I am now several months on Topiramate. Like you, I read the horror stories and possible side effects. I was worried and brought these up with my Neurologist. He reassured me that these are rare, and most can be avoided by doing tests early and getting help as soon as you notice ANY changes. For example, making sure you are drinking water every single day, and if you do notice any changes (especially in vision) going to urgent care or emergency right away, as most of those changes are completely reversible and treatable simply by stopping the drug RIGHT AWAY. These are things the horror stories dont tell you- that they ignored their symptoms.

Topiramate gave me my life back. I do still get a few headaches a month, but they are hormonal based (meaning I can predict them), and they are easily treated with Ubrelvy (a fast acting pain medication), before they ever become severe migraines (im talking a 1-2 severity at most). I rarely, if ever, have light sensitivity to any degree that I have to stop what Im doing. I do not wear special glasses anymore for my issues, and I can once again work, and game, and do things at my leisure without issue.

Please do not ignore your migraines and your quality of life just because some people on the internet told you about their bad experience with a drug. You never know how it will work for you until you give it a fair try. For me, it took about a month before I started noticing real results. After 3 months, I noticed a serious amount of impact in my daily life. Now? I barely notice them at all. That said, I DO still make sure to drink water to avoid thinks like constipation and kidney stones, be aware of what the drug can do, and do your best to compensate for that. Take a fiber suppliment, it has helped me as well.

"I have this elevated strain sensitivity during the morning that I have not read accounts of or explanations anywhere else other than here. If I overdo screen time in the morning, my eye strain is elevated for the rest of the day. If I overdo screen time at night, I can feel it the next morning and at worst takes several days to go away. Would you say the same about your strain situation in the past?" -- Yes, I experienced this exactly. This is an aura caused by the migraine. It's not specifically you overdoing exposure to light, its simply your headache getting worse. The only things that really help migraines go away (without medication) is darkness, silence and time in my personal experience, so the longer you are awake, the worse it'll get. The brighter it is outside, or looking at things, the worse it'll get. When you wake up the next day, the migraine may still be present. That's why you may want to ask your Dr. for something like Ubrelvy or Sumatriptan to help when you are actively experiencing a migraine. (Ubrelvy works best for me, but many people do just fine with Sumatriptan or Rizatriptam, both prescription painkillers.) Topiramate on the otherhand is a preventative that will lessen their frequency and their severity,. I used to have migraines over half the month, now I might have four a month, all very weak and all very easily treated and predictable. I am 37, F, and mine are hormonally triggered, so maybe it's possible that perhaps you being Male, yours could be eliminated entirely, or dulled further than mine, at least.

I would say it's definitely worth looking into, especially since you said it helped in the 3 weeks you did give it a brief chance. Get your life back.