Emgality

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.

Summer Newsletter 2019

(Download PDF)

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

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.