Current UK NHS Guidelines are: Propranolol, then Topiramate. As I cannot currently find a nice flowchart I want to use (probably as I’m getting sleepy) I attach the Scottish ones to give you some idea. Most UK GPs stick rigidly. Consultants more inclined to have preferences and do their own thing also have slightly more choice because a few drugs aren’t available to GPs. Your comorbidities (other conditions) and general health, age and amount of alertness your employment requires etc can all influence choice as can what success or otherwise the doctor has had previously. Particular symptoms don’t seem to count for much here in UK. Neither does whether its straight migraine or VM/MAV all treated the same. I should wait and see what’s suggested. Amitriptyline’s a good one to start with.