who wrote the p3? You should ask the neuro what to do w/ the migraines if they have no abortive for you. My neuro said don't go to the ER as my treatment plan, just rest, dark, quiet, etc. Going to the ER makes mine worse (very bright and loud there) and they don't provide a treatment worth anything anyway. As long as neuro has a plan in writing in their notes that you understand, should be GTG. Sick call didn't even annotate the visit let alone treat.
Until doc says all treatment plans have failed to get you to retention standards and no different plan has a basis for improvement, they need to keep treating. For me we found the best abortive med, but it was insufficient, and we tried one preventive which failed and my other conditions made trying the others a bad idea. I'd think if it wasn't a neuro that said enough is enough, most likely they have other tools to try. We'd been at it for a little over a year, but it wasn't the timeframe that mattered it was exausting the med options.
Its like if you had knee problems. They try physical therapy, no go. If you're a good candidate for knee surgery they have to try to see if that fixes you next, not just throw thier hands up and say, well, we tried, screw it.
If you literally have tried all the options that are realistic, then whoever wrote the P3 just didn't annote that right on the write up and they can do another one. MEB people won't look through your files to find out, that's hard.
But it depends on who turned you down, i suspect neuro is in the middle of playing with meds and its fubaring your work so you're asking for the P3 to start the MEB and someone said no. Try for a T2 or T3 to account for limitations you're experiencing. Topomax was doing ok for me at low doses, but once they upped it, i got messed up bad. Topomax is some serious juju. But they have to give it time, many times side effects diminish. Just need something to cover you until they can say good or bad med. The cognative problems can be severe enough that they may need to restrict you to minor paperwork for awhile or something.