It’s estimated that less than half of all people who experience migraine headaches are aware of their diagnosis. In other words, tens of millions of people have headaches that meet the clinical criteria for migraine, yet they’re unaware that a migraine headache is a type from which they suffer. Often, people misclassify and misattribute their migraine headaches to a different cause. Many factors contribute to the significant lack of migraine awareness in the general sense. However, there are additional compounding factors for people of color who experience migraines.
There are studies that explore the experiential and biological difference between migraine headaches in men and women. However, especially when it comes to migraine research, there’s a lack of quality data focused on racial or socioeconomic disparities. Beyond the biological and behavioral factors that contribute to migraines, it’s critical that research explores the social and structural issues that contribute to overall health.
Generally, we know there are sizeable gaps in the study, diagnosis and care of people with migraines in marginalized and underserved groups — even though these individuals bear a disproportionate burden of the effects from such types of headache. Though awareness, if not clinical study, is increasing in this regard, migraine is becoming one health condition category that is crucial to explore as a health equity concern. When framed in such a way, we can then address migraine health disparity for people of color as an avoidable problem.
It’s essential for anyone who experiences chronic headaches to understand the clinical criteria for a headache to be classified as a migraine. An important foundational aspect of an accurate diagnosis is a proper analysis of individual headache history. In classifying a headache correctly as a migraine, the person must have had at least five headache attacks that lasted between four to 72 hours, and the headache must possess two of the following characteristics:
— Unilateral location.
— Pulsating quality.
— Moderate or severe pain intensity.
— Aggravation by or causing avoidance of routine physical activity (walking or climbing the stairs, for example).
In addition to the qualities of the headache, for it to be classified as a migraine, the person must have at least one of the following during the headache episode:
— Nausea and/or vomiting.
— Photophobia and phonophobia.
Lastly, the features associated with the individual’s migraine headache must not be attributable to another condition or disorder.
As one can see from the above classification criteria, it isn’t necessarily simple for a person with a non-medical background to determine their headaches’ appropriate classification. For example, people may think they have “sinus” headaches or “tension” headaches. Perhaps they’ve taken a sinus headache medication or other over-the-counter-medication that helped, so they assume sinus or tension as the diagnosis (even though they have a migraine that’s partially responding to the medication).
In other cases, people compare their headaches to someone else who has a more severe migraine. They think because they don’t have incapacitating versions with severe nausea and vomiting, they must not have migraines. However, the truth about migraine headaches is that they can range in severity from one individual to the next. Most migraines are at least moderate in intensity, and some are severe. It’s uncommon for a migraine to be described as mild.
Specifically concerning people of color, the issues outlined above are present, in addition to other factors. For instance, a lack of access to physicians of color negatively impacts accurate diagnoses of all kinds, migraine headaches notwithstanding. Further, people of color are routinely dismissed (or their symptoms minimized) for various culturally associated reasons. People of color are also frequently given less medication for painful conditions and are less likely to receive an accurate diagnosis for a painful condition. Each of these examples speaks to an earnest need for medical science to further explore migraine as a health equity issue.
In addition to undiagnosed and untreated pain, the compounding tragedy is that chronic migraine results in a significant disability that can otherwise be successfully treated in many cases. Missed school and workdays (absenteeism) and less productive time at school and work (presenteeism) can be avoided with proper diagnosis and treatment. Finally, when new advancements are being studied to improve treatment options further, if people of color are unaware of their diagnosis, overlooked and not part of the clinical trial programs, there is the potential for bias relative to new and developing treatments.
As a neurologic and medical community, we must do all we can to educate patients, especially patients of color, how migraine headaches present themselves, are diagnosed and often, successfully treated. When it comes to these types of debilitating headaches, no one should have to “grin and bear it” or “just live with” the pain.
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