I have had 3 epidurals over the last 8 years, the last one in June 09, after an MRI showed "moderate to severe" arthritis in my neck vertabrae. My diagnosis is "occipital neuralgia" and my symptoms pretty much fit the migraine profile except for the auras. And I also used to have the prementrual migraines, so I think I am predisposed to them. I have also had fibromyalgia for 20 years, and I believe much of the damage to my neck vertebrae is from constant muscle spasms in my neck and upper back constantly pulling them out of alignment. If I pick up anything weighing over about 7 pounds I almost always have a migraine the next day. I was reading about the soldiers having migraines after minor head or neck injuries, and mine are caused by similiar problems. They really kicked in about 10 years ago. I got my last nerve block (and the MRI) because I was having constant pain from a mucle spasm in the back of my neck, which is where I had the epidural. Now, about 4 months later, I find it hasn't helped me as much as I had hoped. Now the pain and spasms are going AROUND the back of my neck where I had the epidural, and up the sides of my neck into my jaw and head. I saw my rheumatologist last week and he gave me trigger point injections at the base of my neck on the sides for the spasms. I had immediate relief but only for a few days. Once the spasms relax, then the migraine hits. You may get some relief from the epidural, but it has no lasting effect if the root cause is blood vessels expanding or brain chemistry. Pain meds do not work for me, but as I saw elsewhere on the migraine website, injections of keterolac can help. When I lived in VA and I went to my doc with a migraine he would give me an injection of 60mg. of keterolac (Toradol) and it would help. You know people say there is no objective test to determine if someone is having severe pain, but I realized that every time I went in with the migraine my BP would shoot up to 160 over something, when normal was 110/70. Oral keterolac is prone to cause stomach damage, so the only way to get a hefty dose is the injection. A frequent large injection may be a problem for the liver, but I don't know that for sure. Maybe you should tell the pain management doc that epidurals do not work for you. Maybe you should see a neurologist instead of a pain doc - although some of them are neurologists, and some are anesthesiologists. I think the pain docs are more prone to treating this as a mechanical problem, as in practicing sports medicine,instead of a brain disorder. Please keep us posted on your progress! Good luck!