Bridging the Gap in Headache Care: Insights From the International Headache Society Survey in Nepal

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.