Headache & Migraine · Online Across India & New Delhi
Most headaches are not dangerous, but they are often undertreated, mislabelled, or made worse by the very painkillers used to control them. Dr. Shaurya Garg, MD Psychiatry (AIIMS New Delhi), assesses and treats migraine, tension-type headache and chronic daily headache, with attention to the sleep, mood and stress problems that so often travel with them. For chronic migraine, Botox is offered in person in New Delhi.
What a Headache Actually Is
The great majority of recurring headaches are primary headaches: migraine and tension-type headache, where the headache is the illness itself rather than a sign of something else.
There is no scan or blood test that diagnoses migraine or tension-type headache. The diagnosis is clinical, built from the pattern: how often the headaches come, how long they last, where the pain sits, what it feels like, what brings it on, what makes it worse, and what happens alongside it, such as nausea, light and sound sensitivity, or aura. Getting this history right is what separates a treatable primary headache from the small number of headaches that need urgent investigation.
A smaller group are secondary headaches, caused by something else: infection, raised pressure, medication, blood pressure, eye or sinus problems, and rarely more serious causes. Careful assessment is partly about recognising the warning signs that move a headache out of the primary group and into one that needs imaging or a same-day medical opinion.
Why See a Psychiatrist for Headache
Migraine and mood disorders are closely linked. People with migraine are markedly more likely to have depression and anxiety than people without, and the relationship runs in both directions: each raises the risk and worsens the course of the other. Poor sleep, chronic stress and overuse of pain medication are among the most common reasons an occasional headache becomes a frequent one.
This is the part of headache care that is often left out. A psychiatrist is well placed to treat the whole picture: the headache itself, and the depression, anxiety and insomnia that frequently drive it or follow it. Several medicines used to prevent migraine also treat mood, anxiety or sleep, so one carefully chosen plan can often do more than several separate ones. The aim is not to call every headache psychological, but to stop treating the head and the mind as if they were unrelated.
Headaches Seen in Clinic
Naming the headache correctly is the whole task, because the treatment that helps one type can worsen another.
Diagnostic Criteria
Headache medicine uses a shared rulebook, the International Classification of Headache Disorders, third edition (ICHD-3), so that the same headache is named the same way in every clinic. The criteria used most often are set out below. They are shared here to make the diagnosis understandable, not for self-diagnosis: applying them correctly, and ruling out anything serious, is part of the assessment.
| A | At least five attacks fulfilling criteria B to D. |
| B | Headache attacks lasting 4 to 72 hours when untreated or unsuccessfully treated. |
| C | Headache has at least two of: one-sided location; pulsating quality; moderate or severe intensity; worsened by, or causing avoidance of, routine activity such as walking or climbing stairs. |
| D | During the headache, at least one of: nausea and/or vomiting; sensitivity to both light and sound. |
| E | Not better accounted for by another diagnosis. |
| A | At least two attacks fulfilling criteria B and C. |
| B | One or more fully reversible aura symptoms: visual, sensory, speech or language, motor, brainstem, or retinal. |
| C | At least three of: a symptom spreading gradually over five minutes or more; two or more symptoms in succession; each symptom lasting 5 to 60 minutes; at least one symptom one-sided; at least one symptom positive (such as flickering lights or pins and needles); the aura accompanied, or followed within 60 minutes, by headache. |
| D | Not better accounted for by another diagnosis. |
| A | Headache (migraine-like or tension-type-like) on 15 or more days per month for more than three months, meeting criteria B and C. |
| B | Occurring in a person who has had at least five attacks meeting the criteria for migraine without aura or migraine with aura. |
| C | On 8 or more days per month for more than three months, with migraine features on those days, or treated and relieved as migraine. |
| D | Not better accounted for by another diagnosis. |
This 15-days-a-month pattern is the licensed indication for Botox (onabotulinumtoxinA).
| A | At least ten episodes of headache fulfilling criteria B to D. |
| B | Lasting from 30 minutes to 7 days. |
| C | At least two of: both-sided location; pressing or tightening (non-throbbing) quality; mild or moderate intensity; not worsened by routine activity such as walking or climbing stairs. |
| D | Both of: no nausea or vomiting; no more than one of light or sound sensitivity. |
| E | Not better accounted for by another diagnosis. |
Frequency sets the sub-type: infrequent (under 1 day a month), frequent (1 to 14 days a month), or chronic (15 or more days a month for over three months).
| A | Headache on 15 or more days per month in a person who already has a headache disorder. |
| B | Regular overuse for more than three months of one or more acute headache drugs: simple painkillers (paracetamol, aspirin or other anti-inflammatories) on 15 or more days a month; or triptans, ergots, opioids, combination painkillers, or a mix of classes on 10 or more days a month. |
| C | Not better accounted for by another diagnosis. |
Source: International Classification of Headache Disorders, 3rd edition (ICHD-3), International Headache Society. Simplified for readability.
Treatment
Headache treatment has two arms. Acute treatment aims to stop or shorten an attack that has already begun, and works best taken early and not too often. Preventive treatment aims to make attacks less frequent and less severe, and is considered when headaches are frequent, disabling, or already leading to heavy painkiller use. Both are chosen around the specific diagnosis, other conditions, and what a person has already tried.
Much of the work is unglamorous and effective: identifying triggers, correcting sleep, moderating caffeine, addressing painkiller overuse, and treating the mood or anxiety problems that keep headaches going. Preventive medicines, several of which also help sleep, mood or anxiety, are added when they are needed rather than by default, with a clear explanation of what to expect and over what timescale.
NICE recommends a triptan together with an NSAID or paracetamol for many adults, or either component alone when preferred. Examples discussed in practice include sumatriptan, ibuprofen, naproxen and paracetamol; an antiemetic may be added even without nausea.
Propranolol, topiramate and amitriptyline are established options considered around attack frequency, disability, blood pressure, sleep, mood, weight, pregnancy potential and other conditions. Topiramate has important pregnancy-prevention restrictions.
OnabotulinumtoxinA is established for chronic migraine in the right context. CGRP-targeting medicines may be options after failures and eligibility review, but access and cost in India vary. Opioids and ergots are not recommended for acute migraine.
Do not diagnose or treat a new headache from this list. The headache type, red flags, other medicines and days of acute-drug use determine what is safe. Frequent triptan or painkiller use can itself cause medication-overuse headache.
Clinical reference: NICE CG150, headaches in over 12s.
OnabotulinumtoxinA, commonly known as Botox, is an established preventive treatment for chronic migraine. Its use in migraine is supported by the large PREEMPT randomised controlled trials and it holds regulatory approval for this specific indication. In practice it means small injections given at fixed points across the forehead, temples, back of the head, neck and shoulders, repeated roughly every twelve weeks.
Who it is for
Chronic migraine
Headache on 15 or more days a month, with migraine features on at least 8, for over three months. It is not a treatment for occasional or episodic migraine.
How it is given
A short in-person visit
A set of small injections following the standard protocol, in person in New Delhi, repeated about every 12 weeks. No hospital stay.
What to expect
Fewer headache days
In trials, benefit builds over the first two or three cycles. It reduces how often and how severely headaches strike; it does not cure migraine.
Two points are worth being honest about. First, Botox is a preventive treatment: it reduces the number and severity of headache days over months, rather than stopping a single attack, and the fuller benefit often appears only after the second or third cycle, which is why an early course is given a fair trial before judging it. Second, it is specific. The evidence supports Botox for chronic migraine; it has not been shown to help episodic (occasional) migraine or ordinary tension-type headache, and it is not offered for those. Whether it is the right option is decided after assessment, alongside the tablet-based preventives it is usually compared with. The medical consultation and assessment can begin online; the injections themselves are done in person.
There is growing research interest in neuromodulation for headache, including transcranial direct current stimulation (tDCS), a non-invasive technique that applies a weak electrical current to the scalp. Early randomised trials in migraine are encouraging but the evidence is still limited and the best protocols are not yet settled, so tDCS is regarded as an emerging option rather than an established one. It is an area this practice is following closely and expects to be able to offer in future; it is not currently part of the service. Where a neuromodulation approach is clearly indicated now, an onward referral can be arranged.
If low mood or anxiety is part of the picture, the article on what the research actually shows about botulinum toxin and depression looks at that separate and much earlier body of evidence.
· American Headache Society and international guidance on preventive treatment for chronic migraine.
· Systematic review of tDCS protocols for migraine prevention. Journal of Headache and Pain, 2021.
These references are provided for education and do not replace individual clinical assessment.
In Delhi and Online
In-person consultations take place at Annova Health, inside The Face Centre, 3rd Floor, 41 Ring Road, Block Q, Lajpat Nagar 4, New Delhi 110024, Monday to Saturday, 11 am to 7 pm, by appointment. The building is on Ring Road itself and is reached easily from Defence Colony, Jangpura, South Extension, Greater Kailash, East of Kailash, CR Park, Kalkaji and Nehru Place. Moolchand and Lajpat Nagar metro stations are both close by. Directions and a fuller clinic guide are on the Lajpat Nagar clinic page.
Much of headache care works well by video: taking a proper history, reviewing a headache diary, adjusting a preventive, and spotting medication overuse headache, which is common and frequently missed. What needs a room is a neurological examination where the pattern has changed or the features are unusual, and any procedure such as botulinum toxin injection.
An in-person consultation is ₹3,000 for 30 minutes. Online is ₹2,500 for 30 minutes, or ₹4,000 for a pre-booked 60 minutes. Follow-up consultations are charged at the same rate. Full details are on the fees page.
Common Questions
For chronic migraine, yes, within limits. Large randomised trials show that onabotulinumtoxinA reduces the number of headache days per month compared with placebo when given as a repeated preventive course. It reduces how often and how severely attacks strike rather than curing migraine, and the fuller benefit usually appears over the first two or three cycles. It is one preventive option among several and is chosen after assessment.
The evidence and licensed use are for chronic migraine, meaning headache on fifteen or more days a month, with migraine features on at least eight, for more than three months, usually when tablet-based preventives have not worked well or are not suitable. It is not indicated for occasional (episodic) migraine or for tension-type headache. Suitability is decided after a proper assessment.
It is the same medicine, but the purpose, the dose and the injection pattern are different. Migraine treatment follows a specific protocol with injection points across the forehead, temples, back of the head, neck and shoulders, and is aimed at preventing headaches rather than at appearance. Any effect on frown lines is incidental.
The evidence does not support Botox for tension-type headache, and it is not offered for that. Tension-type headache is better addressed by treating its drivers, such as stress, sleep, posture and painkiller overuse, and by preventive medication where appropriate. An accurate diagnosis matters, because tension-type headache and chronic migraine are treated differently.
The injections use fine needles and are generally well tolerated, with brief discomfort at the sites. The most common effects are temporary neck stiffness or discomfort and, less often, mild eyelid or brow drooping that settles. It is a prescription treatment given after assessment, and the risks and expectations are explained beforehand for your individual situation.
Assessment, diagnosis and most medical treatment for headache can be handled well by online consultation across India. Botox is a procedure and is given in person in New Delhi, so the consultation can begin online and the injections are arranged at an in-person visit. New, severe or alarming headaches need local or emergency assessment instead.
A consultation is ₹3,000 for 30 minutes in person in Lajpat Nagar, or ₹2,500 for 30 minutes online, with a pre-booked 60-minute online session at ₹4,000. Follow-ups are charged at the same rate. Medication, where it is used, is bought separately at pharmacy rates. The full fee list is published on the site.
Annova Health, inside The Face Centre, 3rd Floor, 41 Ring Road, Block Q, Lajpat Nagar 4, New Delhi 110024. The building is on Ring Road itself, a short drive from Defence Colony, South Extension, Greater Kailash and East of Kailash, with Moolchand and Lajpat Nagar metro stations both nearby. Consultations are Monday to Saturday, 11 am to 7 pm, by appointment.