A Critical Exploration of Migraine as a Health Disparity: the Imperative of an Equity-Oriented, Intersectional Approach

• Published in: Current pain and headache reports 2018-12, Vol.22 (12), p.79-79, Article 79
• Main Authors: Befus, Deanna R., Irby, Megan Bennett, Coeytaux, Remy R., Penzien, Donald B
• Format: Article
• Language: English
• Subjects: Clinical medicine; Health disparities; Healthcare Disparities - statistics & numerical data; Humans; Internal Medicine; Medicine; Medicine & Public Health; Migraine Disorders - epidemiology; Migraine Disorders - therapy; Minority Groups; Pain Medicine; Poverty; Psychological and Behavioral Aspects of Headache and Pain (D Buse; Race; Section Editor; Topical Collection on Psychological and Behavioral Aspects of Headache and Pain; United States - epidemiology
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-018-0731-3

Purpose of Review Despite recognition of rising prevalence and significant burden, migraine remains underestimated, underdiagnosed, and undertreated. This is especially true among groups who have been historically, socially, and economically marginalized such as communities of color, women, people experiencing poverty, people with lower levels of education, and people who hold more than one of these marginalized identities. While there is growing public and professional interest in disparities in migraine prevalence, there is a paucity of research focusing on racial/ethnic and socioeconomic disparities, and the social and structural determinants of health and equity that perpetuate these disparities. From a health equity perspective, migraine research and treatment require an examination not only of biological and behavioral factors, but of these identities and underlying, intersecting social and structural determinants of health. Recent Findings Significant disparities in migraine incidence, prevalence, migraine-related pain and disability, access to care, and quality of care persist among marginalized and underserved groups: African Americans, Hispanics, people experiencing poverty, un- or under-employment, the un- and under-insured, people who have been exposed to stressful and traumatic events across the lifespan, and people experiencing multiple, overlapping marginalized identities. These same groups are largely underrepresented in migraine research, despite bearing disproportionate burden. Current approaches to understanding health disparities in migraine largely assume an essentializing approach, i.e., documenting differences between single identity groups—e.g., race or income or education level—rather than considering the mechanisms of disparities: the social and structural determinants of health. Summary While disparities in migraine are becoming more widely acknowledged, we assert that migraine is more aptly understood as a health equity issue, that is, a condition in which many of the health disparities are avoidable. It is important in research and clinical practice to consider perspectives that incorporate a cultural understanding of racial, ethnic, and socioeconomic identity within and across all levels of society. Incorporating perspectives of intersectionality provides a strong foundation for understanding the role of these complex combination of factors on migraine pain and treatment. We urge the adoption of intersectional and systems pers