Tourettes

My 9 year old daughter was recently diagnosed with severe migraines and involuntary muscle movement tourettes (not verbal).  We have a family history of an Aneurysms (our cousin-ruptured and survived, my grandmother/her greatgrandmother (ruptured and passed), my sister/her aunt (clamped prior to rupture and survived).  The neurologist has put her on 25mg of Topamax and it is not working, we will be increasing it to 50mg on Monday.

An MRI/MRA have been scheduled and an Agram may follow that, which I am familiar with as I have had these tests as well.  

What other treatment course can we take other than meds that don't seem to be working?  Is there another treatment course to correct these problems?  Is corrective surgery for the tics an option?

[Kevin Kennedy, Ph.D.]

A diagnosis of Tourette's Disorder is appropriate only if there have been multiple motor tics and at least one vocal tic. The motor tics and the vocal tic(s) do not have to be occurring at the same time, however. If there have been no vocal tics, the diagnosis of Tourette's Disorder is not appropriate. Now, relative to treatment of Tourette's, surgery is not an option, but there are many medication options. It is not unusual for Tourette's Disorder to be accompanied by one or more co-morbid conditions (ADHD, Obsessive-Compulsive Disorder, other Anxiety Disorder, for example), and the medication plan can be complicated because of this. It's way too early to conclude that medication will not be effective.

[Tina A.]

She does not have ADHD, Obsessive Disorder or any other disorder.  

With the combo of the migraines and tics, can it be some other brain related problem?  Will the MRI/MRA show that or will an Agram be necessary?