How can I stop these terrible migraines?

Here is My Question:
Migraines are increasing in frequency. I had Cosmetic Botox done in early April and it helped, but it is wearing off. I am getting at least 2 per week, including blinding auras and debilitating pain. My Neurologist (MS Specialist) discontinued Imitrex, and prescribed Zofran for the nausea and vomiting. The pain is unbearable. My PCP prescribed Norco, but I am not happy with the side effects, particularly how long it takes to work, and I do not take it frequently. I have tried a chiropractor and acupuncture, but to no avail. I was advised to get a toradol injection during the migraine. Is that the only solution? It is getting to the point where they are interfering with my ability to function. I would prefer a holistic treatment, but aside from a cartoon sized mallet, what are my options?
Thank you for your help.

Answer:
Given the frequency of your migraines, you would be a candidate for another prophylactic therapy (besides Botox).  Other options could include topiramate, elavil, or inderal.  If prophylactic migraine therapies are ineffective, it has been my experience that sleep apnea should be investigated, because if present, apnea can make headaches refractory in the absence of treatment for sleep apnea.  You can discuss those options with your neurologist.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente

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