Racial disparities exist across many aspects of the healthcare system, including migraine diagnosis and care.

In recent years, advocacy groups and researchers have taken an interest in identifying the causes of racial differences in migraine, including the impacts on care and possible solutions. Researchers have found disparities between people of different races in their experiences of:

  • seeking out care
  • diagnosis
  • treatment
  • self-advocacy

It is possible to address racial disparities by educating those working in medicine and promoting greater diversity in medical schools and clinical trials. Learning to self-advocate can also help.

Disparities in migraine care often begin at the point of seeking out care for headaches and other symptoms.

According to the American Migraine Foundation (AMF), 46% of Black people with headaches seek care compared with 72% of white people.

The AMF identifies several reasons for this disparity, noting that the following factors can affect people belonging to historically marginalized groups:

  • lack of access to healthcare
  • economic issues
  • discrimination
  • mistrust of the medical community
  • lack of representation in the medical community

A 2015 review reported similar findings. The researchers found that while Native American people and white people had the highest prevalence of migraine, the lower rates among Hispanic, Black, and Asian people may be due to a lack of diagnoses.

For example, the study showed that Asian people have the lowest prevalence of migraine, with the condition affecting 9.2% of this population. In contrast, migraine has a prevalence of 17.7% among Native American people, 15.5% among white people, 14.5% among Hispanic people, and 14.45% among Black people. The researchers note that this disparity may reflect reticence around seeking care or issues related to access to and quality of care.

Looking beyond studies of migraine, systemic bias plays a role in healthcare disparities in general.

A 2017 review found evidence that high levels of implicit bias from physicians resulted in more negative interactions for Black people. The review also found evidence of more favorable treatments for white people.

The American Medical Association has identified a lack of diversity among physicians and medical students as a key barrier to health equity.

Where possible, a person should educate themself about migraine. This can help when seeking care, as the person can help guide the conversation, ask appropriate questions, and mention symptoms that may be important for the doctor to know.

When it comes to diagnosing migraine, underdiagnosis may affect certain groups of people. In particular, people who are Black, Hispanic, or Asian and living with migraine may be less likely to receive a diagnosis than white people.

According to the AMF, there is a large disparity in diagnosis rates between white people and Black people experiencing headaches. The organization notes that:

  • 70% of white people living with headaches get a migraine diagnosis
  • 40% of Black people living with headaches get a migraine diagnosis
  • Hispanic people living with headaches have a 50% lower chance of a migraine diagnosis compared with white people

Research shows that Asian people have the lowest prevalence of severe headaches or migraine, which may also be due to a low rate of diagnosis.

Without a diagnosis, people living with migraine cannot get specific care for the condition, which leads to less positive outcomes and a lower quality of life.

According to a 2021 review, disparities in diagnosis occur due to a variety of reasons, including:

  • socioeconomic factors
  • differences in insurance status
  • disparities in geographic locations
  • racism

Education is key to addressing racist treatment in the healthcare system.

Historically, people have incorrectly associated Black people with a higher pain tolerance, which translates to differences in treatment between people of different races.

Even medical studies have exhibited bias. For instance, an old study from 1996 concluded that white people were likely genetically predisposed to experience migraine at higher levels while dismissing socioeconomic factors that might affect the rates of diagnosis.

More recent studies have started to challenge the notion that biological differences play a major role in treatment or other areas of migraine care. However, disparities in treatment still exist.

In a 2017 study, researchers noted that in comparison with non-Hispanic white people, African American people experience:

  • more frequent and severe migraine
  • a higher likelihood of developing chronic migraine
  • higher rates of resulting depression
  • a lower quality of life

In spite of this, the AMF states that only 14% of Black people living with migraine receive prescriptions for acute migraine. In comparison, 37% of white people living with migraine receive acute migraine care.

In other words, racial differences contribute to a lack of both preventive care and treatment during an acute attack. Improper treatment leads to less positive treatment outcomes and a lower quality of life.

Addressing inequality in migraine diagnosis and care requires broad efforts across the medical field.

A 2021 review identified several steps, including:

  • addressing health literacy
  • improving public education
  • optimizing and improving telemedicine
  • engaging in community outreach to educate healthcare professionals working in primary care
  • increasing efforts to recruit underrepresented groups in headache research
  • training providers in cultural sensitivity and competence
  • improving advocacy
  • providing training on implicit bias

The AMF provides several free guides to people living with migraine that address:

An important step for anyone living with migraine is to learn as much as possible about the disorder. Doing so can help them shape conversations with doctors and self-advocate for their care.

A person’s race can affect their ability to get a diagnosis and receive proper care for migraine. Several factors contribute to the differences in how people of different races receive migraine support. These include racial bias, a lack of access to healthcare, and a low quality of care.

A lack of support can lead to less positive outcomes, including ineffective treatment, higher rates of depression, and a reduced quality of life. A person should consider taking the time to learn as much as possible about migraine. A good understanding of the condition can help people better advocate for themselves.