Diagnosis and Treatment of Migraine in People of Color

Medically Reviewed by Murtaza Cassoobhoy, MD on February 10, 2023
4 min read

Migraine is a disabling neurological disorder, triggered by stress, changes in sleep and weather, and other things. It can cause unbearable pain that lasts hours or even days.

Migraine and other headache disorders affect tens of millions of Americans. Experts think at least 39 million Americans live with this condition. Since many aren’t diagnosed or treated for migraine, the number of people affected is likely even higher.

People of color and other underserved groups face even bigger hurdles in getting proper migraine care. Right now, there’s a lack of research into the reasons behind these disparities. But it’s a growing area of study within the scientific community.

The rate of migraine or other serious types of headaches is similar across races and ethnicities. Here’s a breakdown of the numbers, according to one study:

  • Native American: 17.7%
  • White: 15.5%
  • Black: 14.5%
  • Asian: 9.2%

On the surface, migraine rates appear much the same. But a closer look shows differences in diagnosis and treatment that could drive the numbers higher for people of color. The results of one show:

  • Black and Hispanic people are about 25% to 50% less likely to visit a health care provider for migraine.
  • Doctors often diagnose these groups with vague illnesses like “nonspecific headache” instead of a more exact condition. A precise diagnosis influences the type of treatment you receive.
  • Over the years, doctors have started prescribing opioids to Black people at a higher rate than white people. Opioids are not a recommended migraine treatment because the chances of developing a substance use disorder is higher with these drugs.

Bias in the U.S. health care system dates back hundreds of years. Some doctors and scientists believed that Black people were biologically different from whites and even immune to pain. They used these distorted ideas to justify inhumane treatment of Black people in medical research and treatment.

Today, harmful ideas about the Black human body persist in health care. Patients of color find that doctors routinely dismiss or overlook their pain symptoms. As recently as 2016, one study on pain found that about 50% of medical students and resident doctors surveyed believe Black people have thicker skin or higher pain tolerance. These beliefs result in Black people, including those living with migraine, receiving unequal treatment for pain.

Racism in migraine care can magnify other prejudices surrounding the condition. Many people with migraine -- of all racial and ethnic backgrounds -- say others don’t fully understand the illness. Some think of migraine as a simple headache and that the people who have it are lazy, weak, or neurotic.

Socioeconomics and migraine

Researchers have also explored the link between migraine and social and economic factors. People with lower incomes and less education may be more likely to have migraine. These groups are more likely to have a poor diet, higher rates of stress, and less access to adequate health care. All of these things contribute to migraine attacks. These things are often connected to communities of color.

Several other things could also play a role in differences in care for Black and Hispanic people living with migraine, such as:

  • Immigration status
  • Lack of insurance
  • Language barriers
  • Distrust of the medical community

There are no easy answers for overcoming health disparities in migraine care. It will take systemic change within the health care system. A joint effort between health care providers, researchers, and people living with migraine is also needed.

Improved care

One of the first steps is better migraine care in underserved communities. This includes:

  • Access to doctors, including headache specialists
  • Accurate diagnoses
  • Proper treatment, including drug and nondrug options like cognitive behavioral therapy and relaxation training
  • Expanded care for those who are uninsured or underinsured
  • Migraine education
  • Addressing inequality in health care

Diversity in research

Scientific research helps us learn more about health conditions, who they affect, and gaps in health care. And scientists can discover differences in the benefits and side effects of new treatments.

Only a small fraction of people take part in clinical studies. And many times, these studies don’t represent the U.S. population as a whole. Clinical studies tend to be evenly split by sex, but there’s less racial and ethnic diversity. While Black and Hispanic people represent a combined 30% of the U.S. population, they make up just 15% of clinical study participants.

The numbers are similar for migraine research. People of color make up about 10% to 20% of clinical trial participants for new migraine treatments. And although it’s a growing area of research, there are still few studies that focus on the differences in migraine care.

Diversity in scientific research is a critical yet complex challenge. To achieve it, the research community needs to:

  • Recruit more people of color to join and lead research studies
  • Address concerns about historical and current racism and abuse
  • Engage communities of color in the study design process
  • Lower barriers to taking part in clinical trials, such as a lack of transportation and childcare
  • Provide cultural competency training for researchers