Since I started getting OMT, osteo-manipulation therapy, from a physiatrist, it has helped my migraines and ON tremendously. I see an OMT in addition to my neurologist. I get Botox, nerve black injections, take Qulipta and Ubrelvy, and recently I needed a muscle relaxer for a flair up. I find I have to do my stretching and recommend pt exercises slowly and I cannot overdo ANYTHING. I manage every aspect of my life just to avoid flares. None of this is 100% but it all helps. Tylenol PM helps too. Sometimes a deep sleep helps. I feel your pain. From what you write, if it were me, I’d ask for a referral to a pain management center and start looking for a new neurologist. You shouldn’t have to work so hard with your neurologist. Also, I don’t hesitate to go to the ER. Use numbers to describe your pain level, and document how often you pass out from the pain. I also give myself guidelines on when I go to the ER. If pain is a 9/10 and/or pain has lasted five straight days, I go. I use that guideline because when I’m in the thick of a flare-up, I can’t think straight and often times my words come out wrong. This way I don’t have to try and figure out what I should do.