Orange County Migraine & Headache Center is pleased to introduce Aurora Bernal-Renteria to our staff. Aurora is a certified medical assistant that adds a new dimension to our services. She is able to assist the physicians in many aspects of back-office care. Aurora also handles all facets of our Botox process from getting approval by prior authorization to ordering and securing Botox for the patients. Her infectious laughter and positive attitude are a perfect complement to the care and working environment we hold dear.
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.
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.
Dear Patient,
The beginning of the year allows a “fresh start” including setting goals and for some, a new direction to take in life. For our practice, the new direction for 2018 is to move towards being a narcotic/opioid free practice by the end of 2018. Heightened scrutiny and increasing regulation for prescribing narcotics like hydrocodone has occurred in this county. Some pharmacies now set limits on how many days a narcotic may be dispensed. As prescribers, we are required to regularly monitor controlled medication use on a statewide system called CURES.
Our medical practice is devoted to helping those with headaches and mood disorders. We are not a pain practice and are not set up to do urine drug testing as pain practices commonly do as part of monitoring their patient’s narcotic use. In addition, narcotics can work against good headache control by promoting medication overuse headache. Narcotics can create a condition called opioid hypersensitivity in which medications do not work as well. This is possible even with non-narcotic treatments such as triptans.
We realize this change in our practice will cause some of you to have to begin seeing a pain specialist if you are unable or unwilling to give up your narcotic. Our office will help in this process by referring you to a pain group that will work with you to take over the prescribing of the narcotic. We are actively meeting with pain groups to create a network of providers willing to see our patients.
During this process, we will continue to refill your narcotic as we don’t want our patients to suffer withdrawal symptoms. However, any narcotic/opioid medication will only be filled as part of an office visit and cannot be requested to be mailed or picked up in our office. For most, that will mean a monthly visit and the amount prescribed must last 1 full month. Early refills will not be honored. Activity will be monitored monthly on the CURES data base.
Fortunately, there are many effective non-narcotic treatment options for migraine and other headache disorders. Getting off your narcotic may be one of your goals for 2018 – We can help.
In closing, this change in our practice is not meant to be a punishment for those of you taking narcotics. We are moving our practice in a healthier direction and hope you come with us in this journey.
Respectfully,
Susan Hutchinson MD Molly Rossknecht, DO
Orange County Migraine & Headache Center
Dr Susan Hutchinson recounts her journey as a doctor who suffers from migraine and how she has learned to manage the condition to improve her quality of life. Read her story here: https://www.mindbodygreen.com/articles/my-journey-from-debilitating-migranes-to-none
Same day appointments: Our office will make every effort to accommodate same day appointments upon request. However, you need to call first to allow us to see where we can fit you in. Please do not show up without an appointment. Also, keep in mind, that what we can provide for a severe headache is limited to non-narcotic injections such as Toradol or Imitrex, trigger point injections, occipital nerve blocks, and SPG blocks. We are not equipped to administer IV fluids, IV meds, or narcotics.
Prescription Refills: Please allow up to 3 business days for refills to be handled. Do not call our office to request a refill. Have your pharmacy fax us the request. In the case of an ADHD medication like Adderall, then email your request to info@ocmigraine.org. Keep in mind that in most cases, if you need a refill you probably are due for an appointment.
Appointments: All patients must be seen a minimum of every 6 months even if you are doing well: NO EXCEPTIONS. This is Good Medicine! If you are doing well and do not feel you need to be seen this often, then consider having your primary care provider take over future prescription refills.
Completion of Forms/Letters: Keep in mind that there will be a fee to complete forms or to compose letters you request. The fee varies depending on the request and how long it will take the provider to complete. Please allow up to 2 weeks for completion. There could be an additional fee if a faster turn-around is requested. The cost will be determined and payment collected prior to the doctor fulfilling the request.
Email: We provide limited access to email. Emails take up to 5 business days to respond to so DO NOT email us with any urgent requests. Also, keep your emails short and to the point. Long emails will not be answered in full and are best handled by scheduling an office visit. For those living out of the area, phone visits are an option. Our office email is info@ocmigraine.org. If your email response requires specific personal medical information, our office will initiate a secure email protocol using Neo-Certified. Your email will be responded to with a request to sign up with a password for Neo-certified to keep email correspondence HIPPA compliant and confidential.
After Hours Urgent Needs: Dr. Molly and Dr. Hutchinson rotate after hours coverage. If you have an urgent issue, you may call (not text) the after-hours line (949-514-4429) and the doctor covering will do their best to return your call within 1 hour. If you are experiencing a severe problem it will be better to call “911” or go to the Emergency Room. Do NOT call the after hours line during regular business hours as it will go unanswered. During business hours it is better to call our regular office number (949-861-8717) for urgent issues.
Office Hours: Current office hours are as follows:
Mondays: 8:30 am-5 pm
Tuesdays: 8:30 am-5 pm
Wednesdays: 8:30 am-5 pm
Thursdays: 9:30 am-5 pm
Fridays: CLOSED
Saturdays: 9 am-12: 30 pm Two Saturdays per Month (on average)
CLOSED FOR LUNCH FROM 12:30 – 1:45 PM MONDAY thru THURSDAY
Holiday Schedule:
Closed Wednesday Afternoon 11/22 to Monday 11/27 Morning
Closed Friday 12/22 to Tuesday 1/02/18
Feel free to call us if you have questions about our office policies. We look forward to continuing to provide quality care for our patients. Suggestions, comments, and criticisms will be taken seriously.
Sincerely,
Susan Hutchinson, MD Molly Rossknecht, DO, MPH
Orange County Migraine & Headache Center
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.
Many of my migraine patients tell me they don’t even need to listen to the weather report. They can tell when rainy or cloudy weather is coming due to an increase in their migraines.
Why is that?
We don’t know exactly why changes, especially drops, in barometric pressure can lead to migraines but here is what we do know: an approaching storm causes a drop in barometric pressure. This affects the pressure in the external environment including the external ear canal. This can lead to an imbalance between the pressure behind the tympanic membrane (middle ear) and the external barometric pressure. There is a certain air pressure in the sinuses, Eustachian tubes, and inner ear at any given time and if the external pressure drops, that imbalance is thought to trigger a migraine in some migraine sufferers. A change in barometric pressure of as little as .20 millibars impacts the pressure in the ear canal and can lead to migraines.
How can this be treated?
In addition to taking the usual migraine medication, inserting a pressure regulating device (MigraineX) may be helpful. MigraineX looks like a small set of ear plugs (drug & latex free) and is designed to control the rate of barometric pressure changes in the ear canal adjacent to the ear drum (tympanic membrane). The device can be inserted preventively or at first sign of headache if a drop in barometric pressure suspected as the trigger. This product is best used in conjunction with a free App called MigraineX that can predict changes in weather and barometric pressure.
When I first learned about this device, I requested that a limited number of free samples be sent to my office for use in my patients who report that changes in barometric pressure cause migraine attacks. I have given out the first 8 devices this past week and have asked these patients to give my office feedback in coming weeks.
I am skeptical of new products that come into the marketplace promising too much especially if they are expensive. I was very pleased to see that MigraineX can be ordered online through Amazon for only $11.99. In addition, it retails for about $9.99 at CVS and does not require a prescription.
Grant O’Connell, Digital Marketing Manager, Cirrus Healthcare/MigraineX states “What separates MigraineX from other migraine relief medications is, medication-only focuses on relieving symptoms after a headache starts. The best defense against weather-related migraines is to prevent the pressure before it starts. Utilizing our app for weather event alerts will give you a step ahead to minimize the pressure using the MigraineX plugs. We are confident new customers will find MigraineX to be a great reliever from headaches.”
As I am writing this newsletter, I am wearing them and they are comfortable. They were easy to insert. Also, I easily downloaded the MigraineX app.
In a study of 36 patients who used this device in addition to their usual migraine medications, the majority felt their migraine was better treated and less likely to return. For more information, go to www.migrainex.net
For any of you who feel that changes in barometric pressure and weather are a common trigger for your migraines, I suggest you set up an appointment to review our current treatment plan and see if this new MigraineX device makes sense for you.
In summary, MigraineX may be a welcome addition to your Migraine Toolbox if changes in weather and barometric pressure are triggers for you. I welcome your feedback once you have tried this device.
Susan Hutchinson, MD
Director-Orange County Migraine & Headache Center
June 18, 2017
Professor Gretchen Tietjen recently received the annual John Graham lecture award from Paul Rizzoli and thanked friends and collaborators including Lynne Osborn Geweke, Dawn Buse, Sheena K. Aurora and Susan Lynn Hutchinson.
“I am so happy for Dr. Gretchen Tietjen to receive this prestigious award. I was happy to be part of our Women’s Issues Section research that contributed to this award.” – Dr. Susan Hutchinson.
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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.