Key takeaways:
- Lack of schooling, assets and personnel are obstacles to headache care in Africa, Southeast Asia.
- Researchers have an ethical obligation to help medical, nonmedical personnel to deal with these obstacles.
MINNEAPOLIS — Coming into into partnerships with medical and nonmedical organizations in low-to-middle earnings international locations, notably Kenya and the Philippines, could also be a path towards enhancing outcomes in migraine, in response to a presenter.
“There’s a motive why we partnered with these international locations,” Rami Burstein, PhD, professor of anesthesia and neuroscience at Harvard Medical College, mentioned on the American Headache Society 67th Annual Scientific Assembly. “I don’t want to clarify to this authorities what’s the drawback of illness.”
Knowledge have been derived from Burstein R, et al. Overcoming obstacles to headache care in low-and-middle earnings international locations – The story of Kenya and the Philippines. Offered at: American Headache Society Annual Scientific Assembly; June 18-22, 2025; Minneapolis.
“The answer comes from how we educate well being care suppliers who aren’t MDs, how we carry inexpensive treatment, and the way we enhance consciousness,” Burstein added.
Underscoring the necessity for specialised headache care, the prevalence of migraine within the east African nation is unknown for a inhabitants of 56 million, whereas prevalence within the Southeast Asian archipelago is 11 million for a nation of 119 million.
As well as, the near-complete lack of neurologists (one per 2.65 million in Kenya; one per 200,000 in Philippines) signifies that a vary of care-oriented people have to choose up the slack, reminiscent of neighborhood well being personnel, midwives, pharmacists and nurses within the Philippines, whereas nurses and different scientific officers tackle the duty in Kenya.
“Once I was serving in Kenya, no affected person within the underserved neighborhood ever heard the phrase neurologist,” Burstein mentioned. “They didn’t know what a neurologist is.”
With the shortage of specialised workers, Burstein continued, the price of migraine-specific drugs reminiscent of triptans and gepants additionally acts as a barrier. Roughly 99% of all sufferers with migraine use paracetamol, caffeine, or nonsteroidal inflammatory brokers to deal with migraine signs.
“Triptans are too costly,” Burstein mentioned. “Forty years after their introduction into Europe and the U.S., it seems, they’re utilized by lower than 1% of the sufferers in Kenya and the Philippines.”
As a result of the shortage of medical or specialised headache-care workers in addition to an uneven distribution of well being care services in each international locations current extra obstacles for each units of residents, the researchers sought companions to advertise primary schooling measures for sufferers to acknowledge indicators and signs of migraine.
“It’s a must to associate with individuals in an effort to get to the place you need to get,” Burstein mentioned.
Within the Philippines, the place a comparatively extra intensive medical community exists, neurologists, headache specialists, the division of well being, physicians concerned with public well being and native governments joined collectively to deal with the difficulty.
“In Kenya, we did it in a different way,” Burstein mentioned. “There are personal, public and faith-based well being care methods which deal with completely different sufferers and have fully completely different wants. The most important and strongest is the faith-based system.”
Spiritual organizations such because the Convention of Catholic Bishops and Christian Well being Affiliation headed the record, which additionally included a Christian nonprofit specializing in supply of medication and provides, in addition to different authorities companies.
“It’s actually this connection that opened a lot of the doorways for the issues that we wanted to do,” Burstein mentioned.
In response to Burstein, 99.4% of sufferers are seen by individuals who didn’t attend medical faculty, reminiscent of scientific officers, nurses, midwives, pharmacists, and, most significantly, neighborhood well being promoters. The purpose, then, is to train these personnel diagnose and deal with migraine.
“If we can’t discover a technique to educate them, inside 1 day, concerning the means to diagnose a migraine, and 1 day about correct therapy of migraine, we’re merely not going to make a distinction,” he mentioned. “They’re the bridge between the villages and the clinics.” One resolution is instructing these personnel to make use of a “PIN” mnemonic when screening for headache, asking sufferers to acknowledge photophobia, impaired exercise ranges and nausea generally related to an assault.
Moreover, sufferers could be provided the prospect to self-diagnose and well being care employees may quickly diagnose sufferers by way of an eight-question battery, the place answering to 4 or extra within the affirmative signifies migraine presence.
Burstein additionally emphasised the function of inexpensive treatment in migraine outcomes, noting that 99% of the inhabitants of the eight international locations that his group works in doesn’t have entry to sumatriptan. Doses in Africa price between $1.50 and $3.
“When the typical earnings of a household is $15 a month, to pay $1.75 a tablet is nearly unattainable,” he mentioned.
Burstein and his colleagues launched a charity to purchase sufficient sumatriptan to deal with 100,000 sufferers for two years. Additionally they negotiated with non-governmental organizations and producers to carry costs right down to $0.15 a tablet, which is equal to the worth of paracetamol.
“The idea with the federal government was that if we wish them to take over, we have to present them convincing knowledge that we’re making a distinction,” he mentioned. “It solely takes slightly effort so as to add sumatriptan to the treatment the federal government is keen to provide at no cost.”
Lastly, Burstein mentioned consciousness is essential to success.
With an estimated 10.6 million Catholics in Kenya and 86 million within the Philippines, it isn’t stunning that sufferers with migraine in these international locations will seek the advice of a priest and soothe via prayer, Burstein mentioned.
As such, researchers requested the church to assist enhance migraine consciousness via pointed sermons, church bulletins, reference to Christian well being organizations and direct tackle from clergy to parishioners.
“You possibly can monitor what number of sufferers from every of those church buildings makes their method into the clinic within the subsequent week,” Burstein mentioned.
Suppliers ought to work to treatment these inequalities in migraine care, he added. “We should be capable to take duty as a medical society for the elemental injustice created by lack of entry to primary schooling and drugs that may enhance the lives of headache victims in underserved communities,” Burstein mentioned. “Our ethical crucial needs to be guided by the truth that when a affected person has no entry to care, speaking about it isn’t sufficient. It’s a must to do one thing about it.”
For extra info:
Rami Burstein, PhD, may be reached at neurology@healio.com.
