Hey James, all good questions.
I was at 2-3 on the symptom scale for a long time, probably the last 1.5 years.
I also had nasty anxiety, but the dizziness / migraine stuff was the cause. Don’t let the doctor convince you your anxiety is causing dizziness. If he/she had the condition, they would “get it”.
It sounds like you are tolerating Gabapentin and Topirimate, both very good traditional migraine preventatives. So you got this base covered, but there are a few other migraine techniques I would use in parallel.
I would suggest, especially if you have head or nasal “pressure”, to go with the Cefaly device. I think using it was a real turning point for my recovery.
As another suggestion, the new CGRP medications are worth trying - they can be used at the same time as your Toprimate/Gaba as I understand it. I am using Emgality while I’m still on Amitriptyline and have had good results so far.
Others have had great success with Botox - another treatment that can be done in conjunction with your normal meds.
Learning your triggers and avoiding them is definitely helpful, but in my experience this is simply “management” of the condition, not something that was particular helpful to make great strides of progress like clinical migraine treatments. Other people are different though and I respect that. Certainly a migraine diet has been helpful for me, although I am not as strict as I used to be.
My first neurologist was an older man who was not helpful at all. I found a younger neurologist that has been very helpful. He doesn’t understand the anxiety component at all, or all the other weird symptoms I have like shortness/heaviness of breath, or the heavy legs you describe. So, I’ve had help with a psychiatrist as well.
But my neurologist keeps an open mind and offers new solutions each visit. He respects my decisions to take or not to take meds.
So to explain throwing the “kitchen sink” at migraines, I’m talking about all the parallel things you can do at the same time. Traditional meds are one thing, which it seems you have covered, so that is good. The others are things like Cefaly, Botox, CGRPs, GammaCore, CBD oil, exercise, diet, sleep, etc… The more parallel things you can do at once, I think the chances of success are greater. Trigger avoidance can definitely be part of the equation, but like I said for me that is just managing the condition from getting worse. I tried increasing my meditation and mindfullness practice, hoping I would get a handle on it naturally, but no, for me it was mostly a disease that needed strong medical treatment.
Wow, I wrote a small book here, I’ll stop and see if you have any follow-ups!