Ajovy

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

Why didn’t Aimovig, Ajovy & Emgality work for me? I thought they were supposed to be the new “miracle” injections for migraine prevention. I am frustrated-please help!

I am sorry this new category did not work for you. I hope you had an adequate trial for each one which would be a minimum of 3-6 months. All 3 of the CGRP monoclonal antibody injections currently FDA approved for migraine prevention target CGRP, a neuropeptide released throughout the peripheral and central nervous system during migraine attacks. Significantly, these large molecules given via injection only work on the peripheral nervous system. There is a new oral CGRP category coming out that are called “gepants”. These “gepants” in development for acute and preventive treatment of migraine are small molecules and will be able to cross the blood brain barrior and work centrally as well as peripherally. They could potentially be more effective for some migraine patients. In addition, there is another neuropeptide called PACAP that appears to be a key player in migraine pathophysiology. There are drugs in development to target PACAP and perhaps for some migraine patients, targeting PACAP may be more effective than targeting CGRP. Don’t give up-there are new drugs in development.

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

What is the difference between Aimovig, Ajovy, and Emgality for migraine prevention?

All three drugs are part of a category called CGRP monoclonal antibodies and represent the first migraine specific preventive category to come to the US market.  All show good efficacy and tolerability in clinical trials. All are only for adults 18 and over. None have been studied for safety in pregnancy & breast-feeding. Aimovig targets the CGRP receptor and both Ajovy & Emgality target the CGRP ligand to prevent migraine. The main difference is in dosing and administration. Aimovig is given as either a 70 or 140 mg monthly subcutaneous injection and comes as an auto-injector. Ajovy is dosed as 225 mg monthly or 675 mg quarterly subcutaneous injection and comes as a prefilled syringe with a small needle. Emgality is given as a loading dose of 2 injections of 120 mg each then a monthly 120 mg dose. Like Aimovig, Emgality comes as an auto-injector. All three are designed for self-injection at home. Aimovig and Ajovy can be injected in the thigh, abdomen, or upper arm. Emgality has an additional injection site of the buttocks. All three should be disposed of in a Sharps Container. Lastly, all three can be injected as part of an office visit if you feel you are a candidate.

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

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

Is the new Ajovy for migraine prevention better than Aimovig?

There have not been any studies comparing Ajovy with Aimovig. This new category of CGRP monoclonal antibodies is an incredible break-through for migraine prevention. Experience in the “real world” apart from clinical trials may help us answer your question. Significantly, both Aimovig and Ajovy have favorable side-effect profiles, are well-tolerated, and quite effective (as early as 1 week in some patients) in clinical trials.

Some patients may feel one works better than another just like some patients prefer Sumatriptan to Rizatriptan vs others prefer Rizatriptan to Sumatriptan. Treatment needs to be individualized to each patient. We are here to help develop your individualized migraine treatment plan.

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

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