We always try to use one preventive drug or Botox for the treatment of frequent or very severe migraine headaches. However, it is not unusual to go through several drugs and not find one which works well and does not cause side effects. Under those circumstances combining two drugs or Botox injections with a daily drug with is the next step. A study to be presented at the 62nd annual meeting of the American Academy of Neurology looked at 92 migraine patients who did not respond to a single drug. 86 of these patients found relief from a combination of either topiramate (Topamax) with verapamil (Calan, Verelan), or amitriptyline (Elavil) and a beta blocker (such as Inderal or propranolol, or atenolol). Combining two medications makes sense is they have different mechanism of action. For example topiramate is an epilepsy drug, while verapamil is a blood pressure medicine in the category of calcium channel blockers. Amitriptyline is an antidepressant with pain-relieving properties, while beta-blockers are blood pressure drugs. At times we combine two epilepsy drugs or two anti-depressants if they work in two distinct ways.
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