What medication to try next?

The last two years I’ve struggled with 15-30 migraine days a month. I’m getting worn down and becoming hopeless. The migraines are becoming more difficult to treat, and I’m getting stuck in rebound cycles.

I see my neurologist next week, and I want to make medication changes. Right now I’m between vyepti, Cymbalta, and candesartan. He will only want me to make one change at a time.

I am currently on Botox, atenolol, and quilipta.

I have tried: topamax, amitryptaline, nortiptyline, aimovig, Effexor, and all the supplements.

I know it’s a crapshoot, but I’m lost on what to try next. I’m so hopeless and defeated right now - I’m barely getting by.