New Migraine Treatments Available in Hyderabad — What Works and What Does Not

Dr. Anand Karnam woke at 3 AM to travel to Chennai for a migraine fellowship update — a course covering the latest developments in migraine treatment. In this video, he shares what he learned — and what is now available for migraine patients in Hyderabad who have not responded to conventional treatments.

The Migraine Burden in India

Migraine affects approximately 150 million Indians — making it one of the most common neurological conditions in the country. Despite this, migraine is chronically undertreated in India: most patients self-medicate with over-the-counter analgesics, developing medication overuse headache (rebound headache) — a condition that paradoxically causes daily headache from taking too many painkillers.

Acute Migraine Treatment — What Works Best

Triptans: The most effective acute migraine treatment for most patients — sumatriptan, rizatriptan, zolmitriptan. Work best taken at the very first sign of the headache developing (during the prodrome or at the first hint of pain), not when the headache is fully established. Available and affordable in India.

Gepants (ubrogepant, rimegepant): New class of CGRP receptor antagonists used for acute attacks. Not yet widely available in India but increasingly accessible through specialist centres.

Avoid: Codeine-containing combination analgesics — these have high risk of medication overuse headache and dependence.

Preventive Treatment

Preventive medication is indicated when migraine occurs on ≥4 days per month, or when attacks are very disabling. Evidence-based options available in India:

• Topiramate 25–100 mg daily: 50% headache reduction in 50–60% of patients
• Propranolol 40–120 mg daily: effective and inexpensive
• Amitriptyline 10–25 mg at night: particularly useful when migraine coexists with sleep disorder or tension-type headache
• Valproate: effective but requires monitoring; avoid in women of childbearing age
• Candesartan or lisinopril: useful when migraine coexists with hypertension

Greater Occipital Nerve Block

An injectable treatment — a nerve block using local anaesthetic and steroid injected at the back of the skull — provides 4–8 weeks of migraine suppression in many patients. Particularly useful for medication overuse headache management (to break the rebound cycle) and for patients with occipital neuralgia component. Performed in the clinic by Dr. Anand Karnam.

For migraine diagnosis, preventive treatment, and nerve block procedures: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.