That's a really tough situation to be in. It sounds like you're a migraine Pro by this point, but I 'm going to ask some basic and probably stupid questions. Just humor me for a bit.
What's your official diagnosis? CDH, Chronic migraine, ect.? Since you go to one of the big headache centers I assume they performed a differential diagnosis to rule out things like NDPH, comorbid neuralgias (occipital and sub-orbital) and secondary headaches. Have they ruled out some of the less common triggers like cerebrospinal fluid pressure issues, PFO's, etc?
How often do you take analgesics? I know some people have to take pain meds daily and there is just no way around it, but have you ruled out rebound headache as an exacerbating factor?
I know you've been through plenty of med trials. If your interested you can list them and we can try to brainstorm some others to try.
OK with the basics (sorry) out of the way...
Sounds like the pharmacist is worried about
serotonin syndrome. Talk to your headache specialist. You may still be able to take triptans. I wouldn't completely rule it out yet. I've taken triptans (higher doses) and ssri's (moderately high dose) concurrently in the past.
For really bad pain, I believe there is some type of time released morphine capsule. There's marinol as well. A consult with a pain specialist may be warranted.
semi-frequent I.V. treatments (e.g. magnesium, depacon, DHE, etc.)? I know a lot of migraine clinics have their own, in house blends.
They are coming out with or have just come out with a DHE nasal spray.
There are also the older ergot based abortive drugs.
If you really want to go for the gusto, they have some relatively new medical devices out. E.g. Vegus Nerve Stimulators, TENS unit, occipital nerve stimulators, transcranial magnetic stimulators (I think there may be a home/portable unit available now).
I assume you've done the elimination diet thing. There are some anecdotal reports to suggest using some of the epilepsy diets could be helpful. I.e. ketogenic diet (need to be monitored), low glycemic index diet, modified atkins diet, GARD diet.
I hope you find something that is helpful!
Post Edited (EvilFluorescents) : 2/19/2011 12:28:46 PM (GMT-7)