Bridging the Gap in Headache Care: Insights From the International Headache Society Survey in Nepal.
10 affiliations
- 1Department of Neurology Tribhuvan University Institute of Medicine Teaching Hospital Kathmandu Nepal.
- 2Department of Neurology and Neurological Rehabilitation Tongji University Shanghai Yangzhi Rehabilitation Hospital Shanghai China.
- 3Department of Psychiatry Kathmandu University Gandaki Medical College Teaching Hospital Pokhara Nepal.
- 4Department of Neurology Atlas University Medical Faculty Istanbul Turkey.
- 5NOROM Neuroscience and Excellence Center Ankara Turkey.
- 6Department of Neurology, İstanbul Faculty of Medicine İstanbul University İstanbul Turkey.
- 7Azerbaijan State Institute of Advanced Training of Doctors named after Aziz Aliyev Azerbaijan and Republic Diagnostic Center Baku Azerbaijan.
- 8Department of Public Health Mersin University, School of Medicine Mersin Turkey.
- 9Department of Anaesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center Boston United States.
- 10Department of Anesthesia Harvard Medical School Boston United States.
Abstract
Headache disorders impose a substantial public health burden worldwide, with low- and middle-income countries like Nepal facing pronounced challenges due to limited healthcare infrastructure, inadequate provider training, and restricted access to essential treatments. This study aimed to assess the current state of headache care in Nepal, focusing on the distribution and training of healthcare providers, access to medications, and socioeconomic factors that affect treatment adherence. A cross-sectional survey was conducted as part of a multinational joint initiative by the International Headache Society and Middle East, North Africa and Asia Headache Group. Data were collected from 232 healthcare providers across Nepal using a survey questionnaire. Descriptive and comparative analyses assessed geographic disparities, medication accessibility, and provider preparedness. Most healthcare providers were concentrated in urban centers, with 80.2% reporting some form of training in headache care. However, training gaps persisted among rural and non-specialist providers. Overall, 72.0% of healthcare providers reported that their patients had to pay to access medications, while the median provider-estimated proportion of patients unable to afford medications was 40.0% (20.0%-60.0%). Access to migraine-specific therapies, such as triptans, topiramate, and amitriptyline, was substantially lower in rural areas. Providers in urban settings reported greater medication access and specialized care, while rural providers more frequently served younger, socioeconomically disadvantaged populations with limited treatment options. This study highlights significant disparities in headache care delivery in Nepal, driven by geographic, economic, and educational barriers. Furthermore, financial and geographic barriers to effective headache treatment raise important concerns regarding health equity and patients' rights to appropriate relief from avoidable pain and disability. To bridge these gaps, national policies should prioritize structured headache training, ensure essential headache medications are included in public formularies, and deploy telemedicine-based models in underserved regions.
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BibTeX
@article{ojha2026bridging,
title = {{Bridging the Gap in Headache Care: Insights From the International Headache Society Survey in Nepal.}},
author = {Rajeev Ojha and Jinjin Ma and Abhisekh Chapagain and Ravi Raj Timasina and Bikram Prasad Gajurel and Ragesh Karn and Reema Rajbhandari and Niraj Gautam and Derya Uludüz and Aynur Özge and Semih Taşdelen and Sarkhan Amirguliyev and Tayyar Şaşmaz and Rami Burstein},
journal = {Health care science},
year = {2026},
month = nov,
doi = {10.1002/hcs2.70114},
url = {https://europepmc.org/article/MED/42999663},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Bridging the Gap in Headache Care: Insights From the International Headache Society Survey in Nepal.
AU - Rajeev Ojha
AU - Jinjin Ma
AU - Abhisekh Chapagain
AU - Ravi Raj Timasina
AU - Bikram Prasad Gajurel
AU - Ragesh Karn
AU - Reema Rajbhandari
AU - Niraj Gautam
AU - Derya Uludüz
AU - Aynur Özge
AU - Semih Taşdelen
AU - Sarkhan Amirguliyev
AU - Tayyar Şaşmaz
AU - Rami Burstein
PY - 2026
DA - 2026/11/07
JO - Health care science
DO - 10.1002/hcs2.70114
UR - https://europepmc.org/article/MED/42999663
AB - Headache disorders impose a substantial public health burden worldwide, with low- and middle-income countries like Nepal facing pronounced challenges due to limited healthcare infrastructure, inadequate provider training, and restricted access to essential treatments. This study aimed to assess the current state of headache care in Nepal, focusing on the distribution and training of healthcare providers, access to medications, and socioeconomic factors that affect treatment adherence. A cross-sectional survey was conducted as part of a multinational joint initiative by the International Headache Society and Middle East, North Africa and Asia Headache Group. Data were collected from 232 healthcare providers across Nepal using a survey questionnaire. Descriptive and comparative analyses assessed geographic disparities, medication accessibility, and provider preparedness. Most healthcare providers were concentrated in urban centers, with 80.2% reporting some form of training in headache care. However, training gaps persisted among rural and non-specialist providers. Overall, 72.0% of healthcare providers reported that their patients had to pay to access medications, while the median provider-estimated proportion of patients unable to afford medications was 40.0% (20.0%-60.0%). Access to migraine-specific therapies, such as triptans, topiramate, and amitriptyline, was substantially lower in rural areas. Providers in urban settings reported greater medication access and specialized care, while rural providers more frequently served younger, socioeconomically disadvantaged populations with limited treatment options. This study highlights significant disparities in headache care delivery in Nepal, driven by geographic, economic, and educational barriers. Furthermore, financial and geographic barriers to effective headache treatment raise important concerns regarding health equity and patients' rights to appropriate relief from avoidable pain and disability. To bridge these gaps, national policies should prioritize structured headache training, ensure essential headache medications are included in public formularies, and deploy telemedicine-based models in underserved regions.
SN - 2771-1757
ER -