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Peer-reviewedCC BY 4.0Frontiers in Neurology

Clinicians’ perspectives on complementary and alternative medicine use in headache care across Africa and West Asia: a cross-sectional survey

  • Amr Hassan1
  • Freda Dodd-Glover2
  • Rehab Magdy1
  • Aynur Ӧzge3,4
  • Derya Uludüz5
  • Najib Kissani6,7
  • Ahmed Allioueche8
  • Aussan Al-Athwari9
  • Emna Ellouz10
  • Sounga Bandzouzi Prince Eliot Galieni11,12
  • Mendinatou Agbetou13
  • Kigocha Okeng'o14
27 more authors
  • Daniel Gams Massi15
  • Evelyne Diarra16
  • Agbo Panzo Cedric16
  • Chiamaka Edith Okereke17
  • Wael Alwachi18
  • Osheik Seidi19
  • Kadira Abdi Aden20
  • Augustina Charway-Felli21
  • Foksouna Sakadi22
  • John N. Jabang23
  • Denis R. Shatima24
  • Athanase Millogo25
  • Magnerou Annick Melanie26
  • Fatimata Hassane Djibo27
  • Tiwonge Elisa Phiri28
  • Jamal Barros Baco29
  • Grenaba-Duval Lewis Reinier Joël30
  • Frighton Mutete31
  • Jasem Alhashel32
  • Mansoureh Togha33,34
  • Ammar Fayez Mubaidin35
  • Sarkhan Amirguliyev36
  • Abderrahmane Moulaye37
  • Hana Kedah38
  • Aya Alsayyad1,39
  • Doaa M. khalil40
  • Mona Hussein
40 affiliations
  1. 1Department of Neurology, Kasr Alainy Faculty of Medicine, Cairo University
  2. 2Neurology Unit, Department of Medicine and Therapeutics, Korle Bu Teaching Hospital
  3. 3Department of Neurology, Headache Clinic
  4. 4NOROM Neuroscience and Excellence Center
  5. 5Neurologist Headache Specialist, Board Member of International Headache Society, Department of Neurology, Faculty of Medicine, Istanbul Atlas University
  6. 6Headache and Epilepsy Clinic, Past Head of Neurology and Neuroscience Department, Mohamed 6th University Hospital
  7. 7Department of Neurology, Um6p University
  8. 8CHU Constantine, Private Neurologist
  9. 9Consultant Neurologist and Neuro-interventionist, Aden University
  10. 10Department of Neurology, Gabes Hospital, Sfax University (Université de Sfax)
  11. 11Department of Neurology, Loandjili General Hospital
  12. 12Faculty of Health Sciences, Marien Ngouabi University
  13. 13Department of Neurology, University of Parakou
  14. 14Muhimbili National Hospital
  15. 15Faculty of Medicine and Pharmaceutical Sciences, University of Doula
  16. 16Department of Neurology, CHU Cocody, University Felix Houphouet
  17. 17University of Nigeria Teaching Hospital
  18. 18Neurology Specialist, Head of Neurology Department at Ali Omar Askar Hospital
  19. 19Faculty of Medicine, University of Khartoum
  20. 20Hôpital Militaire de Djibouti
  21. 2137 Military Hospital
  22. 22Department of Neurology, Nationale Reference Teaching Hospital
  23. 23Edward Francis Small Teaching Hospital, University of Gambia
  24. 24Department of Paediatrics, National Hospital Abuja
  25. 25Centre Hospitalier Universitaire
  26. 26Faculty of Medicine and Pharmaceutical Sciences, University of Douala
  27. 27Department of Neurology, Hospital National Amirou Boubacar Diallo of Niamey
  28. 28Queen Elizabeth Central Hospital
  29. 29Hospital Central da Beira
  30. 30Department of Neurology, Université de Bangui
  31. 31Livingstone University Teaching Hospital
  32. 32Department of Neurology, Kuwait University
  33. 33Department of Neurology and Headache Fellowship, Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences
  34. 34Headache Department, Neurology Ward, Sina Hospital, Medical School, Tehran University of Medical Sciences
  35. 35Khalidi Medical Center
  36. 36Migraine and Headache Specialist
  37. 37Department of Neurologist
  38. 38Neurology Consultant, Head of Neurology Department and Program Director of Neurology Saudi Board at Hear Hospital
  39. 39Neurology Consultant, MOH
  40. 40Public Health and Community Medicine, Beni-Suef University
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Abstract

Background: Headache disorders impose a substantial burden across Africa and West Asia, where limited access to healthcare may increase reliance on complementary and alternative medicine (CAM). The current study explored clinicians’ perspectives on CAM use, safety concerns, and research needs across countries with different income status.

Methods: A cross-sectional web-based survey of 123 neurologists and headache specialists with at least 5 years of experience in headache management from 37 countries was carried out. They were classified into Low/Lower-Middle Income Countries (LIC/LMIC) and Upper-Middle Income Countries/High Income Countries (UMIC/HIC) groups in accordance with the World Bank income classifications.

Results: Of 123 participants (median age 42 years; 50.4% males), 52.8% were from LICs/LMICs. Clinicians reported that CAMs were frequently used in both groups, and there was no significant difference in overall frequency of CAM use ( p = 0.116). Clinicians in both groups perceived migraine as the most common headache type for which patients used CAM. However, significant differences in CAM modalities were observed. Acupuncture (79.3% vs. 47.7%, p < 0.001), massage (86.2% vs. 63.1%, p = 0.004), yoga (56.9% vs. 20.0%, p < 0.001), and supplements (93.1% vs. 66.2%, p < 0.001) were reported by the clinicians as significantly higher in UMICs/HICs, whereas spiritual healing was significantly higher in LICs/LMICs (70.8% vs. 46.6%, p = 0.006). Clinicians reported that patients in LICs/LMICs were significantly more likely to consult CAM prior to seeking medical care (89.2% vs. 67.2%, p = 0.003), and perceived cost as a major factor influencing CAM use (81.5% vs. 27.6%, p < 0.001).

Conclusion: CAM appears to be commonly encountered in headache care across Africa and West Asia according to clinician reports. Although its use is shaped by cultural beliefs, accessibility, and perceived safety, concerns over unregulated products, herb-drug interactions, and delayed conventional medical treatments were also highlighted.

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Cite

BibTeXRIS
BibTeX
@article{hassan2026clinicians,
  title = {{Clinicians’ perspectives on complementary and alternative medicine use in headache care across Africa and West Asia: a cross-sectional survey}},
  author = {Amr Hassan and Freda Dodd-Glover and Rehab Magdy and Aynur Ӧzge and Derya Uludüz and Najib Kissani and Ahmed Allioueche and Aussan Al-Athwari and Emna Ellouz and Sounga Bandzouzi Prince Eliot Galieni and Mendinatou Agbetou and Kigocha Okeng'o and Daniel Gams Massi and Evelyne Diarra and Agbo Panzo Cedric and Chiamaka Edith Okereke and Wael Alwachi and Osheik Seidi and Kadira Abdi Aden and Augustina Charway-Felli and Foksouna Sakadi and John N. Jabang and Denis R. Shatima and Athanase Millogo and Magnerou Annick Melanie and Fatimata Hassane Djibo and Tiwonge Elisa Phiri and Jamal Barros Baco and Grenaba-Duval Lewis Reinier Joël and Frighton Mutete and Jasem Alhashel and Mansoureh Togha and Ammar Fayez Mubaidin and Sarkhan Amirguliyev and Abderrahmane Moulaye and Hana Kedah and Aya Alsayyad and Doaa M. khalil and Mona Hussein},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1849417},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1849417/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Clinicians’ perspectives on complementary and alternative medicine use in headache care across Africa and West Asia: a cross-sectional survey
AU  - Amr Hassan
AU  - Freda Dodd-Glover
AU  - Rehab Magdy
AU  - Aynur Ӧzge
AU  - Derya Uludüz
AU  - Najib Kissani
AU  - Ahmed Allioueche
AU  - Aussan Al-Athwari
AU  - Emna Ellouz
AU  - Sounga Bandzouzi Prince Eliot Galieni
AU  - Mendinatou Agbetou
AU  - Kigocha Okeng'o
AU  - Daniel Gams Massi
AU  - Evelyne Diarra
AU  - Agbo Panzo Cedric
AU  - Chiamaka Edith Okereke
AU  - Wael Alwachi
AU  - Osheik Seidi
AU  - Kadira Abdi Aden
AU  - Augustina Charway-Felli
AU  - Foksouna Sakadi
AU  - John N. Jabang
AU  - Denis R. Shatima
AU  - Athanase Millogo
AU  - Magnerou Annick Melanie
AU  - Fatimata Hassane Djibo
AU  - Tiwonge Elisa Phiri
AU  - Jamal Barros Baco
AU  - Grenaba-Duval Lewis Reinier Joël
AU  - Frighton Mutete
AU  - Jasem Alhashel
AU  - Mansoureh Togha
AU  - Ammar Fayez Mubaidin
AU  - Sarkhan Amirguliyev
AU  - Abderrahmane Moulaye
AU  - Hana Kedah
AU  - Aya Alsayyad
AU  - Doaa M. khalil
AU  - Mona Hussein
PY  - 2026
DA  - 2026/10/13
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1849417
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1849417/full
AB  - Background: Headache disorders impose a substantial burden across Africa and West Asia, where limited access to healthcare may increase reliance on complementary and alternative medicine (CAM). The current study explored clinicians’ perspectives on CAM use, safety concerns, and research needs across countries with different income status.  Methods: A cross-sectional web-based survey of 123 neurologists and headache specialists with at least 5 years of experience in headache management from 37 countries was carried out. They were classified into Low/Lower-Middle Income Countries (LIC/LMIC) and Upper-Middle Income Countries/High Income Countries (UMIC/HIC) groups in accordance with the World Bank income classifications.  Results: Of 123 participants (median age 42 years; 50.4% males), 52.8% were from LICs/LMICs. Clinicians reported that CAMs were frequently used in both groups, and there was no significant difference in overall frequency of CAM use ( p = 0.116). Clinicians in both groups perceived migraine as the most common headache type for which patients used CAM. However, significant differences in CAM modalities were observed. Acupuncture (79.3% vs. 47.7%, p < 0.001), massage (86.2% vs. 63.1%, p = 0.004), yoga (56.9% vs. 20.0%, p < 0.001), and supplements (93.1% vs. 66.2%, p < 0.001) were reported by the clinicians as significantly higher in UMICs/HICs, whereas spiritual healing was significantly higher in LICs/LMICs (70.8% vs. 46.6%, p = 0.006). Clinicians reported that patients in LICs/LMICs were significantly more likely to consult CAM prior to seeking medical care (89.2% vs. 67.2%, p = 0.003), and perceived cost as a major factor influencing CAM use (81.5% vs. 27.6%, p < 0.001).  Conclusion: CAM appears to be commonly encountered in headache care across Africa and West Asia according to clinician reports. Although its use is shaped by cultural beliefs, accessibility, and perceived safety, concerns over unregulated products, herb-drug interactions, and delayed conventional medical treatments were also highlighted.
SN  - 1664-2295
ER  -