Dr. Anand Karnam trained in Chennai specifically for new migraine treatments. From CGRP inhibitors to nerve blocks, here is what the latest evidence says about migraine management in 2025–26.
Key Points
- Triptans (sumatriptan, rizatriptan) are migraine-specific acute treatments that work by binding 5-HT1B/1D receptors — they are not painkillers and do not work for other types of headache.
- CGRP-targeted therapy (fremanezumab, galcanezumab, erenumab) reduces migraine days by 50% in 50–60% of patients with chronic migraine who have failed other preventives.
- Occipital nerve blocks — an injection of local anaesthetic at the base of the skull — can abort a refractory migraine episode and reduce frequency for 4–6 weeks.
- Preventive medication is considered when migraine frequency is ≥4 days per month, when attacks are severely disabling, or when acute medications are failing.
- Medication overuse headache (MOH) is a transformation of episodic migraine into chronic daily headache due to taking acute medication >10–15 days per month.
150M
Indians suffer from migraine — one of the world's largest migraine populations
Source: Neurological Society of India
50–60%
of chronic migraine patients achieve ≥50% reduction in migraine days with CGRP therapy
Source: NEJM CGRP Clinical Trials 2018–2022
3rd
rank of migraine globally as cause of disability — highest in working-age adults aged 15–49
Source: Global Burden of Disease Study 2019
"As a headache specialist and Fellow of the World Headache Society, I treat patients who have suffered for 10–20 years without effective management. The evidence base for migraine treatment has transformed dramatically — CGRP antagonists, nerve blocks, BOTOX, and neuromodulation devices are all available in Hyderabad. Migraine is a treatable neurological condition. Suffering through it is now unnecessary."
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.
Dr. Anand Karnam
DrNB Neurology · Sri Anand CNC, Chanda Nagar Hyderabad · Sri Anand Child and Neuro Center
DrNB-qualified Neurologist, Fellow of the World Headache Society (FWHS), and Headache Specialist with 12+ years of experience treating epilepsy, stroke, migraine, and movement disorders. Practices at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad.
References & Sources
- 1.Neurological Disorders — WHO — World Health Organization
- 2.Neurology — NIH MedlinePlus — NIH MedlinePlus
- 3.AAN Clinical Practice Guidelines — American Academy of Neurology
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