Help in Columbia - Preventative and pain medications that actually work?

Full Question:

How in the world will a person that "rides the edge of the coin" like me when it comes to migraine find a neurologist, preventative medications and pain medications that actually work without head "pressure" or rebound headaches.  Some of my triggers are actually good for a person and I have limited or removed the rest.  I have spoken to my G.P. and he says there is no one in my area that prescribes narcotics for migraine pain relief.  I have been on Topamax, Lamictal, verapamil, Verelan and others for prevention that quit working after a time.  I have tried Imitrex, Migranal, Relpax, Midrin, Zomig and Frova and others. These either gave me rebound headaches or other side effects that affected my daily life.  My triggers include tomatoes, garlic, chocolate, malt beverages, aged chesses and meats, stress (of course), less than 6 hours of sleep or more that 8 hours of sleep. Help. I don't know where to turn, I live in Columbia South Carolina and have been dealing with migraine for almost 26 years now. Wendy.

Answer:

Dear Wendy;

Sadly, your question shows your issues to be quite similar to those of many, many Migraineurs. Yes, you have several food triggers that you need to avoid, but at least you can avoid Migraines triggered by those. Those, at least, are avoidable, manageable triggers. It's great that you've figured them out. Doing that saves you a great many Migraines.

There's really no "of course" when it comes to stress as a Migraine trigger. There's still some controversy, but we hate to see anyone accept that stress is a trigger without at least trying to see if they encounter triggers during stressful times that they either don't encounter at other times or they're only triggers when the body is stressed. The International Headache Society has removed stress from their list of Migraine triggers and put it on their list of exacerbating factors -- things that make us more susceptible to our triggers. Many people have sworn stress was a trigger for them until they kept a very detailed diary for a few months. More information in Is Stress a Migraine Trigger?. We hope you'll thoroughly investigate this as we think we do ourselves a real disservice by thinking stress is a trigger for us and not looking closely for other triggers during stressful times.

Medications having given you rebound headaches is evidence that you need to continue working to find an effective preventive regimen. That's far better for a Migraineur's health than  taking abortive medications or pain relievers so frequently. Anyone who has more than three Migraines a month needs to be taking something for prevention. There's growing evidence that Migraine is a progressive brain disease. A recent study showed that Migraines can cause brain damage, and that people with three or more Migraines a month are more susceptible to this damage. For more information, see Is Migraine a Progressive Brain Disease? and Yes, Migraines Can Cause Brain Damage.