Unmet needs in migraine management across Southeast and East Asia

Significant gaps and inequalities in migraine care exist across the Southeast and East Asia region, largely influenced by socioeconomic and healthcare disparities, according to the first multinational survey that explored physicians’ perspectives on access to migraine diagnosis and management across the region.

The SEALANT (South-East Asia Local Breach on Migraine Treatment) study was a cross-sectional, web-based survey conducted between November 2024 and August 2025. It included 686 physicians involved in migraine care (mean age, 39.0 years; neurologists, 79.8 percent; headache specialists, 4.5 percent; GPs, 6.3 percent) from seven countries, representing diverse demographic, economic and healthcare contexts. [J Headache Pain 2026;27:47]

The countries were categorized according to the World Bank Group’s income classification into high income countries (HIC; Singapore and Taiwan), upper-middle income countries (UMIC; Indonesia, Malaysia and Thailand), and lower-middle income countries (LMIC; Laos and the Philippines). Data were analyzed descriptively, and comparisons were made across income groups. Results were based on physicians’ perceptions of routine clinical practice rather than objectively verified patient-level data.

Inadequate resources

Overall, 70.0 percent of respondents reported an insufficient number of neurology/headache clinics. This lack was perceived by a higher proportion (87.2 percent) in LMIC and a lower proportion (51.1 percent) in HIC (p<0.001). Nevertheless, 58.3 percent of physicians indicated that their patients typically waited <1 week for an appointment. However, the consultation time for each patient was constrained, with 59.4 percent of physicians reporting that they could spend no more than 15 minutes per visit (vs recommended 45 minutes per visit in Europe). [J Headache Pain 2011;12:419-426]

The participating physicians reported that approximately 60 percent of patients were correctly diagnosed with migraine before specialist consultation, while 44.9 percent experienced diagnostic delays of >1 year possibly due to limited consultation time. More than two-thirds (69.7 percent) of physicians across countries of all income levels agreed that neurologists were responsible for establishing a migraine diagnosis.

Unmet needs in acute and preventive treatment

For acute treatment of migraine, NSAIDs were the most widely available medications across participating facilities, followed by paracetamol and tramadol (96.8, 87.8 and 76.1 percent, respectively).

Of concern, tramadol was reported to be more accessible than triptans or gepants, and the availability of opioids was highest in LMIC (90.2 percent). Opioids, which are not recommended by any major treatment guidelines, were prescribed by 76.2 percent of doctors for migraine management. Additionally, only 28.5 percent of doctors reported that their patients used migraine-specific agents such as triptans, with higher usage by physicians in HIC (56.5 percent). These findings highlight gaps between clinical practice and guideline recommendations in acute migraine therapy across the region.

The most frequently reported barriers to acute treatment of migraine were cost, insufficient efficacy and adverse effects (32.8, 27.7 and 22.5 percent, respectively), with limited efficacy being an issue of greater concern in HIC and cost, in LMIC and UMIC. “These findings further emphasize unmet needs in acute management of migraine, particularly regarding affordability, treatment effectiveness, and tolerability,” noted the authors.

For preventive therapy, tricyclic antidepressants and antiseizure medications were the most accessible (91.1 percent), followed by beta-blockers (89.9 percent). In contrast, migraine-specific preventive therapies, particularly calcitonin gene-related peptide (CGRP)–targeted treatments, were not commonly available, reported in only 53 percent of centres across the region. “These findings highlight a significant unmet need in access to migraine-specific therapies in Southeast and East Asia,” the authors noted.

Preventive medications were prescribed to 60 percent of patients, with tolerability concerns, cost and limited efficacy being the main reasons for not initiating preventive therapy. Although CGRP-targeted preventive therapies were regarded by 77.1 percent of physicians as effective, a considerable proportion (30.2 percent) felt that these treatments were not worth the cost or reimbursement. This finding is consistent across all economic groups.

Regarding medication overuse headache (MOH), only 34.7 percent of patients were reported to understand the recommended limits of older acute medi­cation use and the risk of developing MOH. Patients with higher socioeconomic status, however, seemed to have better understanding of MOH.

Addressing gaps and inequities

“Substantial and inequitable gaps persist in migraine diagnosis and management across Southeast Asia and East Asia, as perceived by physicians. These gaps are driven by shortages of specialist services, delayed diagnosis, reliance on nonspecific treatments, and restricted access to migraine-specific therapies,” summarized the authors. “Addressing migraine as a public health priority through health system strengthening, education, and equitable access to evidence-based treatments is essential to reduce migraine-related disability in the region,” they concluded.