraine attacks. It is a non-invasive pain modulator worn on the upper arm for 45 minutes for a migraine attack. To learn more, watch this short video:

We also want to point out four non-pharmacologic approaches that have helped us personally as well as many of our patients. They include exercise, physical therapy, Pilates/yoga, and meditation/biofeedback/stress-reduction. Exercise in any form can be therapeutic. Dr. Hutchinson loves the out-of-doors so when her gym reopened and offered an Outdoor Cross-Fit Class, she signed up and loves it! In addition, she runs 3-4 miles every other day. Dr. Molly has a Peloton bike and loves the flexibility & convenience of working out from home. Pick what works for you….the important point is to pick and start an exercise routine. Your body including your migraines will thank you!

Posture can affect headache as well as neck pain. If you are suffering from neck pain, consider a physical therapy evaluation with Dr. Pete Rumford in Irvine. He is affiliated with IPA Physio and has helped both Dr. Hutchinson & Dr. Molly with 1:1 sessions. To learn more, go to

For Pilates, consider on-line classes such as offered by Streaming-Salt Pilates, at

Lastly, for those wanting to learn more about the role of biofeedback & meditation in helping headache go to  Dawn Buse is a psychologist who has done extensive research in the field of migraine as it related to biofeedback & mediation. Her website offers lots of helpful information and tools to do treatments like biofeedback on your own. Dr. Buse is a good friend of ours and we highly recommend her website.

In closing, we hope all of you stay healthy and as headache free as possible. We are here to help!

In good health,

Dr. Susan Hutchinson & Dr. Molly Rossknecht