Hello, It is unlikely that the aneurysm and migraines are related in any way, so the chances of an operation on the aneurysm affecting the migraines in any way are very small. It sounds like you are suffering from post-traumatic migraines which can be difficult to treat. Topamax is a reasonable choice, but if there is little to no response at 100mg twice daily after a few months then it is not going to help. Imitrex is good to terminate migraines when they are about to start, but it doesn t work for everyone. There are other preventative medications that you could try: Amitriptyline Nortriptyline Propranolol Valproic acid Venlafaxine Verapamil Candesartan Gabapentin Botox injection can also be helpful There are also newer preventative medications: erenumab, fremanezumab, and Galcanezumab which are injections and tolerated well. For rescue medications other that imitrex (sumatriptan),if it is ineffective you could also try Rizatriptan or almotriptan (fastest acting) but zolmitriptan is also relatively good. butterburr, magnesium and riboflavin also have some low quality evidence for migraine prevention. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Janne Nissinen, Neurologist