Barriers to headache care in low- and middle-income countries

Abstract

Headache disorders are a common cause of disability globally and lead not only to physical disability but also to financial strain, higher rates of mental health disorders such as depression and anxiety, and reduced economic productivity which negatively impacts gross domestic product (GDP) on a national scale. While data about headache are relatively scarce in low- and middle-income countries (LMICs), those available suggest that headache disorders occur on a similar scale in LMICs as they do in high-income countries. In this manuscript, we discuss common clinical, political, economic and social barriers to headache care for people living in LMICs. These barriers, affecting every aspect of headache care, begin with community perceptions and cultural beliefs about headache, include ineffective headache care delivery systems and poor headache care training for healthcare workers, and extend through fewer available diagnostic and management tools to limited therapeutic options for headache. Finally, we review potential solutions to these barriers, including educational interventions for healthcare workers, the introduction of a tiered system for headache care provision, creation of locally contextualized diagnostic and management algorithms, and implementation of a stepped approach to headache treatment.

Keywords: Access to care; Global campaign against headache; Global health; Headache; Low- and middle-income countries.

Fig. 1

Three-tiered system for headache healthcare provision proposed by the Global Campaign against Headache [29]. This system is reliant on improved training of healthcare providers at level one and reserves limited specialist care for individuals with the most complex and difficult to treat headache disorders.

Fig. 2

Illustration of the stepped care approach for headache treatment which has been shown to be cost-effective using modeling analyses based on available data from China, India, Russia and Zambia.

Fig. 3

Typical patient pathway to headache care with barriers with the potential to impact each step in the care pathway noted to the right.