Abstract
BackgroundIn Nepal, traditional treatment using medicinal plants is popular. Whereas medication-overuse headache is, by definition, caused by excessive use of acute headache medication, we hypothesized that medicinal plants, being pharmacologically active, were as likely a cause.MethodsWe used data from a cross-sectional, nationwide population-based study, which enquired into headache and use of medicinal plants and allopathic medications. We searched the literature for pharmacodynamic actions of the medicinal plants.ResultsOf 2100 participants, 1794 (85.4%) reported headache in the preceding year; 161 (7.7%) reported headache on ≥15 days/month, of whom 28 (17.4%) had used medicinal plants and 117 (72.7%) allopathic medication(s). Of 46 with probable medication-overuse headache, 87.0% (40/46) were using allopathic medication(s) and 13.0% (6/46) medicinal plants, a ratio of 6.7:1, higher than the overall ratio among those with headache of 4.9:1 (912/185). Of 60 plant species identified, 49 were pharmacodynamically active on the central nervous system, with various effects of likely relevance in medication-overuse headache causation. ConclusionsMPs are potentially a cause of medication-overuse headache, and not to be seen as innocent in this regard. Numbers presumptively affected in Nepal are low but not negligible. This pioneering project provides a starting point for further research to provide needed guidance on use of medicinal plants for headache.
Highlights
In Nepal, traditional treatment using medicinal plants is popular
We looked for the plants in the encyclopaedia Plants and people of Nepal [13]
We found only one randomized controlled trial (RCT) relevant to use for headache, which was of low quality
Summary
In Nepal, traditional treatment using medicinal plants is popular. Whereas medication-overuse headache is, by definition, caused by excessive use of acute headache medication, we hypothesized that medicinal plants, being pharmacologically active, were as likely a cause. In a large epidemiological study in Nepal, the prevalence of probable MOH (pMOH, defined as the association of headache on !15 days/ month with overuse of acute medication) was higher than reported in Europe [2,3]. In such countries, there is often strong reliance on alternative and complementary practitioners, and the use of plants for medicinal purposes is common [4,5]. We used data from a large population-based survey from Nepal to test the hypothesis: “Medicinal plants, being pharmacologically active, are as likely as other medications to cause MOH”.
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