Holiday Message December 2020

Dear Patient,

We want to say goodbye to 2020 filled with COVID-19 invading our lives, economic and political unrest, and just the uncertainty of daily life. We have all had to adapt in ways that have adversely affected our life and caused undue anxiety, stress, and unhappiness. For many of you, your migraine pattern may have worsened.

Our practice has remained open to take care of your needs. We are very grateful that most of you have been receptive to us practicing virtual medicine by reviewing your medical issues over the phone. We anticipate many of you may want to continue handling follow-up visits by phone even after vaccinated for COVID-19. Phone visits can be convenient and still provide a thorough review of how you are doing with your headache and/or mood disorder issues.

For those choosing to come in person we can accommodate you. This has been important for those of you needing a Botox procedure, a nerve block procedure, a Toradol injection, or simply a preference for an in-person visit. We will continue to take your temperature and screen for COVID-19 prior to entering our office. Disinfecting the exam rooms in between patients and disinfecting all office surface areas will continue to be a top priority to help you feel safe in our office.

On an optimistic note, new migraine-targeted treatments have become available in 2020 including Ubrelvy, Nurtec, and Reyvow for the acute treatment of migraine attacks. Vyepti, an IV CGRP targeted treatment for the prevention of migraine, has also become available and is helping many of our patients who like the convenience of an IV medication administered over 30 minutes every 3 months at a local Infusion Center in Irvine that we are affiliated with.

May you & your loved ones have a safe & joyous Holiday Season. We look forward to 2021 and helping you towards improved health.

Warm regards,

Dr. Susan Hutchinson & Dr. Molly Rossknecht

Orange County Migraine & Headache Center

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:

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

For Pilates, consider on-line classes such as offered by Streaming-Salt Pilates, at

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

What is the difference between Ubrelvy and Nurtec?

Orange County Migraine & Headache Center

Ubrelvy and Nurtec are 2 new oral medications approved for the acute treatment of migraine in adults. Both are in the same category of migraine medication called the “gepants.”  Ubrelvy is an oral tablet 50 mg & 100 mg and is taken as needed for migraine and may be repeated in 2 hours to a maximum of 200 mg in a 24-hour period. Nurtec is a 75 mg orally dissolving tablet and is taken one tablet in a 24-hour period for migraine. Both are well-tolerated and show no evidence of medication overuse headache or vasoconstriction.

Good candidates for Ubrelvy or Nurtec include those for whom the triptans are not well-tolerated, not adequately effective, or are contraindicated. Please schedule an appointment to discuss whether Ubrelvy or Nurtec may be appropriate for you. Both have good access and affordability for those with commercial insurance.


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

May I take Fioricet after taking Ubrelvy for acute migraine?

Orange County Migraine & Headache CenterFioricet and other Butalbital containing medications are CYP3A4 inducers and will cause Ubrelvy to be potentially less effective.  CYP3A4 is an enzyme and activation of this enzyme with an inducer like Fioricet will decrease exposure to Ubrelvy. So it would not be recommended to take both in the same 24-hour period.


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

May I take my Imitrex (Sumatriptan) in addition to Ubrelvy in the same 24-hour period?

Orange County Migraine & Headache CenterYes. In the clinical trials with Ubrelvy individuals were allowed to take a 2nd dose of Ubrelvy or take their triptan like Sumatriptan in 2 hours after dosing if not headache free. There does not appear to be any safely issue taking both Ubrelvy and a triptan in the same 24-hour period.


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

Should I take the 50 or the 100 mg dose of Ubrelvy, the new migraine medication?

Orange County Migraine & Headache Center

Both the 50 & the 100 mg doses of Ubrelvy (Ubrogepant) showed good efficacy over placebo in clinical trials. Both doses are FDA approved for the acute treatment of migraine with or without aura in adults. Either dose may be used. If you start with 50 mg and are not headache free in 2 hours, then you may consider increasing to the 100 mg as your usual dose. Importantly, we have options for dosing. Once taken, either dose may be repeated in 2 hours and the maximum in 24 hours is 200 mg. To learn more, go to

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