Not happy with slow progress controlling migrainous headaches?

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    Hi, I am a 52 year old RN for 31 years and started having daily headaches about 3 years ago when I was being treated for depression. I have no family history of migraines nor did I ever suffer from frequent headaches. I am fortunate that I live in the NY City area and have many Headache Centers in the area. I am no longer on any anti-depressants for depression but I continue to suffer from daily pain. I have been on Pamelor, Elavil, Depakote, zonisamide. and Topamax. I had the most success from Topamax however when raising the dosage and I became extremely anxious and my Dr. discontinued it. I have had Botox and acupuncture as well with little beneficial results. I am currently seeing a neurologist at a Headache Center in NY, doing his residency/fellowship? at Jefferson Hospital in PA. Currently I am on Atacand 32mg, and desipramine 250 mg, the later for about 3 weeks. I still have daily "migrainous" type pain and take a minimum of 100mg of Tramadol a day and when the pain is really bad I add Axert 1-2 tabs/day. It is quite discouraging, although I am NOT depressed just extremely unhappy about my life situation after being very healthy all of my life. I can not identify any triggers although at times the pain increases during ovulation and menstruation. I do avoid the typical food triggers, chocolate, caffeine etc. but really not sure if they play any part in my daily pain. Having been to 2 other neurologists (one at another headache center in NYC) prior to my current physician, I do feel confident he knows his drugs...but I am not happy with the very slow progress. Any suggestions would be extremely helpful. I continue to work as an RN in a busy unit in a NYC hospital. Sometimes I do not know how I manage to take care of my patients and deal with my own pain. Life is truly a daily challenge.

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    Thank you, Susan.


    Dear Susan;

    Your story is one of millions: searching for that right molecule to help taper down the frequency and severity of headaches and Migraines. Most prophylaxis schemes take 2.5-3 months of trial and dosage adjustment Unfortunately, even large, well-known headache clinics are limited with what they can treat IV. This is often due to political constraints, so clinics like mine have the advantage of more kinds of medications, with proper monitoring.

    Looking for a family history of Migraine can be tricky. Most times, when people with Migraines search long and hard enough, they find a family history of "sick headaches" or "sinus headaches" that were actually Migraine.

    I wish you the best of luck in your quest for relief,
    John Claude Krusz and Teri Robert

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    About Ask the Clinician:

    Dr. Krusz is a recognized expert in the fields of headache and Migraine treatment and pain treatment. Each week, he and Lead Expert Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about Dr. Krusz or more about Teri Robert.

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    Last updated December 7, 2009.

Published On: December 12, 2009