Newsletter

May 2023 Newsletter

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Dear Patient,

Good news: our office repairs from our major water damage in late September are nearly complete and we are moving back in. We hope to be operational in coming weeks.  For those preferring virtual phone visits, those will continue to be available.

Due to some ongoing repair work, we cannot allow anyone to enter the office without an appointment. If you want to convert an existing virtual visit to an in-person, please call and request this. Our office phone number continues to be 949-861-8717.

Since our move-out, the address has changed to 41 Creek Road from 33 Creek Road. We are still in the same building and the same #340 suite number. So, the official address now becomes:

Orange County Migraine & Headache Center
41 Creek Road, Ste 340
Irvine, CA 92604

On another note, Dr. Hutchinson is moving into retirement. Dr. Molly Rossknecht, who has been part of our practice for seven years, will take over ownership and management of this practice. Along with this transition, there will be a name change to Orange County Migraine & Wellness Center.  This transition will be effective as of July 1, 2023. A letter with more details will be sent to all active patients.  We will provide continued updates on our website as to details of this transition. We will do everything we can to make this transition as smooth as possible for all of you.

Orange County Migraine & Headache Center opened in February 2007 with the mission statement of helping those with headache and mood disorders. That mission remains with this transition in ownership. We remain committed to helping you, our patient, with alleviating the burden of migraine and/or mood disorders in your life. Our mission lives on.

Warm regards to all,

Dr. Susan Hutchinson, Dr. Molly Rossknecht, & Staff

Orange County Migraine & Headache Center

Orange County Migraine & Wellness Center

 

Newsletter Fall 2022

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Dear Patient,

Our medical office suite was flooded on Saturday, September 24th, when a hot water pipe from the office above us burst. The water damage is severe. Repairs will take at least two months. During this time the office will remain physically closed.

We are completely operational for virtual visits, prescription refills, email correspondence, filling out forms, and answering questions you may have. Becky, our wonderful receptionist, will retrieve messages and return calls.

We will be subleasing from an established medical practice in Irvine. Initially, the availability will only be with Dr. Molly Rossknecht on Thursdays.  The initial focus will be to accommodate those patients needing Botox and other procedures. We cannot accommodate walk-in patients, pharmaceutical reps, or picking up of samples in this temporary location.

Please understand that Dr. Hutchinson, as owner of the practice, must focus her time & energy on all that is involved in the repair work. She will only be available for virtual visits during this time. We ask for your patience during this challenging time. We look forward to seeing you physically when our office suite is completely repaired and full functional.

Sincerely,

Dr. Susan Hutchinson & Dr. Molly Rossknecht & staff

 

Newsletter 2022

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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 GoodRx.com or www.Costplusdrugs.com.
  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.

Sincerely,

Dr. Susan Hutchinson & Dr. Molly Rossknecht & Staff

 

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

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:

https://www.youtube.com/watch?v=tkO2A_g7q4Qhttps://www.youtube.com/watch?v=tkO2A_g7q4Q

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 https://ipa.physio/oc/

For Pilates, consider on-line classes such as offered by Streaming-Salt Pilates, at www.takemetosalt.com.

Lastly, for those wanting to learn more about the role of biofeedback & meditation in helping headache go to www.dawnbuse.com  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

Orange County Migraine & Headache Center’s Response to COVID-19

In light of COVID-19, public health authorities are stating it is necessary for everyone to maintain social distance for your safety and the safety of all of our communities. We therefore strongly urge you to either turn your next visit into a phone visit or postpone your next office visit unless it is absolutely unavoidable. If you feel it is necessary to come in to the office, for example you are due for a Botox procedure or need a nerve block, then only come in if you are healthy, not running a fever, not coughing, and not short of breath. We may take your temperature and will ask additional screening questions before allowing you to enter our exam rooms.

If you are not feeling well, particularly with a cough, shortness of breath, or a fever, you should not come to the clinic and instead contact your primary care provider for further directions. The COVID-19 situation is evolving rapidly and daily and we expect to update this guidance as the situation changes.

At this time we are still staffing the office, answering our phones, and handling prescription issues as well as prior authorizations. Employees are asked to stay home if not feeling well. In addition, extra precautions are being taken by our landlord in cleaning handrails, elevator buttons, and other areas used often.

In summary, please keep your follow-up appointment but allow us to turn your visit into a phone visit instead of an in-person visit. You will get the same amount of time we would give with an in-person visit, prescription refills will be handled, and any needed prior authorizations will be handled. Thank you for your patience in this evolving situation.

We pray for good health for all of you,

Dr. Susan Hutchinson & Dr. Molly Rossknecht

March 19, 2020

Summer Newsletter 2019

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Summer Newsletter 2019

Orange County Migraine & Headache Center

Summer-a time to take vacation, enjoy longer days of sunshine, and a time to learn about some newly approved migraine & cluster headache treatments. This is truly an exciting time in the headache world. In recent weeks, three new treatments have received FDA approval in the United States. Emgality, one of the 3 CGRP monoclonal antibodies approved for prevention of migraine, got approved for the prevention of episodic cluster. Dr. Hutchinson will be going to Indianapolis (home of Lilly pharmaceutical) in July to learn the specifics of how to prescribe for cluster headache and will be a trained speaker to educate other health care providers.  Cluster headache patients will be able to inject Emgality just during their cluster periods unlike migraine patients who inject every month for prevention.  So, if you or someone you know has episodic cluster headaches, plan a visit at the end of July or sometime in August to get this treatment and have it on hand before your next cluster headache flare-up.

Two new treatments have received approval for migraine headache. One is called Tosymra and is a novel nasal delivery of Sumatriptan. It contains a patented membrane permeater enhancer that allows quick absorption into the nasal tissue. In fact, it has been shown to act as quickly as Sumatriptan 4 mg injectable. No needle and better tolerated than the injectable-a great option for migraine attacks associated with nausea and/or vomiting or for those attacks that have rapidly progressed and for which an oral tablet may not work quick enough to bring relief.  The other recently approved product is a device called Nerivio Migraine. It is a remote electrical modulation device placed on the arm and controlled by your smartphone. It is for the acute treatment of migraine.  Some advantages include good tolerability and non-invasiveness.  To learn more, go to www.Theranica.com.  Dr. Hutchinson will be attending an Advisory Board on July 13th in Philadelphia to learn more about this new device.

Lastly, I want to being to your attention that we offer both B-12 and B-complex injections in our office. They can address B-vitamin deficiencies as well as help energy. They can be especially helpful if you are stressed, recovering from an illness or surgery, suffer from fibromyalgia or chronic fatigue syndrome, or have absorption issues due to gastric by-pass. If you are interested in either injection, they can be scheduled as an injection visit with Aurora, our certified medical assistant (CMA).

If you are looking for updated information in the resource/handout section of our website, the following 4 handouts have been recently updated: Preventive Treatment of Migraine; Acute Treatment of Migraine; Medication Overuse Headache; and Cluster Headache. We are going to work on updating all handouts on our website. Feel free to offer suggestions you may have to improve our website and educational services to you, our patient.

Have a wonderful summer. We look forward to seeing you in our office so that we can help you be as headache-free as possible this summer.

 

Warm regards,

Dr. Susan Hutchinson & Dr. Molly Rossknecht

June 21, 2019

Spring Newsletter: Spring Cleaning

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Spring Newsletter

Orange County Migraine & Headache Center

Spring is traditionally a time for “spring cleaning” and so it is for us at OC Migraine & Headache Center. Many of our patient handouts and resource materials date back to 2007. We have now begun the process of updating all materials on our website so that you have access to the most current information.  Here is a sneak preview: our first handout being revised is on the topic of cluster headache. New advances include the FDA approved GammaCore stimulator for acute and preventive treatment of cluster headache. It is a non-invasive vagal nerve stimulator. In addition, studies look very promising for one of the new CGRP monoclonal antibodies to get approval for cluster headache.

Very importantly, we are updating our web-based resources when you want information about a particular topic related to your headaches.  We have identified four in particular that we feel offer good information without being overly promotional. They are the following:

  1. American Migraine Foundation (the patient educational resource affiliated with The American Headache Society to which both Dr. Hutchinson & Dr. Molly belong)
    http://americanmigrainefoundation.org
  1. http://migraine.com (interactive website for migraine sufferers)
  2. http://migraineagain.com (trusted healthcare advice from providers around the world)
  3. National Headache Foundation (large membership base for all types of headache)
    www.headaches.org

 

As we update and work to improve our website (www.ocmigraine.org) we welcome your feedback both positive and negative. Please address your feedback and/or suggestions for new material on our website to our office email at info@ocmigraine.og

Thank you for your trust in our headache-focused medical practice. This is truly an exciting time for headache with many new and emerging treatments both for acute and preventive. We look forward to your next appointment so we can determine which new treatments may be best for you.

Enjoy your spring-cleaning,

Dr. Susan Hutchinson & Dr. Molly Rossknecht

Winter Newsletter: Major policy changes regarding Opioid and Narcotic prescribing at OCM&HC

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Winter Newsletter: Major policy changes regarding Opioid and Narcotic prescribing at OCM&HC

We hope all of you are having a wonderful start to your Holiday Season. This has been a very exciting year for migraine sufferers with the launch of three Calcitonin gene-related peptide (CGRP) antibodies for migraine prevention. Aimovig was released in May. Both Ajovy and Emgality were released in September. This is the first category of migraine prevention that was developed specifically for migraine. Many of our patients are already seeing significant improvement with a reduction in both migraine frequency and severity.

For acute migraine treatment, there are oral CGRP antagonists in development. In addition, non-invasive neurostimulators are available for acute and prevention treatment of migraine and cluster. They include the Cefaly device, the SpringTMS (transcranial magnetic stimulation), and the GammaCore (non-invasive vagal nerve stimulator).

With so many specific migraine treatments emerging, our office has revisited the issue of narcotic and opioid prescribing for migraine. Narcotics like hydrocodone are not FDA approved for acute or preventive treatment of migraine or cluster headache. In addition, they can lead to medication overuse headache which can cause other treatments to not work as well. Lastly, they can cause drowsiness, depression, and can cause death in the case of an overdose.

The state of California is strictly monitoring the prescribing of narcotics and opioids. Responsible prescribing includes random urine drug screening, contracts, and limits on how many pills can be prescribed at one time. We have decided there are too many current restrictions and future restrictions for our office to prescribe any amount of narcotics. We are not pain specialists nor do we wish to be. Therefore, as of January 2019, we will be a “narcotics free” office. No exceptions will be made. All of you currently receiving a narcotic prescription from our office will receive a letter as well as a list of pain specialty practices in the local area. We will help with your transition to a pain specialist for future narcotic prescriptions. For those of you only needing a small amount of a narcotic to rescue a severe migraine, you may be able to request from your primary care provider (PCP).

There is an abundance of non-narcotic ways to treat a severe migraine attack including a Toradol injection, occipital nerve blocks, standing orders at the Hoag Infusion Center for IV medications and IV fluids, sphenopalatine ganglion blocks (SPG’s) administered in our office, a course of steroids, and anti-nausea injections or suppositories. In addition, the new CGRP monoclonal antibodies have helped some of our patients to not need a narcotic as their migraines are so much better.

We encourage you to make an appointment to come in and review your migraine plan. This is an exciting time for migraine sufferers with all the new treatments available. Let’s work together to help you be as headache-free as possible in 2019.

Happy Holiday Season,

Dr. Susan Hutchinson and Dr. Molly Rossknecht
Staff

Fall 2018 Newsletter

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Dear Patient,

We are pleased to announce that a second CGRP Monoclonal Antibody, Ajovy, was approved by the FDA on 9/14/18 for the prevention of migraine in adults. Like Aimovig, it is a subcutaneous injection. Both are well-tolerated and have been shown to be highly effective in clinical trials.

Ajovy is available as a pre-filled syringe vs the auto-injector with Aimovig. Ajovy offers the option of a quarterly (every 3 months) dosing. However, it requires 3 injections for the quarterly dosing. A monthly single subcutaneous injection is also available. For some patients, the quarterly dosing could be done as part of an office visit every 3 months and may be more convenient than the monthly self-injection.

Is one better than the other? The short answer is that we don’t know. There have not been any comparison trials. All trials with this new category of migraine prevention with CGRP monoclonal antibodies were conducted with the active drug vs placebo.

 

Who is a candidate for a CGRP monoclonal antibody (CGRP mAB)?

Any adult migraine sufferer who has 4 or more disabling monthly migraine days would be a candidate. Most insurance companies will require a failure or intolerance to at least 2 standard oral migraine preventives. Currently, this new category for migraine prevention is only approved for adults 18 and over in the US. There is not enough data to know if this new category is safe for pregnancy and lactation.
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We encourage you to make an appointment to explore this new preventive option for migraine. We may be able to give you the 1st injection in the office as part of your visit.

We are entering a new era of headache medicine with the advent of migraine specific preventive treatment that is effective and well-tolerated. You deserve to live a life as free of migraine as possible. We are here to help.

For more information, go to www.Aimovig.com and www.Ajovy.com

 

Dr.  Susan Hutchinson, Dr. Molly Rossknecht, & Staff

Orange County Migraine & Headache Center

9/24/18

Important Update: Aimovig for Migraine Prevention

According to Amgen Pharmaceutical, the overwhelming response to get Aimovig injection for migraine prevention has far exceeded their expectations. As a result, it is taking up to 4 weeks for patients to get their first shipment of Aimovig 70 mg injection once the paperwork has been processed. Our office began submitting Aimovig request electronically about 3 weeks ago to expedite processing of the prescription and enrollment form. Despite our electronic submission process, it is still taking 4 weeks for patients to receive the Aimovig.

Our office reached out to Amgen to see if there is another option while patients are waiting.  We found out that we can send a prescription in to Newport Lido Pharmacy for processing. Newport Lido will do the prior authorization and if approved, patients may be able to get Aimovig for as low as $5 copay. The Aimovig can be shipped to you or you can pick it up from Newport Lido.  Sending the prescription to Newport Lido does not take away the processing for the 2 free months that will come from enrollment in the Aimovig Ally program.

Another option is to go to www. GoodRx.com and get the best cash price for your first injection. My staff informed me Aimovig could be purchased for less than $600 at Costco and a few other retail pharmacies. Some of you may have Health Savings Accounts (HSAs) and be able to use that to pay for your first Aimovig injection.

Some of you have expressed concern about the $25 processing fee that you paid our office.  To clarify, this is to cover the staff’s time in the enrollment process and all the follow-up time tracking down orders now that Amgen is experiencing delays due to the overwhelming response.  Amgen takes full responsibility for the delay that is occurring. For more information, visit the Aimovig Facebook page or see their own message below this announcement.

In summary, Aimovig is and will continue to be a good treatment option for migraine prevention for many of you. We look forward to a new era in migraine treatment.

 

Dr. Susan Hutchinson

July 3, 2018

 

Amgen Apology Per Their Facebook:

We’re excited about the launch of Aimovig, and judging by the overwhelming requests we’ve received, so are you. We know the wait times for some of you have been less than ideal, so we want to take a moment to let you know exactly how we are addressing this. Due to high demand, we have increased the size of our Aimovig Ally™ team, so we can process your requests faster. While we are upgrading our team, please bear with us. Once prescribed, getting you Aimovig as quickly as possible continues to be our number one priority.

New Year’s Newsletter 2018

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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

Newsletter: Update on Office Policies

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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

 

Summer Newsletter: Barometric Pressure Change & Migraine

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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

Alternatives to the Emergency Room

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When a severe migraine hits, many sufferers end up in the ER. This is not ideal for many reasons including the long wait to be seen, the noise and bright lights in the ER, the attitude of the ER staff often treating the migraine patient as a narcotic seeker, and lastly, the cost. There are several alternatives to the ER including an urgent care center, home rescue, or an infusion center.

Urgent cares are typically open from 8 am to 8-10 pm seven days a week and do not require an appointment. They can give injectable medications like Toradol (Ketorolac) for the pain and if necessary, anti-vomiting injectables. Most don’t provide Intravenous Fluids (IV’s) so if someone is dehydrated, may be better to go to an ER. However, the Hoag Urgent Care near our office does offer IV treatment. The cost and wait time are typically much less in urgent care centers compared to the ER.

Home rescue is ideal and a home rescue plan should be part of every migraine patients’ “tool box.” Examples of home rescue include injectable Sumatriptan, nasal formulations of Sumatriptan, injectable Toradol, rectal suppositories, steroids, and narcotics. When a headache is prolonged and/or severe, it often does not respond to oral medication so non-oral treatment forms are preferred.

An Infusion Center can provide IV fluids and IV medication similar to an ER but in a calm and quiet atmosphere. Trained RN’s start an IV and administer the medication. Orders must be sent to the Infusion Center ahead of time and typically are a “standing order” set for a maximum of 90 days. Once the orders are approved and in the system for the Infusion Center, the patient can call for a same day appointment to be treated. There is a maximum number of visits per month that the patient can go for example 4-6 times. Infusion Centers are an excellent treatment option for migraine patients. They are also much less expensive than the ER setting.

I encourage all migraine sufferers to have an emergency plan in place for those migraines that get out of control. Ideally, home rescue can be successful eliminating the need to leave your home. If not successful, urgent care centers and infusion centers are good alternative options to the ER.

I look forward to reviewing your rescue plan to avoid ER visits as much as possible. When those ER visits are needed, a letter from me or your health care provider legitimatizing that you have migraines and are not a narcotic seeker, can help that experience be more comfortable.

Susan Hutchinson, MD
October 30, 2016

 

Summer Newsletter 2016

(Downlowd PDF version)

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

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