Treatments
I am proud to offer the latest migraine management options, including anti-CGRP treatments and injectable options like Botox® as well as GON injections for chronic migraine.
BOTOX
Studies show Botox to be a safe, well-tolerated and effective preventive treatment for chronic migraine. It's licensed and approved by NICE for the treatment of chronic migraine with 15 or more headache days per month. It can help manage, but does not cure, the condition and may not be effective in some patients. The exact mechanism by which Botox works is not fully established but it's believed it blocks the release of neurotransmitters (acetylcholine) at the nerve endings and inhibits the transmission of peripheral pain signals to the central nervous system thus reducing neurogenic inflammation and central sensitisation in the brain. I inject BOTOX® according to the PREEMPT (Phase III Research Evaluating Migraine Prophylaxis Therapy) protocol.
Suitable for chronic migraine and medication overuse headache.
Greater occipital nerve (GON) injection
An occipital nerve block is a safe procedure which involves injecting a combination of a steroid and a local anaesthetic around the nerves at the back of the head. It feels similar to a numbing dental injection and works by reducing inflammation and irritation of the tissues around the occipital nerves, blocking pain signals from reaching the brain thus helping to alleviate migraine symptoms. The effects of the greater occipital nerve (GON) injection typically develop over 1-2 weeks and can last up to two months or more. If necessary, the injection can be repeated every two months but the usual safe frequency is around 3-4 times a year.
I offer this treatment to patients managing persistent or frequent migraine attacks as well as medication overuse headache as part of a comprehensive treatment plan. It is also a very effective option for eliminating cluster headache bouts.
Suitable for migraine, medication overuse headache and cluster headache.
Click the image to link to the National Migraine Centre Podcast. Learn more about injection treatments - Dr Manukyan and colleagues discuss migraine, Botox and GON injections.
Anti-CGRP treatments
CGRP (Calcitonin gene-related peptide) antibodies
A protein which plays a key role in migraine attacks, CGPR is targeted by migraine treatments including Aimovig (Erenumab), Ajovy (Fremanezumab) and Emgality (Galcanezumab). These monoclonal antibodies work by binding to CRGP or its receptor thus helping prevent the sensitisation and hyperexcitability of the brain and reducing the frequency of migraine attacks. This treatment may be considered for up to 6-12 months, depending on its effectiveness. Side effects are generally mild but can include constipation and injection site irritation. As a headache specialist, I can prescribe anti-CGRP treatments and also provide training for self-administration. The drug is delivered via an autoinjector and is administered at home by the patient once every four weeks.
Suitable for migraine and medication overuse headache.
Gepants
A class of oral medications designed to prevent and treat migraine, gepants target and block the action of CGRP (calcitonin gene-related peptide) in the migraine process. Gepant medications include Atogepant and Rimegepant which can be taken during a migraine attack to help reduce pain and associated symptoms. Gepants often have fewer side effects than triptans and can be used as part of a comprehensive treatment plan, particularly for those who may not respond well to other treatments or experience significant side effects.
Suitable for migraine and medication overuse headache.
“I saw Dr Manukyan for my ongoing headaches, which were getting progressively worse. Dr Manukyan offered two injections into my occipital nerves and prescribed me Vydura tablets. This was an absolute game changer, I’ve had only three migraines in three weeks and am now headache free.”
JUNE, 57, SURREY