Recomendations include:

Magnesium supplementation between 300 and 500 mg p. o. q. day; riboflavin supplementation 400 mg p.o. q. day.

A memantine starter pack was given to her. She may continue with her amitriptyline, but in light of the lack of efficacy of both the Wellbutrin and the gabapentin, she should discontinue those.

I would strongly have you consider arranging for dihydroergotamine or Depacon infusion to help "jump-start" the process. I am available to help you arrange this if necessary.

Consider frovatriptan as an abortive agent in light of its longer half-life and its potential for use as a transitional preventative agent. Amerge has been tried by her primary care physician Dr. Singh. A Medrol dose pack may be helpful in
breaking a run of headache.

As a rescue regimen for the emergency department, I suggest a combination of IM/IV medications inclusive of Ketoralac usually 30 to 60 mg, followed along with 25 mg of diphenhydramine, with 25 mg IV Phenergan, and with or without a bolus of Solu-Medrol of 250 mg IV. If that combination is not helpful, modification could be include sumatriptan subcutaneous injection along with an antiemetic and antihistamine.

Interestingly enough, I swear this isn't what he told me--I have no idea what Ketoralac is. I thought my ED recommendation was for anti-inflammatory, anti-histamine, anti-emetic, and subcutaneous imitrex.

This is so tiresome.