I'm on 200mg topamax (topiramate) & 20mg amitryptiline for migraines, but i'm still having breakthroughs. i avoid all triggers. i've had them for 21yrs. help!

It's not working: Alternative approaches include depakote, naprosyn, (naproxen) beta-blockers, indocin, lithium, steroids, occipital nerve blocks, botox, surgical denervation procedure, otc remedies such as acupuncture, riboflavin, feverfew, butterbur, magnesium. See headache specialist, and turn around.

Botox: Botox a injections are now fda approved for the treatment of refractory migraines.