Not sure if you'll see this info since you posted in January and I'm responding in December, but I hope it helps.
I've been dealing with migraines with and without aura for two years now (3-4 per month and almost daily headaches--i.e lesser migraines. Here is what has helped:
1. I found a good neurologist that specializes in migraines. He is the third "migraine specialist" I've seen. Beware - just because the neurologist specializes in migraines doesn't mean he knows more than you would know from reading a few good books. He just better a knowing the differences between the different drugs, but not necessarily knowing which ones might help you.
2. Get control of your diet. I found through my migraine journal (nearly one-year straight of making what seemed to be meaningless entries) that I am very sensitive to blood sugar level changes. At first I thought I was sensitive to a particular food, but after realizing almost every food I ate would trigger some pain, I got the idea that it was my blood sugar changing 15 to 30 minutes after eating. I now don't go longer than four hours without eating at least a little protein and all of my meals are mostly protein.
The other thing I have been suffering from is constant visual auras. Not the fortified scitoma auara that often preceeds my migraine. These are a combination of psarks of light, streaks of light, blurry patches, inability to focus both eyes equally, and the almost always present floaters. These things, especially the floaters, started the same time my migraines started, nearly two years ago. My neurologist suspected I was suffering from persistent visual auras. He drew some blood for a gene test and sent me to a neuroopthomologist (sp?) to make sure nothing was wrong with my eyes.
The neuroopthomologist said my eyes were fine and he suspected my floaters were definitely not the floaters all the optomologists claim as floaters from vitreous fluid in the eye, especially since they often multiply in numbers and structural complexity shortly before a migraine hits.
The blood test showed I had a gene mutation that has been found in others with persistent visual auras. The treatment is a vitamin supplement called Methyl Protect made by Xymogen. If I remember correctly, the neurologist said the gene mutation makes it difficult for my body to use B-complex vitamins. So, I need to take the Methyl Protect which contains an ingredient that helps my body absorb the B-vitamins it needs.
Does it work? I don't know yet. My neurologist said his other patients who reported the same thing as me have had a night-and-day change after three weeks of being on the supplement. The place I went to get this supplement from was out. So they have ordered it and I should get it later this week. I'm supposed to call the doc back after three weeks of taking the supplement to let him know how I'm doing.
FYI...I've done the dopeimax, I mean topomax prevention, the beta-blocker prevention, the xanax prevention, the imitrex and narcotic treatment and nothing seemed to work as well as controlling my diet. Give it a try. Check out the 35-day detection diet at www.foodintol.com. Like I said, it helped me identify the blood sugar issue. I'm still checking to see if I really have a food sensitivity. You might also want to have an IGg blood test done ($450 USD) if you can afford it. It might reveal a food intolerance.
All these things I mentioned, were things I had to learn on my own. However, when I finally found the good migraine neurologist, they were all things he knew about and wanted to have me try. None of the other two bad migraine neurologists mentioned anything about them.
By the way, I see Dr. Wade Cooper at the University of Michigan. I have no idea where you are, but if your close enough, and you're willing wait six months for your first appointment, I highly recommend him. So do many other doctors in this area.
Hope it helps.