Nate, I'm sorry to hear about your injuries. I've suffered from migraines for about 13 years. At my worst I would get 4-5 migraines a week. Each migraine would last between 12-48 hours. I was lucky to find highly motivated doctors because both my primary physician and my neurologist are fellow migraine suffers.

I can completely relate to your description of the side effects of Nortriptyline. My doc put me on Ametriptyline, which I understand is a very similar drug to Nortriptyline. I started the same way you described, with a very low dose (only 5mg) then ratched up to 25mg. This really helped me for about a year. Although, I did experience the same side effects as you, very tired and some strange mood swings. My experience with that drug were that it would work well at preventing the headaches for a while then I would platue and my doc would step up the dosage. At the end of a 3 year period I had slowly ramped up to 300mg. That's when I called it quits with that drug. I could no longer function normally. I missed worked, passed out in the shower and cracked my head open, finally enough was enough.

Then I moved on to all of the other drugs you mentioned. I have tried epilipsy drugs, anti-depression drugs (these I hated they killed my sex life and made me act strange). I've been on anti-seisure drugs, blood pressure drugs, my neurologist even enrolled me in a drug study of a new experimental medicine.

Some of these drugs provided some small benefit. But they all had side effects, most were tolerable. But none of them really seemed to work all that great for me. Finally, my doctors kind of threw up their hands and said we had exhausted all of the medication choices and asked "which one did you like the most?" This of course was over a period of about 10 years, because each drug you have to ramp up to the full dosage, then ramp back down if you want to stop. I found it took about 4-6 months to try a new drug.

I really didn't like any of them and none of them were very effective. That's when I felt desparate enough to try alternative therapies. I tried two different forms of chiropractic treatments, a special bite guard for your teeth, holistic herbs, colon cleansing (not fun), crazy strict diet regimines, essential oils.

Finally, one of the things I eventually tried was acupuncture. I have had really great success with acupuncture, better than any of the drugs I've been on. Best of all there are no side effects. One thing you should note though is it takes time to sort-of build up the effect. When I started going I went twice a week for about two months before slowly tapering down the frequency of treatments.

Now, I go once every three weeks and this combined with a lot of lifestyle changes are pretty effectively managing my migraines. No I only get a migraine about once ever 10 days or so. When I do get one the pain is much less severe and it last only about 18 hrs. When I get a migraine I take a Frova (frovatryptan). These pills are expensive. My insurance only allows me 4 per month.

So I totally recommend investigating acupuncture. As you can see it was like my last choice because I'm not one to buy into what I call hockus-pockus, new-agey, holistic stuff. But I got so desperate I didn't know what else to do. One thing I learned about acupuncture is that there are two different styles, Chinese and Japanese. The Japanese style apparently uses smaller needles and I definitely prefer it. I know alot of people have a big fear of needles and they picture what they see in the movies, some poor schmo lying there like a porcupine with hundreds of needles in them.

Well, that has not been my experience at all. When I see my acupuncturist he has to tell me when he is finished because I can never actually feel the needles going in or coming out (they are so fine). Secondly, he only puts in about 6-8 needles one on the back of each hand between my thumb and forefinger sometimes one in my forearm, and then one on each ankle and on the top of my foot between my big toe and the next one. Then you just relax for about 30 minutes and leave feeling really mellow and destressed.

Best of luck,
Gregg