I have chronic debilitating migraines and have obtained incredible relief with the combination of BOTOX for prevention (it is not cosmetic - the injections are in the head, back of the neck, and the very top of the forehead) for prevention and then three medications to stop the attacks that still do happen, but less frequently: promethazine, imitrex, and indomethacin. I take all three at once and they work synergetically. I know my migraines very well, though, and feel the precursors of an attack, and take the medications at the first signs of a precursor, when they work best. In me, once the attack has set in and there is pain, medications do no work. So it took years of paying attention, but I am finally virtually pain-free, and it has tremendously improved my quality of life.