Preprint / Version 1

Use of medicinal plants for headache, and their potential implication in medication-overuse headache: Evidence from a population-based study in Nepal

Authors

  • Elise Sørnes Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
  • Ajay Risal Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
  • Kedar Manandhar Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
  • Hallie Thomas Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
  • Timothy Steiner Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
  • Mattias Linde Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway

Keywords:

Herbal medications, pharmacodynamic activity, overuse, South-East Asia region, Global Campaign against Headache

Abstract

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. Methods We 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. Results Of 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. Conclusions MPs 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. Keywords: Herbal medications, pharmacodynamic activity, overuse, South-East Asia region, Global Campaign against Headache

Author Biographies

Ajay Risal, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal

Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal

Kedar Manandhar, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal

Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal

Timothy Steiner, Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway

Division of Brain Sciences, Imperial College London, London, UK

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