Burden of headache in Africa

Abstract

The literature on the prevalence and health burden of headache in Africa is scanty. In addition to the limited published materials one has to rely on the personal experience of prominent neurologists to get a broad picture of the magnitude of the problem on the continent. This review focuses on sub-Saharan Africa for the simple reason that the countries south of the Sahara have more or less similar sociodemographic characteristics which provides possibilities to make comparisons and some guarded conclusions.In as far as the global picture of headache is considered, there are similarities and differences between the situation in the North (i.e. Europe and North America) and the tropical South. Headache in Africa is common, although less frequent than in the North. It exhibits similar clinical manifestations. However, sub-Saharan Africa has its own particularities. Because of the low life expectancy in African countries, in prevalence studies one deals with relatively young populations. Environmentally, there is the role of the tropical hot climate and the high prevalence of infectious diseases. It is our observable experience that in the African culture pain is tolerated more than in the West. On top of this, diseases are perceived in the magico-religious context where traditional healing plays a big role. Socioeconomically, low incomes, poor infrastructures and inadequate healthcare coverage make the disease burden of headache different from that in the rich and developed North.

The global burden of migraine: measuring disability in headache disorders with WHO's Classification of Functioning, Disability and Health (ICF)

“…Epidemiological surveys in Nigeria, Ethiopia, Tanzania and Zimbabwe produced prevalences of 3%-6.9% among adults, with all studies reporting a female preponderance (male to female ratios of 1:1.3 to 1:2.8). Tekle Haimanot considered migraine with aura to be relatively rare in Africans [37]. In Asia, whilst studies in Hong Kong, Malaysia and Japan recorded lower prevalences [38][39][40], more recent studies [41] in Turkey [42,43], Oman [44], Saudi Arabia [45] and Iran [46] have found higher prevalences than those included in the meta-analysis, more in line with Western estimates.…”

“…As in developed countries, migraine and chronic tension-type headache are the most common subtypes of headache disorders in South America [32][33][34][35][36]. Tekle Haimanot reported that "literature on prevalence and health burden in Africa is scanty" [37]. Because of the lower life expectancy in African countries, disease prevalence is studied in relatively young populations.…”

Headaches among residents within the Selebi Phikwe Nickel-Copper mining environment, Botswana

“…The emissions of SO 2 , CO, CO 2 , and other gases from concentrator and smelter plants affect people. Hot climate and regular exposure to sunlight are triggering factors of headaches [28], and these are prevalent at Selebi Phikwe. Frequent and persistent headaches have been diagnosed as precursors of meningitis, malaria and stroke.…”

The Global Campaign (GC) to Reduce the Burden of Headache Worldwide. The International Team for Specialist Education (ITSE)

“…In developing countries we observe different barriers to reaching an equitable headache control: these may be ascribed to patients, or to physicians or may have a regional origin [6,7]. The principal patient-related barriers are: delay in seeking treatment and low compliance level, both to some extent coupled with poor understanding of the medical nature of headache disorders.…”

“…Regional barriers are: inadequacies of the health-care system, poor literacy and income, overpopulation, and adverse political priorities [6]. As a result, and encouraged by their misperceptions of headache disorders, people affected by them in lowincome cultures rely overly upon traditional and complementary therapies [7].…”