Thanks Doc! That's exactly the kind of information I was looking for. After four weeks in, we really hesitate to switch meds now. Based on your response, it sounds like there's still a possibility it will be helpful. I appreciate your help.

In the meantime... there are some things you & son can do to help his doctors help him. If you haven't already...

Keep a headache log. For examples/samples, Google: headache log
and use one of those, or tailor your own. If your son is into it, he may even enjoy making up his own on Excel, Visio, etc. and tweaking it to his own needs/situation.

Learn all you can about headaches & migraines to help figure this puzzle out.
Google: migraine types
Google: migraine diagnosis
Google: migraine treatment
Google: migraine prophylaxis
and anything else you can think of. The more you learn/know about these cussed things, the better you can help...

Is his doctor a migraine specialist (not just a neurologist who says he knows/treats headaches/migraine) - one whose practice is limited to just migraines? This can make all the difference, if you can find one.

Doc

elavil is ameritriptyline.... have you been checked for Chiari malformation

Razzle - maybe. I'm not sure, although a lumbar puncture was done, nothing was ever said about Chiari.

We've had some success with the amitriptyline and cyproheptadine combinination. In fact, there was so much success, we were instructed to wean from cyproheptadine. Everything was great...off the med for about three weeks and the headache returned with a vengeance.

I'm inclined to think the amitriptyline hasn't done anything and it was all the cypro. It's been suggested to up the amitriptyline instead of re-adding the cypro.

Is it common to keep increasing the amitriptyline dose over time?

I've heard of it being increased to find the right therapeutic dosage (called titrating) but over time can indicate a development of tolerance. How much was he originally prescribed, and how much are they increasing it to? (I've heard of 10, 20 & 30 mg for migraine).

There may be more info available by googling: amitriptyline for migraine

If you're looking for alternatives to discuss with his doctor, try the searches I mentioned previously.

Doc

Thanks Doc. Yes, I googled some of your earlier searches and found them helpful. Sorry, I had thought I responded to that post, but see I did not. We are going to a headache specialist next month. The current neurologist doesn't seem to think outside the box. We are not experiencing cookie cutter symptoms here and we are becoming frustrated.

My gut is telling me the amitriptyline is not giving him relief and not knowing if the amitriptyline is actually helping, or not, we are struggling with upping the dose, or weaning. We started with 10 mg and increased by that amount until we reached at 50 mg. He never actually had relief until the cyproheptadine was added, but then it was stopped fairly soon and the headaches returned. They now want to increase the amitriptyline to 75 mg.

The side effects from the amitriptyline are starting to wear on him and we do not want to increase this med...especially not knowing if it's actually helping or not. Thanks for your help. I'm just looking for some answers and/or possibilities to take to the headache doc.

that cypro is a antihistamine for allergys ... how does that headaches ??

here are the symptoms of Chiari malformation and the only way to find out is by Cervical MRI . have just your family dr order one . and then you will know

http://chiaricare.com/Chiari-1-Malfo.../Symptoms.aspx

I can relate to that. Early on in my migraine journey, my PCP had to enter something in his computer as to the type of migraines I had. He apologized for being slow about it (not that I even noticed), remarking, "They have 22 different classifications of migraine in here, and none for 'other' and that's what you have. ...Oh, there it is."

Googling: amitriptyline migraine dosage I found:
and a study indicating increasing dosages may not be more effective, and more. I did not spend a lot of time perusing but it appears there are some worthwhile articles in that search.

The high doses of amitriptyline surprised me. In my own experiences with it, 10 mg is enough to lay me out for a day and a half. I may have an unusual sensitivity to this medication.

Personally, I'm not keen on using it for an adolescent for any reason because of the black box warning and associated side effects. OTOH, no parent wants to see their offspring suffer these blasted things.

I hope you have better success with the headache specialist.

Not for nothing, but how is your son's posture? Does he spend a lot of time at a computer?

Doc