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

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

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

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!

Susan Hutchinson, MD Director-Orange County Migraine & Headache Center

New Needle-Free Sumatriptan Delivery

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Imitrex (Sumatriptan) injectable was launched in 1993 in the United States and quickly became the gold standard for fast & effective treatment of a migraine attack. It was the first “triptan” on the market and was quickly followed by an oral and nasal delivery form of Imitrex. Other triptans followed and there are now 7 triptans available in the United States. They include Imitrex, Maxalt, Zomig, Axert, Relpax, Amerge and Frova. Triptans are the most migraine specific medications we have for the acute treatment of migraine. Imitrex now comes in a generic form called Sumatriptan.

Until 2010, Imitex stat-dose (4 & 6 mg) was the only injectable triptan available. The quick onset of action (10 minutes) and the non-oral route made it ideal for:

  1. Migraines associated with nausea & vomiting
  2. Rapidly escalating migraine attacks
  3. Morning migraines

However, some patients do not like to give themselves an injection and may be “needle phobic”.

SUMAVEL Dose Pro is unique. It is a needle-free system that delivers 6 mg Sumatriptan subcutaneously. It offers the same 10 minute onset of action as injectable Imitrex (Sumatriptan) and the same advantages of a non-oral delivery system.

How does it work? The SUMAVEL Dose Pro is a self-contained injection device with 3 simple steps:

  1. Snap (snap off the cap)
  2. Flip (flip back the lever)
  3. Press (press against the skin)

The device is pressed against the skin of the thigh or lower abdomen. It should not be injected through clothing. The Sumatriptan is delivered into the subcutaneous tissue by the force of compressed nitrogen gas that is released once the unit is activated. There is an audible “whoosh” as the nitrogen gas escapes. Once the “whoosh” sound is heard, the Sumatriptan has been delivered. After administering the Sumatriptan, the entire unit can be disposed of in the regular trash. There is no needle to dispose of. At this time the unit is not recyclable but plans for that are underway.

How is it prescribed? It comes in a 6 mg dose. It can be injected as needed for a migraine attack and may be repeated in 1 hour to a maximum of 12 mg in a 24 hour period. It is FDA approved for the treatment of migraine with and without aura and for cluster headache in adults ages 18 and older.

Can it be combined with oral triptans in the same 24 hour period? It is not recommended to combine different triptans in the same 24 hour period. However, I feel it is OK if the oral triptan is Imitrex, generic Sumatriptan, or Treximet since they all contain the same triptan (Sumatriptan). Please call our office if you are unsure about this issue.

What are the side-effects of SUMAVEL Dose Pro? Side-effects may include a feeling of chest tightness, flushing and warmth. Local injection side-effects can include swelling, redness and bruising. A small drop of blood may be present after delivery. In the majority of patients, SUMAVEL Dose Pro is very well tolerated.

In summary, SUMAVEL Dose Pro is a new & unique non-oral delivery system for Sumatriptan. It offers the quick onset of action and effectiveness of injectable Imitrex but without the needle. To learn more, visit

If you feel you can benefit from this new delivery system and medication please call our office and we can set up an appointment. I look forward to demonstrating this unique needle-free injectable system and teaching you how to get fast, effective and needle-free relief from an acute migraine or cluster headache attack.

Our office phone number is 949-861-8717.

Susan Hutchinson, MD Director-Orange County Migraine & Headache Center