Treatment Disparities Continue in Headache Care

A review article published in Neurology, summarizes differences in the treatment of people with headache that are correlated with multiple social determinants of health (SDOH) including race and ethnicity, socioeconomic status, and geographic location. The article also addresses potential means of addressing these disparities.

The rate of migraine and severe headache is about the same (15%) among white, Black and Latino individuals, the rate among Native Americans and Alaska Natives is 19%. White people are 50% more likely to receive diagnosis for migraine than Hispanic/Latinx individuals. Black people who visit emergency departments because of a headache were 4.8 times less likely to receive diagnosis and standard of care treatment than white people with the same complaint. 

“The research shows that headache disparities persist for people who are Black, Latino and Native American and Alaska Natives,” said article author Jessica Kiarashi, MD, of UT Southwestern Medical Center in Dallas, Texas, and a member of the American Academy of Neurology. “Among groups identifying by race or ethnicity, Native Americans and Alaskan Natives have the highest prevalence of migraine and headache disorders, Hispanic/Latinx people have the greatest headache and neurologic needs, and Black men receive the least care. In addition, access to care is limited by low socioeconomic status and geographical barriers.”

Clinical strategies to improve equity and reduce disparities are discussed, including telemedicine to lessen geographic disparities and screening for issues such as trauma, housing stability, and income to better determine unmet needs. Professional training strategies such as better education on headache during medical school and the recruitment and retention in headache medicine of individuals from groups underrepresented in medicine are also addressed. The need to reduce disparities in research would also be beneficial, such as working to recruit individuals from underrepresented groups in research studies and increasing funding support for headache research.

“Race is a social construct that as a vehicle for systemic racism has profound impacts," Kiarashi said. "Abolishing these racial, socioeconomic and geographic inequities would require major cultural shifts in our society. This is a call for reflection and action at the individual, community, institutional and societal level. This is a movement for long overdue change.”