The report, which was recently published by Neurology, the medical journal of the American Academy of Neurology, showed that African American men receive the least care for headache conditions nationwide. It also found significant differences in the diagnosis of migraine, with Hispanic people 50% less likely than White people to be formally recognized as having the condition. Let’s take a closer look at the latest research on the disparities in the treatment and diagnosis of headache disorders based on ethnicity, socioeconomic background, and location.
The Study
For the article, 16 headache experts from across the country analyzed existing research on healthcare disparities and headache disorders. They found that while White people, African Americans, and Hispanics experience severe headaches and migraine at near-equal rates, they receive significantly different levels of diagnoses and treatment for these conditions. Compared with White people, Hispanics and Latinos were half as likely to receive a migraine diagnosis, followed by African Americans, who were 25% less likely. Treatment levels for headache conditions were lowest among African American men. They were less likely to go to an outpatient treatment center for a migraine disorder and when they went to the emergency room with a headache, they were nearly five times less likely than White people with similar symptoms to get computed tomography (also known as a CT scan) to help with a diagnosis. Furthermore, African Americans with headache conditions experienced symptoms for more days each month, higher levels of pain, and overall lower quality of life than White people with the same disorders. “These differences often exist even after adjusting for socioeconomic status, suggesting this is not just about access, but also about differences in care due to the social construct of race and systemic racism,” explains Amaal Starling, MD, associate professor of neurology at Mayo Clinic in Scottsdale, Arizona. Data on Latinos was limited, but the authors note that members of this community tend to have less access to care for chronic pain and are less likely to receive medications that can help prevent headaches. Native Americans and Indigenous people in America were shown to have the highest rates of migraine and severe headache among various groups. They were also most likely to experience allodynia, a migraine-related symptom that causes a person to have pain from things that don’t typically hurt (such as a gentle tap on the wrist). It is often a predictor of poor migraine treatment outcomes, the authors note. While Asians tend to have the lowest rates of severe headaches, data limitations made it difficult for the authors to assess diagnosis levels and treatment outcomes of this group.
Location and Income Differences
Beyond race, socioeconomic status and geography also were associated with disparities in headache disorder diagnosis and treatment. Low-income people, as well as those without health insurance, faced a lower likelihood of receiving treatment for acute migraine, despite having higher rates of the condition. “Having health insurance, as well as having health insurance that covers migraine treatment, are important factors in understanding disparities. People of color and/or with low social economic status may not have health insurance or may not have health insurance that covers these treatments,” says Melva Thompson-Robinson, DrPH, professor of social and behavioral health and executive director of the Center for Health Disparities Research in the School of Public Health at the University of Nevada Las Vegas. She adds: “Given that health insurance is often based on employment, if people of color are more likely to be unemployed, then they are more likely not to have access to this type of treatment.” People in rural areas also faced greater obstacles, including longer wait times, to receiving migraine care. This trend was perhaps the result of a much lower density of headache specialists in rural states, among other factors, the authors note. “Many states have two or fewer headache specialists, as most specialists tend to remain where they are trained as opposed to moving to underserved areas,” explains Dr. Thompson-Robinson.
Reducing Inequality in Migraine Care
Closing the gap on recognition and treatment of headache disorders in people of color and other groups requires “major cultural shifts in our society,” the authors note. Conducting more research on healthcare disparities and implementing those findings into awareness campaigns could be one way to help reduce inequality, says Medhat Mikhael, MD, pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “It is important to learn some of the root causes of those disparities and it is important to educate the public about the diagnosis and treatment options as to avoid suffering,” he said. Improving training among healthcare providers could also help them identify and treat headache disorders among underrepresented groups, adds Dr. Thompson-Robinson. “For those providers in neurology, the American Academy of Neurology has focused efforts on providing cultural sensitivity and competence training for providers as well as addressing lack of representation of people of color and underrepresented people in training programs and academic medicine,” she says. “For primary care providers, educating them about headaches and migraine treatments as well as utilizing telemedicine are key factors.” Another key step would be increasing diversity among headache specialists and participants in research studies on migraine, adds Dr. Starling, adding that healthcare disparities are “a large problem that will benefit from a top-down and grassroots efforts to help those living with headache disorders.” Overall, experts note that the findings of this study are just one of many inequalities that need to be solved in the U.S. healthcare system. The authors say: “This is a call for reflection and action at the individual, community, institutional, and societal level. This is a movement for long overdue change.” The findings are among many examples of inequality in the U.S. healthcare system. Closing gaps in diagnosis and care will require a long-term, multi-pronged approach that includes diversifying research participants, improving training for doctors, and increasing representation of people of color in the healthcare field, among other strategies.
