1. Introduction: The Growing Burden of Stroke in Nigeria

Stroke, a neurological condition characterized by focal or global neurological deficits of vascular origin lasting more than 24 hours, has emerged as a significant public health challenge in Nigeria. The condition occurs when blood vessels in the brain rupture (haemorrhagic stroke) or when a blockage prevents oxygen-rich blood from reaching the brain (ischemic stroke), leading to potentially devastating consequences.

The epidemiological landscape of stroke in Nigeria is concerning. The pooled crude incidence and prevalence of stroke in Nigeria were estimated at 26.0 per 100,000 person-years and 6.7 per 1,000 population, respectively, with incidence and prevalence higher among men than women. These figures, while significant, likely underestimate the true burden due to limited reliable epidemiological data and the fact that most statistics are derived from hospital-based studies that capture only a fraction of cases.

Stroke is now one of the leading causes of long-term disability worldwide. While advances in prevention and acute treatment have reduced mortality rates, the number of stroke survivors living with disabilities has increased, creating substantial burdens on patients, families, and healthcare systems. In Nigeria, the challenges are compounded by limited healthcare resources, inadequate rehabilitation infrastructure, and the high cost of conventional care, which drives many families toward traditional and complementary approaches.

The widespread reliance on traditional medicine for stroke management reflects both the deep-rooted cultural heritage of Nigerian peoples and the practical realities facing families living with this condition. This review synthesizes available literature on Nigerian medicinal plants utilized for stroke management, their modes of administration, scientific evidence supporting their use, and the broader context of holistic and rehabilitative approaches to stroke care.

2. Nigerian Herbal Remedies for Stroke: Scientific Evidence

2.1 Ethnobotanical Surveys: Documenting Traditional Knowledge

Several ethnobotanical surveys have documented the rich diversity of Nigerian plants used for stroke and related cardiovascular conditions.

Ekiti State Survey

A comprehensive survey in Ekiti State identified 28 botanicals belonging to 23 families used in the treatment of body pains, stroke, and rheumatism, with 4 species found to be rare on the abundance scale. The indigenous knowledge documented in this study provides a foundation for conservation strategies and further scientific investigation.

Benin People of Southern Nigeria

A survey of 14 key informants, including professional herbalists, traditional healers, and herbal remedy sellers, documented 17 medicinal plants belonging to 14 plant families used for the management and treatment of cardiovascular diseases (CDVDs), including stroke. The documented plants included:

Plant	Common Name	Plant Family
Theobroma cacao	Cocoa	Malvaceae
Aloe barbadensis	Aloe vera	Asphodelaceae
Momordica charantia	Bitter melon	Cucurbitaceae
Laurus nobilis	Bay laurel	Lauraceae
Morinda citrifolia	Noni	Rubiaceae
Carica papaya	Pawpaw	Caricaceae
Allium cepa	Onion	Amarylidaceae
Ficus exasperata	Sandpaper leaf	Moraceae
Elaeis guineensis	Oil palm	Arecaceae
Olea europaea	Olive	Oleaceae
Persea americana	Avocado	Lauraceae
Moringa oleifera	Moringa	Moringaceae
Beta vulgaris	Beetroot	Amaranthaceae
Allium sativum	Garlic	Amarylidaceae
Hunteria umbellata	–	Apocynaceae
Zingiber officinale	Ginger	Zingiberaceae
Curcuma species	Turmeric	Zingiberaceae

The dominant plant families were Lauraceae, Amarylidaceae, and Zingiberaceae with two representatives each. The plants were mostly collected from home gardens, markets, and local forests, with remedies primarily taken to address hypertension and high blood pressure—major risk factors for stroke—and also used to manage stroke itself and CDVD-related chest pains.

Ethiope West and Sapele LGAs, Delta State

Documentation of medicinal plants used by the Urhobo people of Ethiope West and Sapele local government areas identified 51 plant species belonging to 31 families used for the treatment and management of diseases including stroke, diabetes, hypertension, malaria, and others. The study emphasized the need to conserve these medicinal plants and conduct further scientific studies to ascertain the veracity of therapeutic claims.

2.2 Plants with Scientifically Validated Neuroprotective Effects

2.2.1 Carica papaya (Pawpaw)

Carica papaya leaf extract has been scientifically evaluated for its neuroprotective potential. A study investigating the protective effect of Carica papaya leaf aqueous extract (CPAE) and vitamin E on induced ischaemic-reperfusion injury in rats found significant neuroprotective effects.

Key Findings:

Parameter	BCCAO Group	BCCAO + CPAE (500 mg/kg)
Lipid peroxidation	Significant elevation (p<0.05)	Reduced
Glutathione levels	Reduced	Improved
SOD and catalase activities	Increased (compensatory)	Normalized
Behavioural response	Significantly impaired (reduced lines crossed, rearing, forelimb grip; increased negative geotaxis duration)	Improved
Histological changes	Scattered pyknotic neurons in cerebral cortex and CA1 subfield of hippocampus	Preserved neuronal architecture

The study concluded that pretreatment with CPAE and vitamin E improved oxidative, behavioural, and histological alterations caused by acute ischaemia/reperfusion injury, supporting a protective role for CPAE in stroke. These findings contribute to the continuous search for neuroprotective strategies in stroke management.

2.2.2 Khaya senegalensis (African Mahogany)

Khaya senegalensis bark extract has demonstrated significant anti-inflammatory effects relevant to ischemic stroke management. A study evaluating the anti-inflammatory effects of Khaya senegalensis (KS) bark and Tinospora cordifolia (TC) leaf extracts on striatal ischemic injury in rats found remarkable therapeutic potential.

Key Findings:

Parameter	AMT-Only Group	AMT + KS (200-400 mg/kg)	Statistical Significance
TNF-α levels	708.9 ± 28.058	Reduced to 328.5 ± 5.24 (COM 400mg/kg)	p<0.05
Striatal cell cytoarchitecture	Neurodegenerative changes, cellular hypertrophy, perivascular edema, reactive astrocyte proliferation	Preserved; remarkable improvement	Significant
Inflammatory response	Severe	Markedly attenuated	Significant

The combination of Khaya senegalensis and Tinospora cordifolia at 400 mg/kg showed the most significant protection, leading researchers to conclude that “COM KS+TC possesses anti-inflammatory properties, which could be of potential benefit in the treatment and management of ischemic stroke”.

The anti-inflammatory and free radical scavenging properties of Khaya senegalensis are attributed to its rich polyphenol content, including flavonoids, lignans, and phenolic acids, which have demonstrated chemo-preventive properties against neurodegenerative and cardiovascular disorders.

2.2.3 Ficus platyphylla

Ficus platyphylla stem bark extract, used in Nigerian traditional medicine to manage psychoses, depression, epilepsy, pain, and inflammation, has been investigated for its neuroprotective potential in stroke.

Key Findings:

Parameter	Result
Hypothermic effect	Both doses decreased body core temperature for at least 8 hours
Infarct volume reduction (pre-ischemia administration)	Significant reduction (p<0.05)
Infarct volume reduction (post-ischemia administration)	No significant effect
Neuron preservation	Higher numbers of cells and neurons in peri-infarct area in both pre- and post-treatment groups
Synaptophysin protection	Protected from reduction in peri-infarct region

The researchers concluded that Ficus platyphylla-induced hypothermia attenuates MCAO-induced damage to the brain in mice. The induction of hypothermia is a critical point in stroke management, and pharmacological compounds that reduce the brain’s thermoregulatory “set-point” offer safer and more efficient alternatives compared with endovascular or surface cooling methods.

2.2.4 Antiaris africana

Antiaris africana leaf extract, traditionally used for the management of brain-related problems, has demonstrated significant neuroprotective potential in scientific evaluation.

Key Findings:

A study evaluating the effect of 14 days of pretreatment with Antiaris africana methanol leaf extract (MEA) on bilateral common carotid artery occlusion/reperfusion (BCCAO/R)-mediated alterations found:

• Oxidative stress markers: Significant mitigation of changes in malondialdehyde, reduced glutathione, xanthine oxidase, superoxide dismutase, catalase, and glutathione peroxidase
• Neurochemical disturbances: Improved myeloperoxidase, glutamine synthetase, Na⁺/K⁺ ATPase, acetylcholinesterase, and tyrosine hydroxylase levels
• Excitotoxicity: Reduced excitotoxic damage

The effect produced by 100 mg/kg MEA was similar to that of the reference standard, quercetin, demonstrating the plant’s significant neuroprotective potential. The study concluded that these results “revealed the neuroprotective potential of A. africana in stroke and other ischemia-related pathologies”.

2.3 Documented Antistroke Plants

Based on available literature, a selection of Nigerian plants documented for stroke and related cardiovascular conditions includes:

Plant Name	Common Name	Part Used	Scientific Evidence Level
Carica papaya	Pawpaw	Leaves	High (neuroprotective in animal model)
Khaya senegalensis	African mahogany	Bark	High (anti-inflammatory, neuroprotective)
Ficus platyphylla	–	Stem bark	High (neuroprotective, hypothermic effect)
Antiaris africana	–	Leaves	High (neuroprotective, antioxidant)
Tinospora cordifolia	Heart leaf moonseed	Leaves	Moderate (anti-inflammatory)
Moringa oleifera	Moringa	Leaves	Documented use
Allium sativum	Garlic	Bulb	Documented use
Zingiber officinale	Ginger	Rhizome	Documented use
Curcuma species	Turmeric	Rhizome	Documented use
Aloe barbadensis	Aloe vera	Leaves	Documented use
Momordica charantia	Bitter melon	Fruit/Leaves	Documented use

2.4 Mechanisms of Action

The scientific studies reviewed reveal several mechanisms through which Nigerian herbs may exert their effects in stroke management:

Mechanism	Plants Demonstrated	Effect
Anti-inflammatory action	Khaya senegalensis, Tinospora cordifolia, Ficus platyphylla	Reduction in TNF-α and other pro-inflammatory markers
Antioxidant activity	Antiaris africana, Carica papaya	Reduction in lipid peroxidation; preservation of glutathione; modulation of SOD, catalase, GPx
Hypothermic induction	Ficus platyphylla	Reduction of brain temperature; attenuation of excitotoxicity, apoptosis, and neuroinflammation
Neurotransmitter modulation	Antiaris Africana	Protection of Na⁺/K⁺ ATPase, acetylcholinesterase, and tyrosine hydroxylase
Excitotoxicity reduction	Antiaris africana, Ficus platyphylla	Reduction in excitotoxic damage; NR2B modulation
Cellular preservation	Khaya senegalensis	Preservation of striatal cell cytoarchitecture; reduction of reactive astrocyte proliferation

3. Traditional Practice and Holistic Therapies

3.1 The Role of Traditional Healers

Traditional medicine practitioners play a significant role in stroke management across Nigeria. Practitioners like Madam Alice Oboh of Our Lady Health of the Sick Herbs & Roots Clinic in Ogun State specialize in using natural medicine to treat and heal stroke patients.

Key observations from traditional practice:

• Increasing cases: Following the COVID-19 pandemic, stroke cases reportedly increased substantially, with clinics treating at least 20 stroke patients monthly
• Treatment duration:
  • Fresh stroke cases: 1 to 21 days
  • Cases over one month old: 3 to 4 months
  • Chronic cases (5 years old): 10 to 12 months
• Innovative techniques: Some practitioners use electric fish to revive collapsed nerves (distinct from physiotherapy electrodes), with nerve revival reported within 16 weeks
• Government support: Limited; practitioners rely primarily on licensing and NAFDAC registration

The integration of traditional and orthodox approaches is complex. While practitioners report success in treating stroke, the scientific community emphasizes that stroke is an acute medical emergency requiring urgent conventional care.

3.2 Caution: Unverified Remedies

A Facebook post claiming that a mixture of alligator pepper (Aframomum melegueta, “atare” in Yoruba) and gin prevents or cures stroke was evaluated by fact-checkers. Africa Check spoke with Professor Ikenna Onwuekwe, professor of clinical neurology and internal medicine at the University of Nigeria, who stated:

“There is no place for alligator pepper or any such concoction in the modern management of stroke. These are claims that have not been subjected to research.”

He emphasized that “stroke is a very serious condition, it is an acute medical emergency, and is approached with the same urgency with which we approach a heart attack”. Every minute counts in responding appropriately to an acute stroke case, as the person is at risk of losing more brain function and may die.

3.3 Stroke Rehabilitation in Nigeria

Rehabilitation is a critical component of stroke management, addressing the long-term disabilities that many survivors face. However, stroke rehabilitation in Nigeria faces significant challenges.

3.3.1 Challenges

Challenge	Description
Lack of reliable epidemiological information	Inadequate data hampers adequate response to stroke incidence and prevalence
Lack of guidelines	Evidence-based stroke rehabilitation guidelines are urgently needed; South Africa has had guidelines for nearly two decades, but Nigeria lacks national guidance
Low number of neurological rehabilitation professionals	Trained Physiotherapists in Neurological Rehabilitation are fewer than 100 as of 2016
Inadequate training	Existing rehabilitation professionals often lack training in state-of-the-art stroke rehabilitation; many rely on personal choices rather than evidence-based practice
Lack of coordination	Stroke rehabilitation remains uncoordinated, carried out in general medical wards rather than dedicated stroke units
Lack of policies	Health policies in low-resource countries often do not include rehabilitation; Nigeria lacks any policy for stroke rehabilitation
Poor infrastructure	Limited healthcare facilities, telecommunication, and transport systems

3.3.2 Opportunities

Despite these challenges, opportunities exist for improving stroke rehabilitation in Nigeria:

Opportunity	Description
Community integration	Leveraging existing systems through which communities deal with stroke
Telerehabilitation	Using technology to provide rehabilitation services; can be cost-effective since patients pay out-of-pocket for health services
Self-rehabilitation models	The TASSRET trial (Task-Specific Self-Rehabilitation Training) is currently testing video and manual-based self-rehabilitation programs for stroke survivors in Kano State communities with limited access to therapy services
Research efforts	Growing research on caregivers, quality of life, movement rehabilitation, activities of daily living, and community reintegration
Stakeholder partnerships	Collaboration with national and global health stakeholders
Leveraging SDGs and democratic governance	Using global frameworks and governance structures to prioritise stroke rehabilitation

3.3.3 The TASSRET Trial

The TASSRET trial, currently underway in Kano State, is testing two versions of a self-rehabilitation programme for stroke survivors in communities with limited access to professional therapy services:

Program Features:

• Video version: Delivered via Android phones with visual demonstrations in Hausa
• Printed manual version: Provided with images and written descriptions in Hausa
• Exercise components: Upper and lower limb function, balance training, trunk strengthening exercises
• Progression: Starting with at least 10 repetitions of each exercise, gradually increasing intensity

This research is particularly important because most existing evidence on home-based stroke rehabilitation comes from high-income countries with very different healthcare systems and resources. Developing and testing rehabilitation approaches specifically designed for resource-limited settings could provide models adaptable across Nigeria and other developing countries.

4. Cardiovascular Disease and Stroke Risk

4.1 Plants Used for Hypertension Management

Since hypertension is a major risk factor for stroke, documenting plants used for blood pressure management is relevant. The Benin people survey documented plants primarily used to address hypertension and high blood pressure, which in turn contributes to stroke prevention.

Bioactive Compounds:

Medicinal plants used in CDVD management contain natural bioactive compounds accumulated as secondary metabolites, including:

• Alkaloids
• Sterols
• Terpenes
• Flavonoids
• Saponins
• Glycosides
• Tannins

4.2 Reported Safety

The Benin survey noted that plants and plant-based remedies were “used to manage stroke and to address CDVD-related chest pains without any side effects”. However, this finding requires caution, as rigorous safety data are limited for many herbal products, and the fundamental problem of lack of standardization makes classification difficult.

5. Safety Considerations and Recommendations

5.1 Key Safety Concerns

Concern	Implication
Lack of standardization	Variable potency and possible contamination; lack of quality control
Potential toxicity	Some plants may be hepatotoxic or nephrotoxic at high doses
Drug interactions	Herbal remedies may interact with antihypertensive, antiplatelet, or anticoagulant medications
Critical window	Stroke is an acute emergency; delays in seeking appropriate care can be fatal
Limited safety data	Most evidence focuses on efficacy rather than safety
Inadequate regulation	Many products lack NAFDAC registration or quality assurance

5.2 Recommendations

For Patients and Families:

1. Recognize stroke as a medical emergency: Seek immediate medical attention for acute stroke symptoms (FAST: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services)
2. Disclose all herbal medicine use to healthcare providers
3. Use products from reputable sources, preferably with NAFDAC registration
4. Do not replace prescribed medications with herbal remedies without medical consultation
5. Combine herbal therapies with rehabilitation for optimal recovery
6. Monitor for adverse effects and report immediately

For Healthcare Providers:

1. Ask about herbal medicine use during consultations, particularly for stroke patients and those with hypertension
2. Provide evidence-based guidance on complementary therapies
3. Monitor for potential drug interactions
4. Document CAM use in patient records
5. Support research on safety and efficacy of commonly used herbs

For Researchers:

1. Conduct controlled clinical trials on commonly used antistroke plants
2. Evaluate safety profiles for chronic use
3. Study drug interactions with antihypertensive, antiplatelet, and anticoagulant medications
4. Identify and characterise active compounds
5. Develop standardized formulations for clinical use

For Policymakers:

1. Strengthen NAFDAC regulation of herbal products
2. Fund research on neuroprotective plants
3. Develop national stroke rehabilitation guidelines
4. Integrate traditional medicine into healthcare systems with proper oversight
5. Support conservation of medicinal plant species
6. Develop policies for stroke rehabilitation

6. Research Gaps and Future Directions

6.1 Key Research Needs

Area	Priority
Human clinical trials	Most evidence from in vitro and animal models; human safety and efficacy data needed
Long-term safety studies	Chronic use effects on liver, kidney, other organs
Drug interaction studies	Interactions with antihypertensives, antiplatelets, anticoagulants
Standardised dosing protocols	Defined dosing for herbal formulations
Pharmacokinetic studies	Absorption, distribution, metabolism, elimination
Combination therapy studies	Herbal + conventional treatment interactions
Quality control methods	Affordable quality assurance methods
Epidemiological studies	Better data on stroke incidence and prevalence in Nigeria

6.2 Opportunities

• Development of standardized formulations: Moving from traditional decoctions to standardized pharmaceutical-grade products
• Neuroprotective drug discovery: Active compounds from Nigerian plants could yield new stroke therapeutics
• Telerehabilitation expansion: Using technology to reach stroke survivors in remote communities
• Self-rehabilitation models: Task-specific training programs for home-based recovery
• Integration strategies: Combining the best of traditional and orthodox approaches

7. Conclusion

Stroke imposes a significant burden on Nigeria, with rising incidence and prevalence, substantial mortality, and long-term disability affecting survivors and their families. The challenges of managing stroke are compounded by limited healthcare resources, inadequate rehabilitation infrastructure, and the high cost of conventional care.

Nigerian traditional medicine offers a rich repository of plant-based remedies for stroke management. Scientific research has begun to validate the neuroprotective potential of several plants:

• Carica papaya has demonstrated significant protective effects against ischaemic-reperfusion injury in animal models, with improvements in oxidative stress markers and neuronal preservation
• Khaya senegalensisand Tinospora cordifolia have shown potent anti-inflammatory effects in striatal ischemic injury, with remarkable preservation of neuronal architecture
• Ficus platyphylla has demonstrated neuroprotective effects through hypothermia induction, reducing infarct volume and preserving neurons
• Antiaris africana has shown neuroprotective potential comparable to the reference standard quercetin, with modulation of oxidative stress and neurochemical markers

Ethnobotanical surveys have documented dozens of additional plants used by Nigerian communities for stroke and related cardiovascular conditions .

However, challenges remain:

• Stroke is an acute medical emergency requiring urgent conventional care; delays can be fatal
• Limited human clinical trial data for most remedies
• Safety concerns, including potential drug interactions
• Lack of standardization and regulation for many products
• Significant gaps in stroke rehabilitation infrastructure and services

The path forward requires:

1. Acknowledging and respecting traditional knowledge while subjecting it to rigorous scientific scrutiny
2. Strengthening regulatory oversight of herbal products through NAFDAC
3. Promoting open communication between patients and healthcare providers about herbal medicine use
4. Investing in clinical research on safety, efficacy, and mechanisms of action
5. Developing integration strategies that combine the best of both systems
6. Improving stroke rehabilitation infrastructure through policy, training, and innovative models like telerehabilitation and self-rehabilitation
7. Preserving and documenting indigenous knowledge before it is lost
8. Promoting stroke awareness, including recognition of stroke symptoms and the importance of seeking immediate medical care

As Nigeria continues to face the growing burden of stroke, the careful integration of evidence-based traditional medicine into the healthcare system, combined with strengthening emergency and rehabilitative services, offers promising strategies for improving outcomes and quality of life for those affected by this devastating condition.

8. References

1. Fasola TR, Egunyomi A, Odudu EO. Medicinal Plants of Ethiope West and Sapele Local Government Areas of Delta State, Nigeria. International Journal of Environment. 2014;3(3):252-263.
2. Ogwu MC, Ogwu HI, Kosoe EA. Plants Used in the Management and Treatment of Cardiovascular Diseases: Case Study of the Benin People of Southern Nigeria. In: Reference Series in Phytochemistry. Springer; 2024:909-938.
3. Owoeye O, Mpetcha A, Malomo AO. The protective effect of Carica papaya and vitamin E on ischaemic-reperfusion insult of rat brain following bilateral occlusion of common carotid artery. Afr. J. Med. Med. Sci. 2019;48:139-149.
4. Abdullahi A. Stroke Rehabilitation in Nigeria: Challenges and Opportunities. Clinical Health Promotion. 2021;11(2).
5. Lukpata PU, Abraham A, Adugba AO, Ode AI, Otashu KF. Anti-Inflammatory Effects of Khaya senegalensis Bark and Tinospora cordifolia Leaf Extracts on Striatal Ischemic Injury in Rats. KIU Journal of Health Sciences. 2024;4(1):36-46.
6. Adigun O, Uche H. Why stroke cases are on the rise, by traditional medicine practitioner. The Sun Nigeria. 2022.
7. Africa Check. Mixture of alligator pepper and gin no remedy for stroke. 2021.
8. Kayode J, Bamigboye TO. Indigenous Medicinal Botanicals Used in the Cure of Body Pains, Stroke and Rheumatism in Ekiti State, Nigeria. Bio-Science Research Bulletin-Biological Sciences. 2016;32(1/2):51-58.
9. Sutter B, Chindo BA, Becker A, et al. Methanol extract of Ficus platyphylla decreases cerebral ischemia induced injury in mice. Journal of Ethnopharmacology. 2021;279:114372.
10. Ilesanmi OB, Akinmoladun AC, Olayeriju OS, Saliu IO, Olaleye MT, Akindahunsi AA. Modulation of Key Biochemical Markers Relevant to Stroke by Antiaris africana Leaf Extract Following Cerebral Ischemia/Reperfusion Injury. African Journal of Traditional, Complementary and Alternative Medicines. 2017.
11. Ibrahim R. Task-Specific Self-Rehabilitation Training (TASSRET) Trial for Stroke Recovery in Nigeria. ICHGCP Clinical Trials Registry. 2025.