next medication step?

New user here. I'm currently seeing a neurologist. Had an mri that came back perfect. I'm on the following

Topamax
Propanolol

And I've tried these...
Imitrex
Maxalt
Migranol (ergot)
Vicoprofen
Nucynta (new medication released last year)

Neurologist said I have treatment resistant headaches. None of the above medications work. I have also spent hundreds of dollars on a nerve block procedure that my insurance didn't cover that didn't work.

My question is what is the next step in terms of medication I should ask for when I see my neurologist on Monday.

Thanks

I don't see botox on your list. What, if anything, do you think triggers your migraines?

Haven't tried botox. I have an anxiety disorder and treatment resistant depression as well. I was on zoloft, celexa, wellbutrin, effexor, cymbalta, combination effexor and wellbutrin and celexa/wellbutrin combo and zyprexa. I was also on xanax. I'm no longer on any psychiatric medication I was weaned off of them. I don't know what causes my headaches. I wake up with it and go to bed with it. My mood has thus gotten extremely bad. I have also collapsed from the pain. Three weeks ago I was completely out as I was walking to my bed. I didn't make it to my bed and can't remember what happened at that point but I woke up in the ambulance. I fell directly on my face and couldn't even raise my hands to brace my fall. My whole left side of my face was burned from sliding against the rug.

Have you had a lumbar puncture to check the pressure of spinal fluid in your skull (checking for intracranial hypertension)? It is not something that will show up on an MRI.

No I haven't azgirl. I forgot to mention I have also had two different injections at the hospital.

My first was iv dilauded. The second was injection of toradol. They both failed. The dilauded just made me feel weird.

I also have severe upper back pain and neck pain. It may seem odd but I can't walk for more than ten minutes before I have to sit down. Before I go shopping with my girlfriend I have to scout out where the chairs are so I can sit. I am only 21 years old. I don't smoke or drink.

I used too weight lift and run. I weighed 158 pounds two years ago and currently weigh 246 as of this morning. I started gaining weight around the time I saught treatment for my anxiety disorder.

Do you go to a pain management clinic? Then I have to say, get a new doctor. You might also want to think about neurostimulator impants for your chronic pain.

I am very much in the same boat you are in. Hang in their. Stay strong.

Not got anything to offer I'm afraid, I am not drug savvy and in UK where it differs quite a bit.
But I just wanted to say, if you are new, we need to say welcome to Ronda's.

Hope you like what you find here.

Pen

Tyrosinekinase??? Are you a scientist?

There are other anti-seizure meds. I've had some success with Lamictal. It hits some different receptors than Topamax does. There's also neurontin, gabapentin, valproate. You also said you tried a beta blocker, but alpha blockers are also an option that some people have success with.

There's a pretty comprehensive list of medications here: http://www.healthcentral.com/migraine/medications-161082-5.html

If your neurologist hasn't come up with some of these options on his own, you might want to consider finding a new one. Not all neurologists are specialists in migraine - in fact, very few are.

I wish you the best of luck.

I just read that you also have a treatment-resistant mood disorder. I really, really think you should discuss Lamictal with your doc.

I have not been on Lamictal for about a couple of months, because of lower back pain, an upset stomach, and increased sensitivity to sound, but it did work on my chronic daily headaches.

After being off the med for a couple of months, yesterday I had a particularly bothersome headache, so I decided to take a small piece of a 25 mg tablet to see how that would work. In about four to six hours, the headache pain level decreased by a third. For some reason, it works as an abortive for me.

It seems to me that after it builds up in my system, the side effects hit, and it does not work on the HA as well as the first few days. I wonder if I had had a bigger dosage,would the headache be completely gone.

Martin

did you have a full body MRI or just the head ? have you thought herniated disk in the neck ? thats what not walking far reminded me of. I would see another DR. just for a new view. But I changed DRs quickly. Just have a complete treatment list you and the DR. can refer to together. Sounds like you have something real bad. Hope for some relief soon.

Thanks for the welcome pen.

In response to jwar, I'm not a doctor yet. Too young (21 years old). I'm majoring in biology. Ill be in Optometry school in a year and ill get my phd in about 4-5 years.

In response to rileyoday, I have indeed had an mri done on my neck. It came back great.

Im not going to change my current neurologist, I'm sorry I didn't complete explain him. This will be my third appointment with him. He is actually my second neurologist. He's a young doctor who is very down to earth and since he's closer to my age than other doctors I'm able to level with him. He's a very smart guy and often brings his two partners (who are also neurologists) into the room to help and brainstorm ideas.

My question is geared more towards rescue medications since I have been prescribed about mid-upper level pain relievers that haven't touched the pain, what are some better options.

Thanks. I'm going to talk about lamictal.

Anyone else have any suggestions

Acupuncture has helped some forum members, me included. Do a search on this forum, there are several threads in which member have stated their experiences with acupuncture. As several people have stated, not all acupuncturists are created equal. Also, there are various techniques and some may not help you at all. That is also my experience.

Martin

[left]I have tried most of the same medications you list - but it seems that most docs here prescribe such varied level/doses -- I am up to 400+mg of Topomax and the same of Lamictal, (which is 2x - 3x what many docs recommend - .... serious side effects with grammar and spelling.) - my neurologist suggested heading in another direction soon, as this combination (similar anti-seizure approach) has helped somewhat - still down more than 50% of time with complex migraine. Also have tried Flunarizine (Canadian?) .... and frankly just hit a blank when trying to remember other approaches tried over past 3 years ..... but for 'rescue meds' - I prefer the migranol, fiornal and fiorcet - codeine for knock-out when necessary.

For abortive medications I use midrin and indomethacin. If it's a bad migraine, both drugs at the same time are pretty effective for me. Triptans don't work for me - ultimately they make me feel like total shit and the headache rebounds as soon as they wear off (usually worse than it originally was). You might want to discuss these options with your doc.

have you tried a chiropractor? i got some relief there. A good one can x-ray your head/ neck and might see something.

For pain relief I still use oxycodone. You might try that if nothing else is working.

My advice is to proceed carefully with lamictal. While it seems to work for some people others of us have gotten bad side effects.

If you have not tried natural supplements that is worth a try. Both my brother and myself have gotten significant migraine relief from the following daily supplements:
400 mg magnesium gluconate
5000 mg vitamin D
12.5 mg iodide
4 omega-1000 tablets
(www.omega-1000.com is a good source)