I'm very sorry. I know how debilitating these headaches can be.

I'm not sure you are really going to like the answers...especially in terms of the fatigue part of the medications. However, by combining meds, using small dosages, taking them at night...etc. things can be done to help with side effects.

The Tramadol doesn't make the greatest sense to me. I have not heard of folks taking this for relief of migraine pain, although each person is an individual. Sometimes meds cause a rebound reaction, actually making the migraines come more often. I would be concerned that this medication might cause this.

The Nortriptyline is a fairly common preventative; although there is one called Elavil in that class that is more commonly prescribed. I suspect that they are very similar. They can cause drowsiness and if this is your case, it is best to take them at night and to try to keep the dosage small.

The medication that has probably had the best results is Topamax. It is FDA approved for migraine prevention. However, this medication is NOT without side effects. The worst is that can cause a strange memory loss. However, Topamax might be more effective than many meds and some get nice results when they take it with a med like Nortiptyline. Small amounts of both can be effective. Please inquire about this medication, but recognize that although it can be very helpful, it is somewhat "tricky" in terms of side effects.

To stop the pain, I would ask your doctor about adding Imitrex to the Naproxan. There was a study that showed these two things in conjunction work VERY WELL. In fact, someone recently came out with a combo tablet.

There are some vitamins that might help with migraine prevention. You can take a calcium/magnesium tablet, a B50 tablet and Co-Q10. Other natural things to experiment with: Feverfew and Butterbur. These things will not likely replace medications, but might help to keep them from getting to high dosages.

Ask your doctor about Axid for your stomach or see if you can find it over the counter. Don't take "just anything" because sometimes these meds can give a very headache sensitive person more headaches.

One more thing, if you are not doing so already, keep a food dairy or at least pay attention to the foods you eat. Once you are prone to getting headaches, you might "trigger" easily. Certain foods can make you more "prone." Some are obvious like wine, chocolate and aged cheeses.

If you are a coffee drinker, cut back or eliminate it. What I sometimes do, since these meds can make a person fatigued, is drink a cup with half regular coffee and half decaf coffee in the mornings when I am very fatigued. Then decaf the rest of the day.

Generally, you should avoid coffee and caffeine. Then if you get a a very bad migraine, go ahead and drink some coffee with your medication because it will help to get rid of it.

I have been battling these things for a long time and I know what I am talking about. If your doctor does not have an interest in this topic, please seek a second opinion. I do wish you better days ahead.