Can you describe your reaction to Triptans? Any help at all? From your post I interpret that you currently take at least one but may have mixed results? If they were all the dissolving type, I would try both pills and also the Imitrex shot. Sometimes people cannot properly absorb certain types of medications. Also, if your doctor agrees, take two of the pills at once or take one and then wait a couple hours and take another if you do not get relief. Some people need a higher dose. Worth a shot before you give up on this class.
Also, have you tried any ergots (Migranal, Cafergot, etc)? Or, Midrin?
Analgesics have been shows to not cause rebound when limited to 2-3 treatment days a week of the same type of medication. Watch out for any medications that contain Tylenol, Ibuprofen, etc, including cold medicines, sleeping pills, etc. Some people will even take one analgesic two days a week and a different one another two days a week, as long as they both do not have the same analgesic in them.
Good luck with the calcium channel blocker! Another big gun preventative to try is Topamax, an anti seizure medication. That class in general seems to be tough on side effects, but higher chances of working on a tough migraine patient.
When were you taking any of the preventatives that made you sleepy in relation to when you needed to wake up? I did better with those taking them a few hours before bed, as I was already winding down, and then devoting 8-10 hours for sleep. Then, by the time I needed to be functional in the morning I was ok. After a few months at the full dose, those types of side effects seem to get better for many people. Make sure you give each medication a full trial.
If you are at all disappointed with your neuro, please find a new one. Having an experienced doctor is the best thing I ever did for my treatment. Also, you will accomplish much more on your own with research and bringing in ideas to the doctor (as well as being informed about your treatments) than any visit with a doctor. These forums are awesome! I have gone through dozens of doctors and some are much much better than other ones. The best ones seem to like to see you monthly to check progress, switch up meds, etc. They will always have something new to try each visit. They will ask you to keep a migraine log. They may even call you at home to see how you are doing.
How often do you go to the ER? There are some shots your doctor may be able to have your pharmacy special order that you or a loved one can administer to keep you out of the ER after another treatment has failed. Having a plan of a preventative, first line abortive, nausea/vomiting medication, and second line (rescue) abortive is ideal.
Do the migraine typically subside after the 5 hours you quoted? Does taking a sleeping pill and sleeping it off ever help? I'd think if you have a migraine come on, take something and it doesn't abort it, and go to the ER, by the time you get the treatment the migraine may almost be over. For you, multiple preventatives may be a better plan to try and lessen the pain and reduce the frequency. After you do this, maybe you could focus more on the abortives. Once you find a preventative that at all helps, you can add in another one or try a similar one to see if you could get better results. Even if a medication gives you 20% relief for example, if you add a second one that does the same, that's a big difference!
How often do you take Fiorinal? Do you have any head pain on days without migraines? Any luck identifying migraine triggers by keeping a diary including weather, foods, sleep, etc?
Do you get groups of migraines together, or are they in a predictable pattern such as a few a week? Any times of the month worse than others? Think there is a hormonal connection?
Best wishes.
