Migraine care in the Eastern Europe region

Background In Eastern Europe, migraine imposes a substantial yet heterogeneous burden, ranking second among neurological disorders in disability-adjusted life years (DALYs) according to Global Burden of Disease (GBD) estimates. Methods To capture context-specific challenges, we conducted a regional case study with experts from Moldova, Ukraine, Romania, and Serbia, analysing epidemiology, healthcare organization, barriers to care, access to medications, education, awareness, and advocacy. Results Despite established primary care systems and neurological expertise, migraine care relies heavily on specialists, leaving diagnostic and treatment gaps at the primary level. Access to therapies is uneven: while analgesics and triptans are broadly available, modern options (anti-CGRP monoclonal antibodies, gepants, botulinum toxin, neuromodulation) remain restricted by cost, reimbursement, or availability. Awareness is insufficient, stigma persists, and structured education in headache medicine is scarce. Advocacy initiatives exist but remain fragmented and underfunded. Conclusion Migraine in Eastern Europe is prevalent but under-recognized, with persistent barriers to timely diagnosis and effective care. Addressing these gaps requires national policies prioritizing migraine, improved education and training, broader access to evidence-based treatments, and stronger advocacy. Regional collaboration, supported by the International Headache Society, offers a pathway toward equitable and modern headache care.