Complicated Migraine or Intractible Migraine

by Kelly D

I am 36 years old and have suffered from migraines since I was 19. They have increased in severity over time, and most significantly since the birth of my daughter 2 years ago. I have had a migraine now for 11 days. This is the longest one I have ever had. I normally take Imitrex, but it hasn't worked on me the last few times, and obviously not this time either.

I went to the ER and they gave me Reglan and Dilaudid, but that only dulled the pain, it did not abort the headach. I was also instructed to take Fioricet every 4 hours over a two day period, and that didn't work. I have tried Tylenol and Ibuprofen, Fish Oil, Percoset. I have been getting through my days with Compazine and Zofran and one light off in my office.

I am at a total loss, and the Dr. does not seem to want to send me to a Neurologist, and told me to "just learn how to live with it". Needless to say, I called the insurance and changed PCP's. Unfortunately, I have to wait two more weeks to get in to see the new doctor, but I am still working on the referral.

I really don't know what to do at this point. I HAVE to work, I have a two year old, and I am reduced to a confused, dizzy, vomiting mess most of the time. Any suggestions are welcome.
Thank You,


Hi Kelly,

Oh my ..."just learn to live with it"?? Sounds like someone never had a headache.

Clearly you do need to see a neurologist because for some reason your headache profile changed and you moved into status migrainosus. When a headache profile changes, this is considered a a neurologic flag an should have neuroimaging such as an MRI. Be sure to ask the neurologist about this.

Now..with all the things you have been given, I don't see steroid on the list. If you have to go back to the emergency room (and I think you should) they should consider an IV of steroid, with reglan for nausea and the dilaudid again if you need it. Then you need to be on prednisone for 2 weeks and then taper off it. A good ER doc can do this for you and give you the tapering dose but you will have to follow up with primary care.

Best of luck!! Oh..try to find a neurologist who is board certified in headache. Here is a list of specialists

National headache specialists

Unfortunately, status migrainosus does not respond too well to oral medication and needs IV meds.

Mary Kay Betz MS RPA-C


I've had my migraine under control for a few years now using estrogen. Recently my insurance decided to mess with my dosage and what they would pay for. Resulting in a 22 day migraine. Took Axert and Alieve around the clock nothing helped; finally got some sort of anti-inflamatory injection that help for a day or so. I don't do narcotics they don't help. Went back to the estrogen. paid out of pocket, got my levels stabilized again and no more migraine.

For me it's seems to be keeping the dose very level and on time. I can't tolerate any fluctuations.

I had to find a doc willing to go there and a neurologist who was on the same page. It's the only thing I've found that really makes a difference. Botox also helps me but it's really expensive.


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Complicated Migraines

by Iris Alonzo
(Austin, Texas)

I am a 30yr old female, have suffered with migraines for the past 15+ years. I currently have a neurologist but am kind of dissapointed with his answers.

So almost a year ago my left side went numb, tingling, and migraine for 3 weeks, I had decadron and magnesium injected. Every week I have a headache and miss a lot of work. This week it was my full right side with numbness, tingling AND my face was pulling all on my right side, my eye was droopy and was unable to talk at times.

I am very scared because I have kids and a full time job. My neurologist said it was a migraine which is fine but I'm worried about driving, having attacks..haven't went to work in 3 days. My neuro said it was ok to go back, but didn't say get some rest or anything. I'm currently taking amitryptiline and he started me on Cambia.

My mother has the same problem...she is not able to work. What would you recommend? I have no insurance so paying out of pocket. MRI, lumbar puncture are normal.



Hello Iris,

Thank you for the complete history. You sound like so many of my patients. I am glad that your neurologist (or someone) did the full work up to include the MRI. I am not sure an LP was warranted but there may have been other symptoms to indicate it was necessary.

You have been diagnosed with migraines so amitryptiline is a good choice to help you sleep and to treat migraine. I would consider adding in low dose anti-seizure med which treats migraine. Either topamax or depakote depending on which your neurologist recommends. Most of our patients are on two medications at the same time, to prevent the migraines. Both meds are currently generic.

You do not mention whether or not you have tried any of the triptans such as Imitrex or Maxalt. If your headaches are severe, you may need injectable Imitrex which works faster. During a severe migraine the gut slows down in processing things so oral medications do not work as well as injectable.

Finally, you need to address the anxiety. Numbness and tinging that occur on one side of the body, including the face, is an anxiety attack until proven otherwise. Unfortunately there are about 5 serotonin receptors in the brain and they are responsible for migraine, anxiety, depression , nausea and vomiting...sound familiar?

Talk to your neurologist about the anxiety as it causes migraines to get worse. Until BOTH are addressed you may see only minimal improvement.

Good luck
Mary Kay Betz MS RPA-C

PS..migraines have a genetic component so you did get it from Mom, but she got it from someone else.

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Does the scenerio above sound like you? If not, or if you think you need more information please read about different types of headaches to find out which type of headache you are experiencing.

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