Identifying Barriers to Migraine Care for Female Over‑The‑Counter Users in Pakistan's Corporate Sector

Abstract

Objective: This study aimed to identify the barriers to formal migraine care for female over-the-counter (OTC) analgesic users working in Pakistan’s corporate sector, and to explore the association between these barriers and medication-overuse headache.

Methods: A cross-sectional questionnaire-based study was conducted from April to August 2025 in two neurology clinics in Skardu and Lahore. Data on demographics, migraine characteristics, OTC use patterns, and barriers to care were collected. Descriptive and inferential statistics were employed to analyze the relationship between the dependent and independent variables. Multivariable logistic regression was used to identify predictors of MOH.

Results: a total of 321 patients participated in the study with 100% response rate. The prevalence of MOH was 25.9%. Heavy OTC use (≥10 days/month) was the strongest predictor of MOH (AOR= 4.28, 95% CI: 1.07–17.16, p = 0.040). Financial barriers were also independently associated with MOH (AOR = 1.24 per unit increase, 95% CI: 1.03–1.50, p = 0.024). The primary reason for delaying medical consultation was workplace inflexibility (49.2%), followed by internalized stigma (29.9%); financial cost was cited by only 11.5%. Financial barrier scores were significantly higher among participants with the lowest monthly income (<36,000 PKR) compared to the highest (>50,000 PKR) (p<0.001).

Conclusion: Among female corporate employees in Pakistan, reliance on OTC analgesics is high and driven predominantly by workplace inflexibility and stigma, leading to a significant risk of MOH. Targeted interventions, including workplace policy reforms and awareness campaigns, are urgently needed to mitigate these barriers and improve migraine care.