Q. I am writing from the United Kingdom and hope you may be able to give help or advice. My neurologist consultant has diagnosed my condition as "benign cough headache," and I have undergone a CT scan, which showed no abnormalities. The symptoms I have I first noticed some 10 months ago, and they came on suddenly. Whenever I bent down, sat down, stood up, coughed, sneezed, blew my nose, lay down or did anything that put any pressure on my body, I would get severe head pain and extreme pain at the back of my eyes. I have suffered from migraine for many years, but with this new condition I do not get any aura or other signs that I got before a migraine. I have been prescribed amitriptyline and pizotifen, but these have not proved to remove the head pain conditions. I am now at the stage where I have differing extremes of both head and eye pain continually all day every day, and therefore am hoping you might be able to give some advice as to how I can either get rid of this condition or able to manage it, as it is now affecting my daily life.

Q. I have been on Depakote® and amitriptyline for migraines since about 1996. I kept the headaches reasonably under control (I've had them since 1985) with those two preventive medications and lifestyle management (strict diet, regular exercise, enough sleep and decreasing stress). I do, however, have moderately severe arthritis of the neck from a car accident in the 1970s. For the past year, I have had a migraine every day except four intermittent days; I can't figure out what I could be doing wrong. I avoid rebound headaches by alternating my use of Norgesic Forte® with Tylenol 500®, or when necessary, Imitrex® or Amerge®. I'm careful not to take more than the prescribed amount of any medication. My question is this: Would Neurontin® be of help to me? Has Depakote ceased to be effective? Or could the arthritis in my neck have finally won the battle I've been having with it? My neck pain is excruciating at the end of a work day, especially if I've had a headache. Neck pain is one of the precursors to a migraine for me.

Q. I have been getting headaches for 15 months and it's starting to make me depressed. I can't live a normal life. The doctor says it's stress. I don't feel stressed, but he has me taking amitriptyline. It seems to work slightly, but after nine months I don't think it's ever going to cure this condition. Is there a surgical procedure to control headaches?

Amitriptyline is included in a group of medications classified as tricyclic antidepressants. Amitriptyline is one of the first successful medications in this class to be developed. It was discovered in the late 1930s before scientists had today’s understanding of the chemistry of the brain. This drug was developed as a way to reduce anxiety. Frequently, people with depression are often very anxious. When amitriptyline was given to patients with anxiety, it also improved the depression. This result prompted further research and the development of newer agents to treat depression. As scientific understanding of the brain progressed, scientists discovered that amitriptyline and related compounds worked on a series of chemicals called neurotransmitters. The antidepressants influenced the production and efficiency of these neurotransmitters.