I'm a fellow NDPH'er and I'll try to explain some potential options. Obviously there are tons of things to try--even after my headache clinic told me that they had exhausted their available treatments several years ago I continue to try new things. I'd be able to temper this list much better if I knew how you've responded specifically to each of the medications you're on now and the ones that were administered to you in the hospital, but I'll post some suggestions that come to mind.
- While Topamax didn't work for you, other anti-seizure meds might, in particular Zonegran and Valproic Acid (you mentioned having it in the hospital but not at home, I believe).
- Anti-inflammatory medications can help keep the pain in check and there are plenty available that are a lot more potent than Naproxen. Some you'd take as needed, like the Toradol you were administered in the hospital, while others are sometimes prescribed to take daily. One of the most common is Indomethacin though there are a ton of others.
- Antidepressant medications often are useful in treating headaches as well as being helpful in maintaining mental health. Elavil can be helpful, though it's a member of an older class of antidepressant medications. The newer SSRIs like Prozac, Zoloft, Lexapro, etc. might be worth trying if you've been on Elavil for a month or two and don't feel like it's helping.
- Beta blockers and Calcium channel blockers can sometimes be effective in headache treatment. Verapamil and Propranolol are examples, respectively.
- Other medications don't fit into these usual categories. Neurontin (Gabapentin) and oral Lidocaine come to mind.
I understand why you want to avoid narcotic medications. Ideally they should only be used when your treatment options have been exhausted--a circumstance that I hope you never experience but, if you do, it won't be for at least several more years (because there are a lto of treatment options).
I'm a little uncertain why you don't want to try Botox injections. They're a part of standard headache treatment plans these days and are truly not much of an ordeal. Another injectable treatment is nerve blocks. A local anaesthetic is injected into areas around nerves in your head, neck or face. If your headaches have any origin in neuralgia (nerve pain) this can be particularly helpful. Further, if this is particularly helpful, nerve stimulators can be implanted under your skin in the area(s) around the affected nerves which can keep the pain in check (I tried this is two areas, though it wasn't helpful for me).
Other things to consider are biofeedback training, non-prescript
ion supplements like Magnesium, certain B-vitamins, feverfew, and butterbur, amongst dozens of others, making dietary and/or lifestyle changes (particularly in maintaining regular, good sleep), trying alternative treatments like acupuncture or hypnosis, TMS (Transcranial Magnetic Stimulation, a relatively new treatment that I'm quite interested in), and good mental health (consider seeing a therapist if you aren't already--constant pain takes a heavy toll on the body and mind and it's never too early to look after that).
Anyhow, I hope that you know that you have a lot of potentially helpful treatment options ahead of you. The ones that I mentioned are only a part of what's available.
DX: NDPH (2003-present), CRPS (1998-?) possible Abdominal Migraine (2010-present)
RX: Lamictal, Indomethacin, Propranolol, Provigil, Viibyrd, Oxycontin, Clonazepam, Zyprexa, Melatonin, Magnesium, Boswellia Serrata extract (Boswellic acid)
CPAP for mild sleep apnea
PRN: Ketamine nasal spray