DTK,

Wow. You have your hands full.

Dr. Matthew is listed on our directory of Patient Recommended Migraine and Headache Specialists, which means that I've had positive recommendations from patients who have seen him. I don't know where you're located, but if you can look at the list to see if you have more than one choice.

Absolutely, in your position, seeing a Migraine specialist is a good step. It's going to be important that all of your doctors are willing to confer with each other, so insist up on it. That's part of what you pay them to do, and they need to talk to coordinate your care.

Have the hormonal fluctuations been a Migraine trigger for you over the years? If so, it's hard to tell if the hysterectomy will make things better or worse, or make no difference at all. If those fluctuations haven't been a trigger for you, there's no guaranteel, but it's possible that it won't make any difference at all.

Migranal Nasal Spray is, as you probably already know, a Migraine abortive medication that works to stop the Migrainous process, thus stopping the symptoms. There are other abortive medications you can try -- Imitrex, Maxalt, Zomig, Amerge, Relpax, Axert, and Frova -- as well as Treximet, which is a combination of Imitrex and Naproxen Sodium. Each of the triptans binds to different combinations of serotonin receptors, which is why our bodies may respond differently to each of them. It's well worth discussing the ones you haven't tried with your doctor.

Something we have to keep in mind with those medications though is that

taking Migraine abortive meds such as the triptans or ergotamines (Migranal) or any kind of pain medication -- prescription or over-the-counter -- more than two or three days a week can make matters worse by causing medication overuse headache (MOH), aka rebound. See Medication Overuse Headache - When the Remedy Backfires for more information on this.

I've been where you are -- spending lots of $$ to see doctors, but not making any progress. Getting to a Migraine specialist is what helped me finally start making progress.

Please keep me posted?

Good luck,