{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:37:33Z","timestamp":1782970653698,"version":"3.54.5"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Headache disorders are a leading cause of disability worldwide, yet service delivery in low- and middle-income countries (LMICs) like Egypt remains understudied. This study aimed to assess the national landscape of headache care in Egypt, focusing on provider training, treatment access, medication availability, and systemic disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study is part of a larger multinational initiative conducted under the auspices of the International Headache Society (IHS). The study included 321 Egyptian neurologists. The data collection process was carried out through both electronic surveys and in-person interviews. The surveys included questions covering the following items: profile of headache patients, characteristics of healthcare services available for headache patients, headache medication choices and affordability, and perceived barriers to proper headache management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Based on the neurologists\u2019 perspective, the primary headaches accounted for 85% (65\u201390%) of all headache cases, whereas secondary headaches accounted for 10% (5\u201320%) of headache cases. About 91.9% of the neurologists reported that anxiety was the most common comorbidity with headache, followed by depression (81.9%). Approximately 80.1% (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f257) of patients had to pay to access medicine, and the estimated percentage of patients who could afford medication was 60 (40\u201370). The average number of headache patients assessed by each specialist per week was estimated to be 25 (10\u201350) patients. About 89.7% (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f288) of the participants reported receiving formal training on the diagnosis and treatment of migraine. Seeking medical advice from non-specialized physicians was reported by 82.9% of the included participants to be one of the commonest causes for the delayed diagnosis of headache. Most participants (76.6%) reported that financial constraints may be a contributing factor to non-compliance with medications in patients with headaches.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identifies urgent gaps in the equity, affordability, and structure of headache care in Egypt. Policy action is needed to implement structured headache services, expand provider training, and improve access to essential and newly developed medications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1860601","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:24:59Z","timestamp":1782966299000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Headache service quality in Egypt: current status, identified gaps, and strategic directions"],"prefix":"10.3389","volume":"17","author":[{"given":"Amr","family":"Hassan","sequence":"first","affiliation":[{"name":"Department of Neurology, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beni-Suef University","place":["Beni-Suef, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehab","family":"Magdy","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derya","family":"Ulud\u00fcz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical Faculty, Istanbul Atlas University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aynur","family":"\u00d6zge","sequence":"additional","affiliation":[{"name":"Headache Clinic","place":["Mersin, T\u00fcrkiye"]},{"name":"NOROM Neuroscience and Excellence Center","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Semih","family":"Ta\u015fdelen","sequence":"additional","affiliation":[{"name":"Department of Neurology, \u0130stanbul Faculty of Medicine, \u0130stanbul University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarkhan","family":"Amirguliyev","sequence":"additional","affiliation":[{"name":"Azerbaijan State Institute of Advanced Training of Doctors Named After Aziz Aliyev","place":["Baku, Azerbaijan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayyar","family":"\u015ea\u015fmaz","sequence":"additional","affiliation":[{"name":"School of Medicine, Mersin University","place":["Mersin, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Osama","family":"Abdulghani","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ain Shams University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramez Reda","family":"Moustafa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ain Shams University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Essmat","sequence":"additional","affiliation":[{"name":"Department of Neurology, Al Azhar University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Yacoub","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Abdelghaffar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fayoum University","place":["Fayoum, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nourhan Abdelmohsen","family":"Taha","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ain Shams University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas","family":"Elgenidi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahla","family":"Merghany","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cairo University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherien Mohamed","family":"Farag","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ain Shams University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May M.","family":"Fayez","sequence":"additional","affiliation":[{"name":"Department of Neurology, El Mounira Hospital, Ministry of Health","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doaa Mahmoud","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Beni-Suef University","place":["Beni-Suef, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Burstein","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine, Deaconess Medical Center","place":["Boston, MA, United States"]},{"name":"Department of Anesthesia, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1016\/S0140-6736(20)32160-7","article-title":"Migraine: epidemiology and systems of 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Rationale and description","volume":"22","author":"Steiner","year":"2021","journal-title":"J Headache Pain"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1186\/s10194-025-02016-0","article-title":"Burden of migraine among Egyptian people: prevalence and comorbidities","volume":"26","author":"Samir","year":"2025","journal-title":"J Headache Pain"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e000851","DOI":"10.1136\/bmjno-2024-000851","article-title":"Prevalence and characteristics of headache among medical students in Egypt: a multicentric cross-sectional study","volume":"6","author":"Mohamed","year":"2024","journal-title":"BMJ Neurol Open"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s10194-015-0569-6","article-title":"Prevalence of primary headache disorders in Fayoum governorate, Egypt","volume":"16","author":"El-Sherbiny","year":"2015","journal-title":"J Headache 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headache","volume":"57","author":"AbdElkader","year":"2021","journal-title":"Egypt J Neurol Psychiatry Neurosurg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1186\/s12889-024-17913-3","article-title":"Unravelling the dilemma of self-medication in Egypt: a cross-sectional survey on knowledge, attitude, and practice of the general Egyptian population","volume":"24","author":"Ali","year":"2024","journal-title":"BMC Public Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"581373","DOI":"10.3389\/fpubh.2020.581373","article-title":"Prevalence of Workaholism among Egyptian healthcare workers with assessment of its relation to quality of life, mental health and burnout","volume":"8","author":"Kasemy","year":"2020","journal-title":"Front Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/s10194-016-0707-9","article-title":"Headache service quality: evaluation of quality indicators in 14 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