annie,

You have two good questions here, but there are no simple answers to either of them. In both cases, nobody can predict what will work for you. Gamma knife radiation isn't a treatment that's been researched much for Migraine, so there's not much to draw on. Some doctors try nerve blocks first where they're considering this treatment because that's at least some indication of whether you're a good candidate for the procedure.

Regarding preventive medications, I know how easy it is to feel as if you've tried everything out there, but there are so many medications that can be used for Migraine and headache prevention that it's literally impossible. To me, that's good news that gives us more hope. You can find a list of potential Migraine and headache preventives in Migraine preventive medications - too many options to give up!

In the emergency room, again it depends on what works for YOU. Sometimes, the best treatment for intractable Migraines that aren't responding to medications is IV infusion therapy to get the cycle broken. For more information, see IV Treatment of Refractory Migraine. Quite a few people find that a simple IV infusion of magnesium sulfate or an injection or infusion of Maxeran stops their Migraines when they have to go to the ER.

How many days a week are you using Imitrex or indomethacin? Taking Migraine abortive meds such as the triptans or ergotamines 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.

It may well be time to consult a Migraine and headache specialist. It's important to note that neither neurologists not pain management specialists are necessarily Migraine and headache specialists. Take a look at the article Migraine and Headache Specialists - What's So Special? If you need help finding a Migraine specialist, check our listing of Patient Recommended Migraine and Headache Specialists.

I know you're going through a rough time. If you'd like some additional support, come join our discussion forum. You'll need to register again once there because it's a separate membership database, but you can use the same member name, email address, and password that you used here. You can find our forum at http://forums.healthcentral.com/discussion/migraine/forums.

Good luck,

Teri