Thanks for the query.
Regarding the treatment of migraine, Depakote (divalproex sodium) is an approved drug for preventing migraines. It is a medication that needs to be taken every day in order to prevent migraines. Cymbalta is an antidepressant which works both for migraine as well as underlying depression.
“Triggers” are specific factors that may increase your risk of having a migraine attack even if you are under treatment. So it is possible to have a headache even while you are receiving treatment. Common triggers are sleep deprivation, stress and certain foods. Identification of specific triggers and avoidance of these would reduce your chances of having a migraine attack. Treatment of this would typically involve avoiding the triggers and/or switching to a new drug which might suit you better. The latter needs to be done in consultation with your neurologist. The doses do not need to be increased in your case as you are already receiving optimum dosage.
So I personally feel that if you have benefited from Depakote and experiencing no side effects, you can continue on this medication. Or else consult your neurologist for change of medication. Avoid triggers for migraine, if possible. By keeping a headache diary, you will be able to identify some of the triggers for your headaches.
I am sorry you are dealing with this frustrating concern and I hope you can find yourself in better health soon with the help of your neurologist. You need to be on medications to prevent migraine becoming more chronic in the future.
Hope that this information helps and hope that you will get better soon.
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I've had migraines for 18yrs & have tried everything under the sun in that time... including occipital nerve blocks & Botox. I was placed on Topamax 100mg almost 10yrs ago with good results. I would still get 1-3 migraines a month but they didn't last as long or as intense. About 7yrs ago my neurologist told me to take 250mg of Magnesium as well. But 2yrs ago my migraines began to get worse. My neurologist added Lexapro 10mg to my prophylactic regiment as well as increased my Topamax to 200mg/day & Magnesium to 500mg/day. I still get the occasional migraine a few times a month but they don't last for days as they can do, nor are they as severe. I can't avoid one of my biggest triggers... changes in barometric pressure... but I have them under excellent control. So much so I can usually treat them with 2 Excedrin Migraine instead of Fioricet & Hydrocodone. And it's been well over a year since I've had to go to the ER for an injection to break a migraine cluster. Even with prophylactic treatment you can & will get what you referred to as "breakthrough migraines" but you should not be experiencing them as frequently or should they be as severe. Figuring out your triggers is the best thing so you can avoid them as much as possible. If you find minimal improvement with your current treatment & avoiding your triggers... you should go back to your neurologist & make some adjustments to your medications. :)