I had an MRI earlier this month. It was basically like being trapped inside an undersized tanning bed and being forced to listen to bad 8-bit dungeon crawling music for an hour. But the results are back and, despite how insulting it may sound, the results are actually good - everything is "unremarkable".
I've been on Topiramate for two and a half weeks now. Long enough for the 24/7 "early-treatment phase exhaustion and nausea" to finally wear off. Not everyone has that initial phase, but the neurologist started me off at a high dose - necessary, he said, because of my large size. There are other side effects, too. Soda and other carbonated drinks taste disgusting. As someone on /r/askscience so accurately described it, soda now "tastes like flat Alka-Seltzer poured from an old ashtray". I also don't sweat as much. It was a little nerve-wracking at first, and Roy was particularly worried about that one, but once the nausea wore off and I'd been able to get back on an exercise program, I've come to realize I can still sweat, I just don't do it as much, and it takes me longer than usual to start. So I do have to be careful and be aware of my body temperature, even more so once the weather gets warm enough for hiking.
I also find that I randomly experience little boughts of "brain fog" throughout the day. Sometimes I will get stuck on a word when I'm talking and can't figure out what it is, or I'll go back and reread something I wrote and realize I left a word or two out completely (which I hope goes away soon, as freelance editing/transcription work is sort of my gig right now and no one wants an editor who has brain farts).
So far there hasn't been any improvement. I've had either a headache or a migraine nearly every day this month (so far, only two days have been pain free. That's been pretty typical the past year or two). But it's only been two weeks, and the neurologist said that two weeks ought to be the point at which I should start feeling better. So I'm jumping the gun on the whole "this isn't working" conclusion. Wow, it took me twenty seconds to remember the word "conclusion". I'm just so anxious to be migraine free. I'm tired of being in pain and, when I'm not, being afraid of when the pain is coming back.