The challenge of migraine in South Africa: Complex, misunderstood— and surmountable is an Economist Impact report, supported by Eli Lilly. This report aims to assess the impact of migraine in the social, economic and health-system context of South Africa.
Often regarded as simply a bad headache, migraine is in fact a recurrent, often life-long, condition with a range of symptoms. It is also the second-leading cause of disability worldwide. Around one in ten people are affected by migraine, with a higher prevalence among women by a factor of about 2:1. In addition, the impact of migraine has increased in recent years.
Lacking a diagnostic scan or blood test, detection of migraine is often reliant on primary-care providers who lack training in diagnosing neurovascular conditions. As such, migraine is often under or misdiagnosed and under- or mistreated. The impacts on sufferers’ family, work and social life are significant, as are the broader socioeconomic impacts, especially in terms of productivity losses.
Migraine is a difficult condition to manage—even countries with well-equipped, equitable health systems struggle to do so effectively. In South Africa, universal challenges are bolstered by an under-funded, inconsistently resourced health system that is reluctant to fund the most effective migraine treatments, as well as a broader lack of knowledge around migraine. Yet the worst impacts—if approached in an appropriate way, from the individual to the health system and socioeconomic level—are preventable, and the burden manageable.
Review affordability and use of treatments: There is a concern by decision-makers that spending will spiral if more people are treated for migraine and more migraine treatments are made available. This misunderstands the complex nature of migraine— and the fact that most people will not require expensive drugs or specialist treatment. People suffering from migraine should be encouraged to seek support from a specialist, as the appropriate treatment can significantly improve quality of life.
Elevate the importance of lifestyle-based prevention: Lifestyle-related approaches to prevention can reduce the likelihood and impact of migraine attacks and limit the chances of episodic migraine becoming chronic. Given the strong links between migraine and stress, stress management, biofeedback and mindfulness-linked CBT offer a way to head off the worst impacts of migraine.
Improve education among healthcare workers and the wider public: The keystone that will enable people, health workers, health decision-makers and employers to overcome the burden of migraine is education. A large part of education efforts should be focused on the health sector. Primary care providers must be better supported to recognise migraine and take appropriate approaches to treatment. Outside of health services, greater awareness must be created about the complex characteristics of migraine, the impacts on people’s lives, and the benefits that can be gained by individuals and society as a whole if it is understood and managed correctly.
