article · The Journal of Headache and Pain
BACKGROUND: The Middle East and North Africa (MENA) region presents a unique demographic, cultural, and socioeconomic profile that influence migraine burden and management. Comprehensive multicenter data on patient characteristics, treatment access, and complementary and alternative medicine (CAM) use in this region are limited. The aim of this work was to compare sociodemographic and clinical characteristics of migraine patients in low-/lower-middle-income countries (LICs/LMICs) versus high-/upper-middle-income countries (HICs/UMICs) in the MENA region, and to explore disparities in medication access, treatment adherence, patient satisfaction, and CAM use. METHODS: This cross-sectional multicenter study included 676 adult migraine patients across 12 MENA countries. Data were collected via structured interviews and medical record verification, covering sociodemographic, lifestyle, clinical, and treatment-related variables, as well as knowledge, attitudes, and experiences with CAM. RESULTS: Patients from LICs/LMICs had significantly longer delays from headache onset to diagnosis compared with those from HICs/UMICs [6 (3-9) vs. 1 (0-3) years; effect size = 1.344, 95% CI: 1.175-1.511, P-value < 0.001]. Chronic migraine was significantly more prevalent in LICs/LMICs (44.3% vs. 20.8%; OR = 0.331, 95% CI: 0.236-0.463, P-value < 0.001), as was medication-overuse headache (38.5% vs. 15.0%; OR = 0.282, 95% CI: 0.195-0.406, P-value < 0.001). Access to medications was more restricted in LICs/LMICs, with 79.4% relying on out-of-pocket payments versus 42.1% in HICs/UMICs (OR = 0.210, 95% CI: 0.138-0.319, P-value < 0.001). Medication adherence was lower in LICs/LMICs (52.0% vs. 78.9%; OR = 3.458, 95% CI: 2.471-4.838, P-value < 0.001). Patient dissatisfaction with healthcare services was markedly higher in LICs/LMICs (35.5% vs. 7.9%, P-value < 0.001). Patients in LICs/LMICs reported greater reliance on traditional healers, religious leaders, and CAM modalities such as cupping, herbal remedies, and spiritual healing. CONCLUSION: This study highlights substantial disparities in migraine diagnosis and management between patients from LICs/LMICs and HICs/UMICs across the MENA region. Financial constraints and cultural influences may shape treatment adherence and CAM use in LICs/LMICs.
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DOI: 10.1186/s10194-026-02424-w
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