Was followed by neurologist for 10+ years and we tried multiple preventive and abortive medications.  For some time Imitrex worked well. It stopped working when I started taking SSRI's for Depression (which is stable on these medications).  Was referred to pain clinic due to the impairment with the discs.  I have 9 total but all are considered mild and not needing surgical intervention at this point. Tried multiple non-opiate type pain relievers with little effect or serious side effects.  Current tx works pretty well but has created a transformed migraine.  Without the opiates I was unable to work in part due to difficulty sitting and being unable to drive.  Doctors put me on oxycontin 10mg/2x daily.  Works beautifully and I'm back to being fully functional.  However, I have 2 severe "headaches" a week and once a month a hormonal migraine that doesn't respond to most medications and usually must be broken at the ER with protocol that includes opiates.  Obviously not a good long term plan.  We are attempting nerve ablations which seem to be going well and with goal of lowering dose of opiates.  Given these multiple conditions - level of severity/impairment - and having to choose between transformed migraine and nerve pain how would one treat these various conditions?  One neurologist told me to get off ALL pain killers, even OTC medications.  However, he didn't have an answer for how to treat the pain created by disc degeneration, arthritis, and spinal canal narrowing.  I have tried medications like Neurontin which put me to sleep at 600mg and wasn't really relieving pain as well as Lyrica which I couldn't tolerate - in addition to multiple drugs in at least 5 different categories, abortive and rescue.

Sorry this is so long.  I've been labeled a "complicated" patient.  I'm also a psychologist who understands addiction, brain chemistry, and physical brain changes.  Pain doc and neurologist at odds and ER doesn't know what to do with my once monthly visits.  Neither doc will suggest protocols to ER which is their prerogative.  I'm stuck in the middle, torn between TM or debilitating nerve plan.  Very curious to read your response.

Thanks so much

.