Editorial for ‘migraine care around the world’ topical collection for Cephalalgia Reports

Migraine is a lifelong neurological disorder that is estimated to affect over 1 billion people worldwide, and represents a leading cause of disability common to otherwise diverse geographical areas, cultural groups and socioeconomic conditions. ¹ Migraine alone accounts for 5.6% of the global disease burden, surpassing the combined impact of all other neurological disorders. ² Further, migraine disproportionately affects younger adults, and in particular women, representing the leading cause of disability in this demographic worldwide. ³ The impact of migraine is also determined by the huge economic losses it causes on health systems, with yearly costs estimates of around €50 billion for Europe alone. ⁴ Less is known about the economic impact across regions of the world.

Despite its enormous impact, migraine as a public health priority is highly variable and remains often underdiagnosed and undertreated. ⁵ While high-income countries are experiencing an unprecedented shift in treatment paradigms with the introduction of novel medications targeting disease-specific pathways, low- and middle-income economies often face a lack of resources needed to tackle the issue. ⁶ This disparity exacerbates the gap in access to care, contributing to significant health inequities across different regions of the world. ⁷

One key factor contributing to this disparity also lies in the lack of consistency in migraine management. The International Headache Society has recently addressed this issue by creating the global recommendations for the pharmacological treatment of migraine, meant to standardize practices and offer treatment alternatives even in regions with significantly limited resources.^8,9

Another important step in advancing migraine care across countries is to better understand and account for country-specific needs. By assessing regional policies and access to treatment for migraine, we can compare the effectiveness of different healthcare models and more accurately identify the barriers impeding adequate access to migraine care.

In light of this, Cephalalgia Reports will be launching a topical collection, part of the recently introduced ‘Global & Community Health’ series in which we will welcome papers exploring the unique aspects of migraine care across various regions of the world, including and not limited to: Latin America, the Indian subcontinent, Central Asia, Eastern Europe, the Middle East and North Africa, and sub-Saharan Africa. This collection will provide a platform to highlight diverse approaches, socioeconomic and healthcare challenges and innovations, while addressing regional differences in the burden of migraine, as well as disparities in knowledge, diagnosis, and management.

The articles will examine the local burden and epidemiology of migraine, offering detailed insights into how healthcare services for migraine are structured and managed in different regions. They will describe the key providers of headache care, the main barriers that are faced – including disparities, health inequities, cultural or societal perceptions and underserved populations – and the availability of different migraine treatments. Further, the collection will address the implementation of evidence-based management practices, pharmacological and non-pharmacological approaches, differing access to treatment, and reimbursement strategies. Finally, the papers will also delve into migraine training practices, including the level of education on migraine received in medical schools, and highlight any advocacy efforts and public awareness campaigns aimed at implementing positive change.

We believe that through this collection, we will collectively gain insights into best practices and lessons learned to reduce inequities. By enhancing the global understanding of migraine care, its strengths, as well as its shortcomings, we hope to elevate the voices and expertise from underrepresented countries, ultimately improving migraine care around the world.