“Ticks and shaking?”

I am sorry you are experiencing these symptoms and feel like you are not being heard by your treating physicians. That must be very frustrating. I am not a neurologist and am not seeing you in person. However, many of your medications can potentially worsen tics or cause involuntary shakingtremors Fluoxetine, Topamax, Elavil, Gabapentin, and Trazodone are the most likely culprits if someone is experiencing new or worsening tics or tremors. If multiple CNSactive drugs are combined e.g., antidepressants, anticonvulsants, sedatives, the risk increases. I recommend discussing a medication review with your prescribing providerespecially if symptoms began after a dose change or new medication was added. Topamax levels can be checked since if it's too elevated, it can cause tremors and myoclonus. You should also be evaluated in person for serotonin syndrome. It can initially present with symptoms like clonus, tremors, hyperreflexia, and progress to agitation, fever, and autonomic instability if untreated. Some of your medications combined with Prozac would put you at risk for this. Highrisk combinations Fluoxetine Trazodone or Fluoxetine Buspar. In addition, I would have the following labsmicronutrients checked as deficiencies can contribute to involuntary shaking, tremors, or muscle twitching. Magnesium Serum Mg Vitamin B12 Vitamin D 25hydroxy Calcium Total and Ionized Potassium Thiamine Vitamin B1 may require specialty lab or whole blood testing Iron Studies Iron Ferritin TIBC Total Iron Binding Capacity Transferrin saturation Supportive Labs if applicable CBC Complete Blood Count check for anemia or infection CMP Comprehensive Metabolic Panel kidneyliver function, electrolytes TSH Thyroid Stimulating Hormone thyroid issues can mimic tremors Homocysteine or Methylmalonic Acid more sensitive markers for B12 deficiency 1. Magnesium Function Stabilizes nerve and muscle function. Deficiency effects Tremors, muscle spasms, fasciculations, even seizures. Common causes Diuretics like Lasix, poor diet, alcohol use, GI loss vomitingdiarrhea, PPIs like Omeprazole longterm.

I hear your frustration, and you're absolutely right to advocate for yourself. Constant shaking and tics without headache pain doesn't fit the typical pattern of complex migraines. While some migraines can present without head pain called silent or acipital migraines, they usually involve other specific symptoms and aren't constant. Your instinct that something else might be going on deserves to be taken seriously. There are many other conditions that could cause these symptoms and warrant investigation. Consider asking your doctor about checking thyroid function hyperthyroidism commonly causes tremors, vitamin levels especially B12, magnesium, and vitamin D deficiencies, and reviewing all your current medications many common drugs can cause involuntary movements as side effects. Other possibilities include essential tremor, tic disorders, functional neurological symptoms, or even postinfectious conditions like PANDAS. Blood work to check for inflammation, metabolic imbalances, and autoimmune markers could provide important clues. Don't give up on finding answers. If your current neurologists aren't listening, consider seeking a second opinion, perhaps from a movement disorder specialist who might have a different perspective. In the meantime, keeping a detailed symptom diary noting when the shaking and tics are better or worse, any potential triggers, and how they affect your daily activities can be valuable information for any doctor you see. You know your body best, and you deserve healthcare providers who take your concerns seriously.