Migraine & Headache Care
Severe or chronic headaches are not just a minor discomfort—they can be a debilitating neurological condition that disrupts work, social life, and overall well-being. Dr. Annapureddy Jagadish provides personalized preventive and acute headache management strategies.
Comprehensive Headache Management:
- Acute Headache Relief: Advanced pharmacological interventions to stop active migraines and cluster headaches quickly.
- Preventive Care Plans: Long-term clinical protocols (oral medications, lifestyle counseling, and trigger identification) to drastically reduce headache frequency.
- CGRP Inhibitor Therapies: Access to the latest targeted biological treatments that block calcitonin gene-related peptide (CGRP) receptors involved in migraine pain.
- Greater Occipital Nerve (GON) Block: A targeted nerve block injection that provides rapid relief for debilitating migraines and occipital neuralgia.
- Botox Injections for Chronic Migraine: FDA-approved OnabotulinumtoxinA (Botox) therapy for adults with chronic migraine (15+ headache days/month).
- Secondary Headache Evaluation: Thorough diagnostic scanning to rule out underlying structural or systemic causes of severe headaches.
Greater Occipital Nerve (GON) Block
The Greater Occipital Nerve block is a highly effective, minimally invasive injection procedure that targets the GON — a nerve that runs from the base of the skull up over the scalp — to break the cycle of severe migraine and occipital headache pain.
What is a GON Block? A small volume of local anaesthetic (with or without a corticosteroid) is injected at the base of the skull near the greater occipital nerve. This numbs the nerve and interrupts the pain signals travelling from the back of the head and scalp to the brain.
How It Works:
- The patient sits or lies comfortably; the injection site (back of the head, near the occipital protuberance) is identified by palpation.
- A fine needle delivers the anaesthetic and/or steroid mixture around the nerve — the procedure takes under 5 minutes.
- Pain relief can begin within minutes to hours, lasting from weeks to several months depending on the individual.
Who Benefits Most:
- Chronic migraine sufferers not responding adequately to oral medications.
- Occipital neuralgia — a condition causing sharp, shooting, or electric shock-like pain from the neck to the scalp.
- Cluster headaches and cervicogenic (neck-related) headaches.
- Patients needing rapid relief to break a prolonged migraine episode (status migrainosus).
Why Choose a GON Block:
- Quick outpatient procedure — no anaesthesia or hospital admission required.
- Provides rapid relief often within 24 hours.
- Can be repeated safely every few weeks to months.
- Serves as both a diagnostic tool (confirms nerve involvement) and a therapeutic treatment.
Botox Injections for Chronic Migraine
OnabotulinumtoxinA (Botox) is an FDA-approved and evidence-based preventive treatment specifically licensed for chronic migraine — defined as 15 or more headache days per month, with at least 8 being migraines.
What is Botox for Migraine? Unlike cosmetic Botox, therapeutic Botox for migraine involves injecting small, precise doses of botulinum toxin into specific head and neck muscles. It blocks the release of neurotransmitters involved in pain transmission, preventing migraine signals from being activated.
How It Works:
- Botox is injected at 31 fixed sites across 7 head and neck muscle areas: forehead, temple, back of head, neck, and upper shoulders.
- The protocol follows the PREEMPT injection paradigm — the gold standard established in clinical trials.
- Each session involves approximately 155–195 units delivered via a series of small, well-tolerated injections.
- Full treatment effect is typically seen after 2–3 treatment cycles (every 12 weeks).
Who is Eligible:
- Adults with chronic migraine (≥15 headache days/month, ≥8 of which are migraines).
- Patients who have not responded to or cannot tolerate 2–3 oral preventive migraine medications.
- Those seeking a non-daily medication preventive approach.
Why It Works — The Science:
- Botox blocks the release of CGRP and other pain-signalling neuropeptides at peripheral nerve endings around the head and neck.
- It reduces neurogenic inflammation and central sensitisation — key drivers of chronic migraine.
- Clinical trials (PREEMPT 1 & 2) showed a reduction of ~9 headache days per month vs placebo.
What to Expect:
- Each treatment session takes approximately 15–20 minutes in the clinic.
- Treatments are repeated every 12 weeks as part of an ongoing preventive programme.
- Most patients notice improvement after the 1st or 2nd treatment cycle.
- Side effects are minimal — mild injection site discomfort, temporary neck soreness — and fully reversible.