EMERGENCY:Thunderclap headache, new severe headache after 50, headache with fever and neck stiffness, or headache with new neurological signs —call040-46324365immediately — 24 hours, 7 days— 24/7
Headache & Pain Syndromes in Hyderabad:
From the Migraine That Ruins a Week to the Face Pain That Strikes Like an Electric Shock
Expert diagnosis and treatment of migraine, cluster headache, trigeminal neuralgia, CRPS, post-herpetic neuralgia and more at KIMS Neuroscience, Secunderabad.
11 Conditions
MVD, CGRP & SCS
040-46324365
Headache and pain syndromes are conditions that produce pain in the head, face, or body either as the primary problem or as a chronic neuropathic process out of proportion to any tissue damage. They include the primary headache disorders (migraine, cluster, tension), the trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, SUNCT and SUNA), secondary headaches such as idiopathic intracranial hypertension and medication overuse headache, and neuropathic pain syndromes (trigeminal neuralgia, post-herpetic neuralgia, CRPS, central pain). Distinguishing a primary headache from a "secondary" headache caused by an underlying brain problem is the first step — and KIMS Neuroscience uses the SNOOP10 red-flag screen at every assessment, ensuring no secondary cause of headache is missed before a primary headache diagnosis is assigned. KIMS Neuroscience Hyderabad treats: Migraine · Cluster Headache · Paroxysmal Hemicrania · SUNCT & SUNA · Tension-Type · Trigeminal Neuralgia · Post-Herpetic Neuralgia · Complex Regional Pain Syndrome · Central Pain Syndrome · Idiopathic Intracranial Hypertension · Medication Overuse Headache.
- What they are
- Disorders that produce pain in the head, face, or body without (or out of proportion to) tissue damage — including the primary headache disorders (migraine, cluster, tension), the trigeminal autonomic cephalalgias, and neuropathic pain syndromes (trigeminal neuralgia, post-herpetic neuralgia, CRPS, central pain).
- Conditions treated
- Migraine · Cluster Headache · Paroxysmal Hemicrania · SUNCT & SUNA · Tension-Type Headache · Trigeminal Neuralgia · Post-Herpetic Neuralgia · Complex Regional Pain Syndrome · Central Pain Syndrome · Idiopathic Intracranial Hypertension · Medication Overuse Headache.
- When a headache is an emergency (SNOOP10 red flags)
- Two S: Systemic symptoms (fever, weight loss, jaw claudication) · Secondary risk factors (cancer, HIV, immunosuppression) · N: Neurological symptoms or new signs · Two O: Onset sudden (thunderclap) · Older age of onset (>50) · Five P: Pattern change · Positional · Papilloedema · Progressive · Precipitated by Valsalva or exertion. Any one of these = urgent assessment before labelling as primary headache.
- Modern migraine treatment
- CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) for chronic and refractory migraine · Botulinum toxin PREEMPT protocol · Triptans for acute attacks · Specific management of medication-overuse headache and menstrual migraine.
- Curative surgery for trigeminal neuralgia
- Microvascular decompression (MVD) at KIMS produces 70–80% pain freedom in selected patients · Gamma Knife stereotactic radiosurgery and percutaneous procedures available for patients unsuitable for open surgery.
- Interventional pain options
- Greater occipital nerve block · Sphenopalatine ganglion block · Trigeminal branch and supraorbital blocks · Spinal cord stimulation for CRPS, failed back surgery syndrome, and refractory central pain · Ketamine infusion for refractory CRPS.
- Contact KIMS
- Emergency (thunderclap headache or red flags): 040-46324365 · Outpatient: 040-44885000 · Multidisciplinary pain team · No referral required
| Fact | Details |
|---|---|
| Conditions covered | Migraine · Cluster Headache · Paroxysmal Hemicrania · SUNCT & SUNA · Tension-Type · Trigeminal Neuralgia · Post-Herpetic Neuralgia · CRPS · Central Pain Syndrome · Idiopathic Intracranial Hypertension · Medication Overuse Headache |
| SNOOP10 red flags | Systemic symptoms · Secondary risk factors (cancer, HIV, immunosuppression) · Neurological signs · Onset sudden/thunderclap · Older onset (>50) · Pattern change · Positional · Papilloedema · Progressive · Precipitated by Valsalva/exertion — any one = urgent assessment before primary headache label |
| Migraine treatment ladder | Acute: triptans, NSAIDs, antiemetics · Preventive: beta-blockers, topiramate, amitriptyline · Advanced: CGRP mAbs (erenumab, fremanezumab, galcanezumab), Botox PREEMPT |
| Cluster headache | Most painful condition known to medicine · High-flow oxygen and sumatriptan injection for acute attacks · Verapamil and steroid bridge for prevention · Surgical options for refractory chronic cluster |
| Trigeminal neuralgia | Microvascular decompression (MVD) at KIMS: 70–80% pain freedom · Gamma Knife stereotactic radiosurgery and percutaneous procedures available |
| CRPS treatment | Graded motor imagery and mirror therapy · Ketamine infusion · Spinal cord stimulation for refractory cases · Multidisciplinary pain team at KIMS |
| Contact | 040-46324365 (emergency, thunderclap or red flags) · 040-44885000 (outpatient) · No referral required |
What Are Headache & Pain Syndromes?
Headache is the most common neurological complaint in the world — and one of the most undertreated. In India, fewer than 10% of people with frequent migraines receive preventive treatment. Most manage alone with over-the-counter analgesics until medication overuse headache compounds the original problem. The pain syndromes beyond headache — trigeminal neuralgia, post-herpetic neuralgia, CRPS, central pain — are among the most severe conditions in all of medicine.
At KIMS Neuroscience, Secunderabad, the headache and pain clinic provides the full range of evidence-based treatments: structured preventive therapy, nerve blocks (GON, SPG), CGRP-pathway treatments for migraine, botulinum toxin for chronic migraine, microvascular decompression for trigeminal neuralgia, spinal cord stimulation for CRPS, and multidisciplinary pain management. The goal is not just pain reduction — it is restoring the ability to work, parent, and live.
Emergency Red Flags — Call 040-46324365 Immediately
• Thunderclap headache (worst of your life, peaks within 60 seconds)
• New headache after age 50
• Headache with fever and neck stiffness
• Headache with new neurological symptoms
• Headache after head injury
• Progressive headache worsening over weeks
When Headache Is an Emergency — SNOOP10
Any one of these ten features in a headache patient requires urgent assessment before labelling as primary headache. At KIMS, any SNOOP10 feature triggers urgent MRI brain and, if indicated, lumbar puncture before assigning a primary headache diagnosis.
Systemic symptoms
Fever, weight loss, night sweats, jaw claudication, scalp tenderness, myalgias. Think giant cell arteritis (in patients >50 with new headache and jaw claudication), systemic infection, meningitis, or malignancy with CNS involvement.
Secondary risk factors
Known cancer (even treated), HIV/AIDS, immunosuppression (chemotherapy, biologics, transplant), anticoagulants (raised risk of intracranial haemorrhage). A new headache in a cancer patient is a brain metastasis until MRI proves otherwise.
Neurological symptoms or signs
New focal weakness, diplopia (double vision), ataxia, altered consciousness, cognitive change, speech difficulty. Any new neurological symptom accompanying headache = urgent assessment.
Onset sudden — thunderclap
Headache reaching peak intensity within 60 seconds. Subarachnoid haemorrhage until proven otherwise. Requires emergency CT brain + lumbar puncture if CT normal. Do not send home.
Older age at onset
New headache with onset after age 50, especially with no prior headache history. Think giant cell arteritis (test ESR, CRP, temporal artery biopsy), intracranial mass, subdural haematoma.
Pattern change
New headache type the patient has never experienced before, or a significant change in character, frequency, severity, or response to treatment in a previously stable headache. A change in an established migraine pattern warrants investigation.
Positional aggravation
Headache significantly worse lying flat or on bending forward (suggests raised intracranial pressure, IIH) · Headache significantly worse on standing or upright (suggests low CSF pressure, spontaneous intracranial hypotension, CSF leak).
Papilloedema
Swelling of the optic disc on fundoscopy — a sign of raised intracranial pressure. Requires urgent assessment for IIH, intracranial mass, or other cause of raised ICP. Fundoscopy should be performed in every patient with new progressive headache.
Progressive worsening
Headache worsening progressively over days to weeks despite standard treatment — increasing frequency, severity, or duration. Think intracranial mass, subdural haematoma, or IIH. Failure to improve with typical headache treatment is itself a flag.
Precipitated by Valsalva, exertion or sex
Headache triggered or significantly worsened by coughing, sneezing, straining at stool, lifting, exertion, or sexual activity. Think Chiari malformation, intracranial mass, CSF flow obstruction, or subarachnoid haemorrhage.
Conditions We Treat
01
Migraine
The most common disabling neurological condition globally. Episodic or chronic, with or without aura. CGRP-pathway preventive therapy, botulinum toxin PREEMPT, and acute treatment optimisation. Menstrual migraine addressed specifically.
Trigeminal Autonomic Cephalalgias (TACs)
Trigeminal autonomic cephalalgias are a group of primary headache disorders defined by strictly unilateral head pain combined with ipsilateral autonomic features — eye redness, tearing, nasal congestion, eyelid drooping, or facial sweating — on the same side as the pain. These features reflect activation of the trigeminal-autonomic reflex arc: pain signals from the trigeminal nerve drive autonomic output through the facial nerve. The three TACs treated at KIMS are distinguished by attack duration and frequency, and — critically — by their specific treatments: what works for cluster headache does not work for paroxysmal hemicrania or SUNCT. Accurate diagnosis is the prerequisite for effective treatment.
02
Cluster Headache
The most painful condition known to medicine — and the most common trigeminal autonomic cephalalgia (TAC). Strictly unilateral orbital or periorbital attacks lasting 15–180 minutes, occurring 1–8 times daily during cluster periods of weeks to months, with ipsilateral autonomic features (eye redness, tearing, nasal congestion, drooping eyelid). Acute treatment: high-flow oxygen (100%, 12 L/min) and subcutaneous sumatriptan. Prevention during cluster periods: verapamil. Surgical options (sphenopalatine ganglion stimulation, occipital nerve stimulation) for refractory chronic cluster headache at KIMS.
03
Paroxysmal Hemicrania
A trigeminal autonomic cephalalgia (TAC) with 5–40 daily attacks of severe unilateral orbital or temporal pain lasting 2–30 minutes, with ipsilateral autonomic features. The defining feature — and the diagnostic test — is an absolute, complete response to indomethacin at therapeutic doses. A patient whose attacks do not fully resolve with indomethacin does not have paroxysmal hemicrania. Occurs in episodic and chronic forms. Indomethacin is the treatment; alternatives (if indomethacin is not tolerated) include COX-2 inhibitors and topiramate with much lower evidence.
04
SUNCT & SUNA — Short-lasting Unilateral Neuralgiform Headache Attacks
Ultra-short, high-frequency trigeminal autonomic cephalalgia — attacks lasting 5–240 seconds occurring up to hundreds of times per day, with prominent ipsilateral conjunctival injection and tearing (SUNCT) or autonomic features without conjunctival injection (SUNA). Can be triggered by light touch to the face, eating, or eye movement. The most refractory of the TACs to treat. First-line treatment: lamotrigine. Carbamazepine, gabapentin, and intravenous lidocaine infusion for acute crises are used at KIMS.
05
Tension-Type Headache
The most prevalent headache globally. Bilateral pressing pain without nausea or photophobia. Episodic vs chronic. Medication overuse as the major complication. Amitriptyline, physiotherapy, and lifestyle management.
06
Trigeminal Neuralgia
Electric-shock face pain lasting seconds, triggered by touch, chewing, or speaking. The most severe pain syndrome in clinical practice. MVD by the KIMS Neuroscience team at KIMS: 70–80% pain freedom. Gamma Knife and percutaneous procedures also available.
07
Post-Herpetic Neuralgia
Persistent burning neuropathic pain after shingles. Very common in India where VZV vaccination is not universal. Gabapentinoids, tricyclics, lidocaine patches, capsaicin 8%, and nerve blocks. Shingrix prevention counselling.
08
Complex Regional Pain Syndrome (CRPS)
Disproportionate pain, swelling, skin changes, and movement dysfunction after limb injury. Graded motor imagery, mirror therapy, ketamine infusion, and spinal cord stimulation at KIMS.
09
Central Pain Syndrome
Neuropathic pain from CNS injury: post-stroke thalamic pain, MS pain, spinal cord injury pain. Amitriptyline, pregabalin, lamotrigine, and spinal cord stimulation for refractory cases at KIMS.
10
Idiopathic Intracranial Hypertension (IIH)
Raised intracranial pressure without a structural cause — presenting as daily progressive headache, transient visual obscurations, pulsatile tinnitus, and papilloedema on fundoscopy. Most common in overweight women of childbearing age; also triggered by doxycycline, retinoids, lithium, and other medications. Carries a specific risk of irreversible visual field loss if untreated. Management: acetazolamide, structured weight loss, ophthalmological monitoring, and — for vision-threatening cases — CSF shunt or optic nerve sheath fenestration.
11
Medication Overuse Headache (MOH)
The most common cause of chronic daily headache in India. Develops when acute headache medications are taken too frequently — triptans or combination analgesics on ≥10 days per month, or simple analgesics on ≥15 days per month. The brain sensitises to the regular drug presence and generates headache in their absence — creating a self-perpetuating cycle. Treatment: supervised withdrawal of the overused medication (outpatient or inpatient protocol at KIMS), followed by evidence-based preventive therapy. CGRP monoclonal antibodies are specifically effective in MOH.
KIMS Headache & Pain Capabilities
Nerve Blocks
Greater occipital nerve (GON) block · Sphenopalatine ganglion (SPG) block · Trigeminal branch blocks · Supraorbital/supratrochlear nerve blocks.
CGRP mAb Therapy
Erenumab, fremanezumab, galcanezumab for chronic migraine and preventive-refractory migraine.
Botulinum Toxin
PREEMPT protocol onabotulinumtoxinA (155–195 units, 31–39 sites) for chronic migraine.
MVD Surgery
Microvascular decompression for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia by the KIMS Neuroscience team.
Stereotactic Radiosurgery
For trigeminal neuralgia in patients unsuitable for open surgery.
Spinal Cord Stimulation (SCS)
For CRPS, failed back surgery syndrome, and refractory central pain at KIMS neurosurgery.
Ketamine Infusion
For CRPS and refractory pain syndromes — KIMS anaesthesia and pain coordination.
Multidisciplinary Pain Team
Neurology + Neurosurgery + Anaesthesia + Physiotherapy + Psychology — complex cases reviewed at KIMS MDT.
Expert Consultation
Our multidisciplinary pain team — Neurology, Neurosurgery, Anaesthesia, Physiotherapy and Psychology — reviews every complex case. Call 040-44885000.
Why Choose KIMS Neuroscience?
MVD Surgery by the KIMS Neuroscience team
Spinal Cord Stimulation for CRPS & Central Pain
CGRP mAb & PREEMPT Botulinum Toxin Protocols
Multidisciplinary Pain MDT — Neuro, Anaesthesia, Physio, Psychology
Headache & Pain Programme
A dedicated specialist programme for migraine, cluster headache, trigeminal neuralgia and facial pain — CGRP-pathway therapy, Botox for chronic migraine, nerve blocks, and inpatient care for status migrainosus.
Explore the Headache Programme →Common Questions
Thunderclap headache (worst headache of your life, peaking within 60 seconds), new headache after age 50, headache with fever and neck stiffness, headache with new neurological symptoms, or headache after a head injury are emergency red flags. Call 040-46324365 immediately.
Fewer than 10% of people with frequent migraines in India receive preventive treatment. Most manage alone with over-the-counter analgesics until medication overuse headache compounds the original problem — which is why structured preventive therapy at a specialist clinic matters.
Microvascular decompression (MVD) by the KIMS Neuroscience team achieves 70–80% pain freedom. Gamma Knife stereotactic radiosurgery and percutaneous procedures are also available for patients unsuitable for open surgery.
CGRP monoclonal antibodies — erenumab, fremanezumab, galcanezumab — are the first migraine-specific preventive medications. They are particularly useful for patients with chronic migraine (≥15 headache days per month, 8 of them migraine), patients who have failed at least two preventive medications, and patients with medication overuse. Given as monthly or quarterly injections, with onset of effect in 4–12 weeks. At KIMS, eligibility is assessed at the headache clinic.
Medication overuse headache (MOH) develops when acute headache medications are taken too frequently — typically 10 or more days per month for triptans, opioids, or combination analgesics, or 15 or more days for simple analgesics. The headache becomes daily and refractory to the same medications. Treatment requires withdrawal of the overused drug (under specialist supervision because withdrawal headaches are common) and introduction of a structured preventive plan. This is one of the most common reasons referrals reach the KIMS headache clinic.
Yes — direct headache and pain-clinic appointments are accepted. Outpatient: 040-44885000 (Mon–Sat). Bringing a 2–4 week headache diary (date, time, severity, triggers, medications taken) makes the first assessment much more efficient. For thunderclap headache, new severe headache after 50, fever + neck stiffness, or headache with new neurological signs, call 040-46324365 immediately.
Initial consultation 30–60 minutes including history, headache classification (using ICHD criteria), red-flag screening (SNOOP10), and examination. MRI is selected based on red flags, not done routinely for typical migraine. A complete management plan — acute treatment, preventive plan, and lifestyle / trigger modification — is in place at the first visit, with follow-up at 4–8 weeks.
Don't Live With Pain That Has a Treatment
Structured preventive therapy, nerve blocks, MVD surgery and spinal cord stimulation are available at KIMS. Speak with our headache and pain specialists today.
International enquiries: info@kimsneurosciences.com