Migraine is a neurological condition that can affect physical, mental, and emotional well-being. However, people with migraine have very different experiences of the condition and its treatment.

In the United States, an estimated 1 in 6 adults experience migraine or severe headaches, according to data from a 2020 study.

Emerging research suggests that significant disparities exist in how migraine affects different groups.

Despite migraine’s high prevalence, clinicians frequently miss or misdiagnose the condition. Among those who get an accurate diagnosis, many do not receive appropriate treatment to manage migraine effectively.

One study found that only about 8% of people with migraine receive adequate care for their condition, including a consultation, an accurate diagnosis, proper treatment, and the avoidance of medication overuse.

The research also showed that inadequate care is more likely to affect historically marginalized groups.

A person’s assigned sex at birth and their sexual orientation may affect their experience of migraine.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Females and migraine

Researchers have observed a significant sex bias with migraine, with the condition affecting a reported 21% of females compared with about 11% of males.

Females are three to four times more likely to experience migraine than males over the course of their life. Although the frequency of migraine is about equal between the sexes during childhood, there is a steeper increase in migraine for females around puberty.

Experts believe that this difference is likely due to a combination of biological features, such as sex hormone levels, and social and environmental factors that increase the risk of migraine, such as stress.

Sexual orientation

Studies suggest that there are also disparities in migraine based on sexual orientation, possibly due to stigma or discrimination.

According to one study, people who identify as lesbian, gay, or bisexual are 83% more likely to experience migraine than people who identify as exclusively heterosexual.

A national health survey that used data from 2013 to 2018 found that the prevalence of migraine was highest among:

  • bisexual women: 36.8%
  • lesbians: 24.7%
  • bisexual men: 22.8%

The findings also suggest that gay men are less likely to experience migraine than heterosexual women but more likely than heterosexual men. The prevalence among these groups of individuals was 14.8%, 19.7%, and 9.8%, respectively.

In general, the prevalence of migraine does not vary significantly by race or ethnicity. However, researchers have identified that significant gaps in migraine diagnosis and care can affect various racial and ethnic groups. This may be due to discrimination or lack of access.

According to the findings of one study, in comparison with white people, African American and Hispanic people are 25% and 50% less likely, respectively, to receive a diagnosis of migraine.

This gap may be due in part to the observation that historically marginalized racial and ethnic groups are sometimes less likely to seek care from a medical professional. According to the American Migraine Foundation (AMF), only 46% of Black people with migraine seek help from a healthcare professional compared with 72% of white people.

Research also suggests that African American people are less likely not only to get an accurate diagnosis of migraine but also to receive appropriate treatment when necessary.

Latino people with migraine are also less likely to have access to appropriate medical care, says the AMF.

Alongside discrimination, another possible cause of racial or ethnic disparities in migraine care is underrepresentation in clinical trials. A 2017 review that looked at 36 migraine trials reported that only 17% of clinical trial participants were not white.

Diverse clinical trial participation is important to understand how treatments work in different populations. The underrepresentation of People of Color in clinical trials may make it difficult to determine whether certain medications work differently in different groups.

Socioeconomic status is one of the strongest predictors of how likely a person is to receive an accurate migraine diagnosis and appropriate care.

In 2018, approximately 2 in 5 adults in the U.S. with migraine were classified as “poor” or “nearly poor,” and a similar number were unemployed.

In one study, people with an annual household income of at least $75,000 were more likely to be under the care of a medical professional for migraine than people who made less than $30,000 a year. They were also more likely to receive an accurate diagnosis and receive appropriate treatment.

The researchers observed similar trends when comparing people with and without health insurance.

A 2020 study found that about 20% of people with migraine have no health insurance. These figures are concerning when considering the cost of migraine care. According to a 2018 study, when counting the direct and indirect costs of migraine, spending was nearly $9,000 higher per year for people with migraine than for those without.

This estimate does not account for newly approved biologic therapies for migraine, which may cost up to $7,000 a year without insurance.

Systemic efforts to address racism and reduce bias in medical care are necessary to help break the cycle of disparities in all aspects of healthcare, including migraine.

People can take steps on an individual level to help reduce disparities, as well.

For example, those with migraine can use materials from trusted resources, such as the AMF and the National Institutes of Health (NIH), to help learn more about migraine and migraine care.

By learning more about their condition, people with migraine can be better equipped to advocate for themselves in the clinic. Knowing what to talk about can help prevent delays in diagnosis.

Other ways in which people with migraine can self-advocate for their health include:

  • tracking their migraine patterns and triggers
  • identifying self-care practices that reduce their migraine symptoms
  • joining an online or community support group
  • finding the right specialist and getting a second opinion, when necessary

For people with financial barriers to adequate migraine care, various patient assistance programs exist to help cover some or all of the costs of treatment. A healthcare professional can help a person navigate these resources.

Migraine is a common but underdiagnosed condition. Clear disparities in care exist based on:

  • sex and gender
  • sexual orientation
  • race and ethnicity
  • socioeconomic status

People in these groups are less likely to receive a timely, accurate diagnosis, and they often do not receive access to the treatment they need.

Individuals in historically marginalized groups who have or suspect that they have migraine can advocate for themselves in healthcare settings by learning more about the condition, speaking up about their symptoms, and being vocal about receiving the care they deserve.