Health disparities and barriers to effective and proper migraine treatment
By Conor Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.
An article by Paul Rizzoli in Harvard Health Publishing breaks down new research on healthcare disparities faced by patients with headache disorders. This research focused mainly on migraines, the most common type of post-traumatic headache following concussion. According to the article, researchers Jessica Kiarashi et al. found significant disparities based on race, sexuality, socioeconomic status (SES), urban/rural geographic differences, and more. The research was published in Neurology.
“Although the frequency of migraine among racial groups in the US is roughly equivalent, African American and Hispanic patients are, respectively, 25% and 50% less likely to be diagnosed with migraine compared to white patients.” The study also found that “African Americans are less likely than white patients to utilize health care settings for migraine. They are also less likely to receive a headache diagnosis, and less likely to be prescribed migraine medication.“
The most prevalent disparity was in the use of medications for pain control, with nonwhites significantly less likely to use pain medication, likely due to a combination of historic underprescription of pain medication for nonwhite patients, along with (merited) distrust of the healthcare system by these populations.
The research also found that those with low socioeconomic status had migraines at a 60%-higher rate than those financially better-off, meaning that “patients of color with low incomes are at twice the risk for health disparities.” According to the article, the research also addresses provider demographic makeup, geographic urban/rural access differences, and homogeneity of research subjects as potential factors contributing to these disparities.
The authors suggest the following measures as ways to address and reduce these disparities:
“Improve patient and physician education about headache disorders, including how to access and advocate for care.
Improve education for primary care providers in the management of headache disorders, especially in regions where there are fewer headache specialists.
Advocate for structural and scalable changes designed to improve access to care, with innovations such as telemedicine to help remove travel barriers.
Offer training to providers in implicit bias and cultural sensitivity and competence.
Develop recruitment strategies to increase representation of underserved groups, both as headache medicine providers and as participants in headache research.”
We recommend our pages on Headaches After Concussion and Headaches: Advanced Page for further reading.