Doc has put me on tapering dose of 60mg prednisolone for chronic migraine not resp. to drugs and partial resp. to botox. he says that non resp. to prednisolone means my migaine is psychiatric. true ?

Migraine treatment: There are many good medications for migraine treatment. Migraine is a serious and complex neurologic disorder. Today effective management of migraine involves three specific strategies: 1) patient education 2) non-pharmacological management (diet, sleep hygiene, acupuncture) and 3) pharmacological (triptans, topamax, (topiramate) etc) management. Rec.:see orofacial pain or headache specialist. Hope it helps.

Not true: Response rates of headaches is highly variable to steroid treatments. Most of my patients with severe migraines don't really respond all that favorably to them. It's not considered one of the first lines of choice in treating migraine headaches & certainly has no value in distinguishing between primary (unprovoked migraines) vs secondary headaches (caused by something else such as psych problem).

No: If you got response to Botox (even a partial response), nerve compression may be a component to your headaches. Get evaluated by a plastic surgeon with experience treating headaches surgically - you may be a candidate for surgery to relieve your headaches.

Maybe not: I would have a second opinion. Migraines are difficult at times some respond very well to therapy others are resistant. See another physician preferably board certified neurologist

Not true exactly: Prednisolone is not a common migraine treatment protocol. Often times there's also a underlying dietary, or food allergy source to migraine that can be exacerbating or causing continuous, chronic issues, along with stress. So it would be good to have a food allergy panel done with complement testing to rule out this possibility. Then look at other possible triggers. You don't want to be on chronic steroid treatment.

Partly: Characterizing migraine as purely psychiatric represents an older view of medicine that separates body and mind. While true that there are specific physical or structural causes of migraine, many are a result of emotionally-driven physical responses. Understanding this interplay may help you better address potential triggers if no specifically structural abnormalities have been noted on MRI or EEG