Medicinal Plants Used in the Treatment of Mental and Neurological Disorders in Ghana

Ethnopharmacological Relevance

Mental and neurological disorders are a serious public health challenge globally, particularly in developing countries where cultural factors and limited access to standard healthcare have led to a reliance on traditional medicines. However, ethnopharmacological characterization of traditional medicines used to treat these diseases is lacking. In this study, an ethnobotanical description of plant species used in treating mental and neurological disorders in Ghana and an update of their experimentally validated pharmacological relevance are provided.

Materials and Methods

Two hundred herbalists agreed to participate but sixty-six specialized in treating mental and neurological disorders were interviewed on their traditional medical practice. Literature review was conducted to verify the experimentally validated pharmacological importance of the reported plants.

Results

Thirty-two plant species belonging to twenty-eight families were identified. Most plant species had either analgesic (50%), anxiolytic (18.8%), or anticonvulsant (15.6%) properties. Others had reported sedative, anti-Alzheimer's disease, motor coordination, antipsychotic, antidepressant, cognitive enhancement, and neuroprotective properties. While Ageratum conyzoides L. (Asteraceae) and Ocimum gratissimum L. (Lamiaceae) were the most commonly mentioned species with analgesic properties, Lantana camara L. (Verbenaceae) was the most-reported anxiolytic product, with Cymbopogon citratus DC. (Gramineae), Mangifera indica L., Tetrapleura tetraptera Schum Taub. (Fabaceae), and Persea Americana Mill (Lauraceae) being the most studied anticonvulsants.

Conclusions

This study provides the first report specifically on medicinal plants used in treating mental and neurological disorders in Ghana. Most of the identified plants have been scientifically confirmed to possess neuro- and psychopharmacological properties and may serve as templates for drug development.

Prevalence of Migraine in a Rural Area in South Tanzania: A door-to-door Survey

We set out to assess the prevalence during the previous year of migraine in a rural area surrounding the Mnero Diocesan Hospital in Southern-Tanzania. A door-to-door survey from August until December 1999 using a questionnaire based on the criteria of the International Headache Society (IHS), including 1047 households with 3351 persons, was done, consisting of a screening dialogue with a representative family member followed by a face-to-face interview with the affected subject. Of the 3351 participants (female 1876; male 1475; age > 10 years), 23.1% had suffered from headache during the past year; overall prevalence of migraine was 5.0% (female 7.0%; male 2.6%); 1.4% reported migraine without aura (female 1.8%; male 0.9%); and 3.6% reported migraine with aura (female 5.2%, male 1.6%). The peak prevalence was found in female persons in the fourth (11.1%), in male persons in the third decade of life (3.8%). Compared with other African surveys, the prevalence rate of migraine headache in South Tanzania is slightly higher than among Ethiopian and Zimbabwean Africans.

Prevalence of primary headaches in an urban slum in Enugu South East Nigeria: a door-to-door survey

OBJECTIVE/BACKGROUND

This study aims to determine the prevalence of primary headache disorders using the second edition of international classification of headache disorders among urban slum dwellers. Headache is a common neurological disorder and one of the most common reasons for visiting the neurology clinics in Nigeria. Low socioeconomic status has been linked with primary headaches. Factors that may precipitate and sustain headaches are common in Africa especially in urban slums. There are limited population based data on the prevalence of headache from Nigeria and other African countries.

METHODS

A 3 phase cross-sectional descriptive study was done to survey at least 40% of the adult population (Igbos) living in an urban slum using the International Classification of Headache Disorders 2nd Edition (ICHD-I) criteria using a validated Igbo language adaptation (translation and back-translation into Igbo language) of a World Health Organization protocol for screening neurological disorders in the community.

RESULTS

The lifetime prevalence of headache of any type was 66.7% (95% confidence interval [CI] 64.2-69.2), significantly higher in females (70.2% [95% CI 67.0-73.4]) than in males (62.3% [95% CI 58.5-66.1]; P = .0.002). The prevalence of primary headaches was also significantly lower in males than in females (44.9% [95% CI 45.5-53.3] vs 53.2% (95% CI 49.3-57.1), P = .002). Female (52.1%) drinkers had a statistically higher prevalence of primary headaches than male drinkers (43.6%; P = .004). The prevalence of migraine was 6.4% (95% CI 5.1-7.7); 7.5% (95% CI 5.6-9.4) in females and 5% (95% CI 3.3-6.7) in males (P = .058). Migraine with aura was similar in both males and females. Migraine without aura was significantly higher in females (5.7%) than males (3.1%) (P = .022). Tension-type headache (TTH) had an overall prevalence of 13.8% (95% CI 11.3-16.3), males 12.2% (95% CI 9.7-14.7), and females 15.1% (95% CI 12.6-17.6; P = .118.) The peak decade for all primary headaches was 20-29 years for males (49.8%) and 60-69 years for females (57.5%).

CONCLUSION

Headache is a common health problem in an urban slum in Enugu south east Nigeria where 66.7% of participants had experienced headache in their lifetime, and 49.4% had experienced primary headaches. The prevalence of migraine and TTH were 6.4% (5% in males and 7.5% in females) and 13.8% (12.2% in males and 15.1% in females), respectively. The peak ages of migraine and tension-type headache were 30-39 and 60-69 years, respectively. The prevalence of primary headaches was significantly higher among subjects who used alcohol significantly.

Epidemiology of headache

Epidemiological studies conducted in the general population point to average headache prevalence rates of 46% for 1-year prevalence and of 64% for lifetime prevalence. For migraine, most studies conducted in the adult general population of western Europe and North America indicate rates between 5% and 9% in men, and between 12% and 25% in women. Non-western countries report lower figures. Migraine shows no gender differences in children, while in the elderly its frequency appears much reduced in both genders. About one-third of migraineurs suffer from migraine with aura. For tension-type headache, prevalence data reports in the literature are few and conflicting: rates range from 11% in Singapore to 20-40% in the USA and over 80% in Denmark. It is worth noting that the highest figures are found in studies where a personal interview has been employed. This probably indicates that the prevalence of this headache subtype is particularly sensitive to the method of data collection. Cluster headache occurs in 1-3 per thousand of the general population, with a gender (M:F) ratio of about 3:1. About 4% of the adult general population suffers from chronic daily headache.

Prevalence of migraine headache in a rural area of northern Tanzania: A community-based door-to-door survey

Our aim was to assess the 1-year prevalence of migraine headache in a rural population within the catchment area of the Haydom Lutheran Hospital in northern Tanzania. From December 2003 until June 2004 a community-based door-to-door survey was carried out, using a questionnaire based on the criteria of the International Headache Society, including 1192 households with 7412 individuals selected by multistage cluster-random sampling. The overall 1-year prevalence of migraine headache was found to be 4.3% [316/7412, 95% confidence interval (CI) 3.8, 4.7] with an age-adjusted rate of 6.0% and a male : female ratio of 1:2.94 ( P < 0.001). Of these individuals, 132 did not fulfil all criteria for migraine headache, hence, these patients had to be classified as migrainous disorders with a crude prevalence rate of 1.8% (132/7412. 95% CI 1.5, 2.1). The remaining 184 patients met all criteria for migraine resulting in a 1-year prevalence of 2.5% (184/7412, 95% CI 2.1, 2.9) and a male : female ratio of 1:2.51 ( P < 0.001). The present survey shows that migraine headache is not uncommon in northern Tanzania. The recorded prevalence of migraine headache is located within the median of previous African prevalence surveys, which confirms the trend of lower migraine frequencies in rural Africa compared with western countries.

The global burden of headache: a documentation of headache prevalence and disability worldwide

This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.

Epidemiological and clinical characteristics of migraine in Sivas, Turkey

OBJECTIVE

To investigate the epidemiology of migraine in Sivas, Turkey, including its prevalence, clinical characteristics, and impact according to age, sex, and socioeconomic status.

METHODS

Thirteen hundred twenty subjects were personally interviewed by a neurologist. Each household member with headache was asked questions regarding their headaches including age at onset, frequency, duration, character, location, severity, aggravating and ameliorating factors, and prodromal and associated symptoms. Migraine diagnoses were determined in accordance with the classification criteria of the International Headache Society.

RESULTS

Migraine was identified in 173 subjects (45 males and 128 females), and lifetime prevalence of migraine was 7.9% (95% CI, 5.66 to 10.1) in males and 17.1% (95% CI, 14 to 20) in females. Aura was reported by 1.4% of males and 3.3% of females.

CONCLUSION

Migraine prevalence in Turkey is similar to that reported in Europe and the United States.

Headache epidemiology. Emphasis on migraine

Through the use of IHS criteria, large population-based epidemiologic studies in Denmark, the United States, France, Canada, and elsewhere have shed light on the descriptive epidemiology of migraine. Although migraine is a remarkably common cause of temporary disability, many migraineurs, even those with disabling headache, have never consulted a physician for the problem. Prevalence is highest in women, in persons between the ages of 25 and 55, and, at least in the United States, in individuals from low income households. Nonetheless, it occurs with high prevalence outside these groups at highest risk. The prevalence of migraine may be increasing in the United States, but this is uncertain. Longitudinal studies are required to better determine the incidence and natural history of migraine, as well as the life course of comorbid conditions.

Migraine, chronic tension-type headache, and cluster headache in an Ethiopian rural community

Fifteen-thousand-five-hundred adults (> or = 20 years) in a rural district in Ethiopia with a population of 250,000 were studied for chronic headache. Door-to-door survey was performed by trained lay health workers using a questionnaire with a high degree or reliability and validity. The 1-year prevalence of migraine headache was 3.0% (4.2% for females and 1.7% for males) with the peak age specific rate in the fourth decade. Migraine headache was about three times more common in females than in males at any decade. Two-thirds of migraine sufferers had rather frequent attacks. The most frequent trigger factors were emotional stress (90%), changes of weather (78%), physical exhaustion (75%), and smell (70%). Migraine with aura was rare. Family occurrence of migraine in first-degree relatives was 30%. The 1-year prevalence of chronic tension-type headache was 1.7%, while cluster headache was found to be extremely rare. Compared to similarly performed surveys, the prevalence of migraine among rural Ethiopians was less than among Nigerian Africans.

Epidemiology of headache

This thesis is based on nine previously published papers. It represents the first prevalence study of specific headache entities in a representative general population, where the diagnoses are based on a structural interview and examination by a physician using internationally accepted operational diagnostic criteria. The study population was a random sample of 1000 men and women aged 25-64. The participation rate was 76%. The prevalences of the different forms of headache are assessed and the study provides descriptive data concerning symptomatology, precipitating factors, impact of female hormones, use of medical services and work consequences of the headache disorders and describes various factors associated with the disorders. Only half of migraineurs and one-sixth of subjects with tension-type headache consulted their general practitioner because of headache and even less consulted a specialist. These consultation rates reflect the selection of cases that may bias studies in clinic populations. The study supports the notion that migraine and tension-type headache are separate clinical entities and that migraine without aura and migraine with aura are distinct subforms of migraine. Migraine and tension-type headache are sex- and age-dependent disorders with female preponderance and lower prevalence in older age groups. The female preponderance may be explained by clinical factors related to female hormones. There is no clear evidence of any association between sociodemographic variables and migraine or tension-type headache. Tension-type headache is related to a series of psychosocial variables while migraine is not. The results suggest that migraine is primarily a constitutional disorder and tension-type headache a more complex phenomenon influenced by several psychosocial factors. The limitations of cross-sectional data in pointing out risk factors with sufficient certainty are stressed. Longitudinal follow-up studies are the most important challenge in future epidemiological headache research.

Population variation in migraine prevalence: a meta-analysis

A meta-analysis of published studies was conducted to identify factors which explained variation in estimates of migraine prevalence. Twenty-four population based studies contributed a total of 168 gender and age specific estimates of migraine prevalence. In linear regression analysis, 70.6% of the variation in these prevalence estimates was explained by gender, age (AGE+AGE2), a binary variable for case definition, and an interaction term between age and the case definition. Initially, we identified five groups of case definitions among the 24 studies. Only the definition of Waters (any 2 of warning, nausea, or unilateral pain) was associated with statistically significant differences in prevalence estimates among studies; accordingly the other 4 groups were combined. Several other factors were examined as predictors of migraine prevalence including the method of selecting the study population, the source of the population, the response rate and whether diagnoses were confirmed by a clinical assessment. None of these factors substantially increased explained variance. We conclude that after taking sociodemographic factors and case definition into account, estimates of migraine prevalence are remarkably stable among studies.

Migraine, polycythemia and chronic mountain sickness

In the epidemiological study among 379 adult men with permanent residence at 4300 meters (14,200 feet), we found 32.2% with migraine (mostly migraine with aura), 15.2% with tension-type headache (episodic more than chronic), and 7.2% with other headaches. The frequency of migraine increased with age from 30.1% in the 20-29 year age group to 36.8% in the 50-59 year group. Episodic tension-type headaches also showed this trend. We found an age-specific increase in the frequency of high hemoglobin (Hb > 213 milligrams), low oxygen saturation (O2 saturation < 81.5%) and high chronic mountain sickness scores. Male migraineurs and those with more than two headaches per month had the highest hemoglobin levels and chronic mountain sickness scores when compared with high altitude men without headaches.

[Prevalence of headache as an symptom in a urban area of Salvador, Bahia]

The prevalence of headache was studied as part of an epidemiologic survey of neuropsychiatric disorders carried out with an adult sample (N = 1,511) of an urban area of Salvador City, Bahia, Brazil. The overall prevalence of headache complaints was 14.8%, significantly higher among the eldest, female, less educated, migrants, unemployed, low SES and married/divorced. Stratified analysis for age and gender as confounders erased out the effect of marital status and socio-economic status indicators. The presence of psychiatric disorders was strongly, significantly associated with the prevalence of headache (odds ratio of 4.2). These results are compared to the international literature, emphasizing the extremely lower rates found as well as the profiles of risk factors completely distinct from those reported in other sociocultural realities.

Neurological disorders in Nigerian Africans: a community-based study

In a Nigerian town with a stable population of 20,000, a door-to-door survey was conducted, using a questionnaire involving a complete census and a simple neurological evaluation which had previously showed a 95% sensitivity and an 80% specificity for detecting neurological disease. Positive responders were evaluated and categorised, using agreed criteria for diagnoses. Nearly 100% cooperation was obtained. Life prevalence ratio for at least one episode of headache was 51/1000. Crude point prevalence ratio for migrainous headache was 5.3/100, and peak age-specific ratio was in the first decade. Prevalence ratio for epilepsy was 533/100,000 and peak age-specific prevalence ratio occurred in the 5-14 years age groups. The prevalence ratio for peripheral nerve disorders was 268/100,000, and age-specific prevalence ratio for tropical neuropathy increased with age. Prevalence ratio for stroke was rather low at 58/100,000, but was probably due to the people's attitude to the disabled elderly and high mortality of stroke which showed annual mortality rate of 70/100,000 which increased with age to 1519/100,000 per year in the eighth decade. Crude prevalence ratios (cases per 100,000) for others are 112 for neurological complications (including sciatica) of spondylosis, 15 each for poliomyelitis, motor neurone disease, development speech disorders, 10 each for syncope, hereditary neuropathies. Parkinson's disease, benign essential tremor, primary cerebellar degeneration, cerebral palsy, mental retardation, organic psychosis (probable intracranial tumor) and 5 each for muscular dystrophy, pyomyositis, spina bifida occulta, alcohol dependence and cerebral malaria. The implications of the findings are important for development of community neurological services in the developing countries.