Looks like I got mine working.
Build:
Mobo: B450M Mortar
Bios: 7B89v1B
GPU: RX 460
Was getting the constant header 127 problem and all VMs with the GPU attached even failed to start.
Solution:
1. Updated to the latest BIOS
2. Update to custom built kernel (described below ~ its easy just copying a couple files)
3. After that the GPU was able to boot into the VM, but I noticed the screen had graphical tears, and the logs indicated vfio_region_write failed. This was solved by adding a script to ensure unraid didn't try to reserve the only GPU (even though I have the `append vfio-pci.ids`) Following the below guide helped me here (just make a script and run it)
After doing the above 3, I finally got it working, and was able to boot back into my Windows 10 Gaming VM. Hope that helps somone, and thanks all!