Migraine care in India and Sri Lanka: Current practice standards and the road ahead

Migraine is a leading cause of disability in India and Sri Lanka but remains underdiagnosed and undertreated. Both countries, with their differing healthcare systems, provide an important regional perspective on migraine care. We utilized a combination of structured search as well as relevant literature screening to identify studies and practice standards on migraine care in India and Sri Lanka, from year 2000 to July 2025 with emphasis on large clinical studies, multicentric studies, and randomized controlled trials following PRISMA guidelines. India's care delivery of migraine is via a large network of public and private sector hospitals, with three strata of physicians working at primary, secondary and tertiary care centres, and primary physicians are the first point of contact for patients. Additionally, private practitioners see sizeable proportion of patients with free referral to public sector at all levels. Subsidized medications are available all over the country with options for private medical insurance as well as government medical insurance for selected cases. Sri Lanka on the other hand has universal healthcare system that provides free, publicly funded care to all citizens, financed through general taxation, complemented by a growing private sector. While a larger number of medications are available in India, newer therapies are challenged with high costs and lack of insurance coverage for many. Newer medications are currently not available in Sri Lanka. Similarly, headache research is widespread in India but suffers from the lack of institute support whereas it is in a nascent stage in Sri Lanka. India and Sri Lanka present striking differences in care of migraine and research opportunities. While therapeutic advances and research have progressed in India, universal health coverage is a challenge. Sri Lanka needs to incentivise research while bringing in newer antimigraine therapies to optimize patient outcomes.