Have you thought about using a mouth guard? I had similar problem that you ran into. My dentist saw holes in my mouth and he said I was grinding my teeth and experiencing bruxism. I was grinding my teeth because of stress and anxiety in my life. My dentist wanted to create a custom mouth guard for me, but it was too much money. I did some research online and found affordable/high quality mouth guards from TotalGard.com on google. I now have a night guard that has eliminated my teeth grinding and my pain is gone. I hope you find the solution to your problem and find peace within yourself!
forgive me if i have already asked you some of these questions, but I don't remember answers:
if you have hereditary migraine (likely), and the migraines are what is disabling you, the only course to try is with a neurologist who also specializes in migraines (they may specialize in other brain related problems, too, like diagnosing MS, etc). First you will need to keep a diary to try to find triggers that you can avoid. I don't know the frequency and severity of your migraines, except you seem to be able to keep working with them. If disabling, you would cycle through migraine preventative drugs (usually lower-than-clinical doses of various anti-epileptics, old fashioned tri-cyclics, neurontin, etc., until you see if one of them prevents your migraines. If you are taking a vasoconstrictor (don't know maxalt - I think it is Brittish? that is in the same family as Imitrex, or Relpax, you would be trying to find a daily drug that greatly reduces the frequency of taking rescue medications like Maxalt, Imitrex, or Repax. You don't want to be taking a rescue medication multiple times a week indefinitely, or you can get rebound headaches.
If you are not depressed, you might want to very slowly taper off the effexor, if you think any of your various headaches are more frequent or worse since you got up to an effective dosage. 2 requirements before you taper off effexor: do it slowly and under a doctor's supervision, like with all anti depressants, to avoid a temporary depression while your neurotransmitters are adjusting. If you do taper off, don't do it during the months you are trying low doses of migraine preventatives, because you want to see if frequency or duration is affected by a single med, so you don't want to be changing other meds at the same time. Effexor is great for those who need not only to increase the amount of serotonin, but also need to increase the amount of norepinefron, another neurotransmitter. If you already have enough norepinefron, the effexor could make the levels high enough for some side effectst that wouldn't help anxiety or spasms, etc. Too many people are given a serontonin reuptake inhibitor solely because a doctor doesn't want to prescribe controlled substance painkillers, they have been advertised to help with pain, but if you are not depressed except for dealing with chronic pain, sometimes it gives more side effects than therapeutic value.
If you have tension headaches, and THEY are what is disabling, then you would have to try to find ways to alleviate them. When you first took soma (there is a cheaper generic version now) did it stop your headaches and pain for a few weeks? That would be the kind of simulation that would tell a headache doctor, if the tension headaches are your most disabling problem, that stopping them is your priority. There is even a botox course for tension headaches, kind of injecting them around your head in a sort of ring of injections, but it is expensive, not covered, and might not work. Stress reduction, breathing and relaxation exercises all day, and exercise are key for tension headaches, I think.
The main thiing is to try to get an accurate diagnosis of which is most disabling for you, hereditary migraine, depression, and if it is one of them, just get a soft mouthguard that minimizes grinding and shock, and work on trying migraine prvention first.
If you have local pain that is most severe around yourTM joint, spreads from there and causes the most disabling pain, work on getting a temporary rest for your jaw: a soft biteguard, and a short course of soft food, or botox. If doing this stops the disabling problem, put your $$ into trying to reduce TMjoint pain, but there is no cure for that yet, just management with finding a soft mouthguard that relieves inflammaton there, occasional somas, stress reduction, exercise, and ruling out apnea (get a sleep study with bruxism leads included) that can aggravate a TMjoint if you are jawing and gasping for breath all night long.. For a very very few, fixing a bad bite might do it.
I think that if you haven't tried defining which approaches will tell you what is most disabling, and try to find a treatment for that, you could waste $$.
Hope this helps