Migraine in Marginalized Communities

""Believe you can and you're halfway there." Theodore Roosevelt

Migraine in Marginalized Communities: What the Data Reveals (and What You Can Do About It)
 @Ms.IronsSharpens

Migraine is more than a headache it’s a complex, debilitating neurological disorder that affects over 39 million Americans. But while migraine doesn’t discriminate, access to diagnosis, treatment, and compassionate care often does.

Disparities in Migraine Care: The Data Speaks Loudly

Research shows that people in marginalized communities especially Black, Hispanic, Indigenous, and lower-income individuals are less likely to be properly diagnosed or treated for migraine, despite similar or greater prevalence.

Here’s what the data reveals:

• Under-diagnosis and Under-treatment:

  A study published in Headache: The Journal of Head and Face Pain analyzed U.S. population data and found that Black individuals are less likely to receive a migraine diagnosis than white individuals, even when symptom reports are comparable (Burch et al., 2021). Similarly, Hispanic adults with migraine are less likely to use prescription medications or seek specialty care compared to non-Hispanic white adults, as shown in the American Migraine Prevalence and Prevention (AMPP) Study (Lipton et al., 2007).

• Barriers to Access:
  In marginalized communities, access to neurologists and headache specialists is limited due to geographic, financial, and systemic barriers. The American Migraine Foundation highlights that only 1 in 3 migraine sufferers consult a healthcare professional, with lower rates in communities of color.

• Cultural and Language Disconnects:
  According to a 2022 study in The Journal of Pain, implicit bias, language barriers, and provider mistrust play a significant role in underreporting and miscommunication during medical encounters. These factors lead to shorter appointments, less effective treatment plans, and decreased adherence.

• Intersection with Gender and Class:
  Migraine disproportionately affects women and for women of color, this burden is compounded. A Black woman from a low-income background may be more likely to have her symptoms dismissed as stress or depression, rather than properly investigated as a neurological condition.

What Physicians Can Do: From Awareness to Action

Improving migraine outcomes for marginalized communities doesn’t require a complete system overhaul it starts with intentional shifts in clinical awareness, communication, and care delivery.

1. Rethink Assumptions and Expand Diagnostic Curiosity

Implicit bias training is helpful but it must be paired with clinical curiosity. If a patient presents with chronic head pain and sensory sensitivity, resist the urge to attribute symptoms to stress or anxiety too quickly. Ask about light sensitivity, nausea, aura, and frequency. Remember: migraine symptoms can look different based on cultural expression or pain tolerance norms.

Practical Tip: Use inclusive screening tools like the ID-Migraine™ questionnaire (Lipton et al., 2003), available in multiple languages, to structure intake and improve consistency across patients.

2. Normalize Headache Conversations in Preventive Care

Many patients from marginalized backgrounds don’t report migraine unless explicitly asked, either due to stigma, normalization of pain, or language differences in describing symptoms.

Practical Tip: During routine exams, include simple questions :
"How many times in the last 90 days has migraine impacted your ability to work?"
This question can open the door for a deeper conversations especially when asked in a trauma-informed and non-judgmental way.

3. Bridge Gaps with Community Health Workers or Patient Navigators

Studies show that patient navigators improve care adherence and satisfaction in underserved populations. These team members can help patients overcome logistical barriers (transportation, insurance, prescription coverage), while also providing cultural context.

Practical Tip: If your clinic doesn't have access to navigators, partner with local health departments or nonprofits that offer support for neurological conditions or chronic illness management.

4. Improve Access with Tiered Treatment Options

Many first-line treatments for migraine, such as CGRP inhibitors or branded triptans, can be expensive or not fully covered by insurance. However, effective migraine care doesn’t have to be out of reach. A patient-centered approach can include neuro-modulation devices, behavioral therapies, lifestyle modifications, and culturally responsive non-pharmacological strategies such as hydration routines, dietary adjustments, stress reduction techniques, and sleep hygiene. These options are often more accessible and sustainable—especially when tailored to the individual’s environment, preferences, and lived experience.

Practical Tip: Create tiered treatment plans that include both prescription and non-prescription strategies, including hydration, sleep hygiene, stress reduction, and dietary changes—tailored to the patient’s actual living conditions and preferences.

5. Track and Audit Your Practice

What gets measured gets improved. Ask:

• Who is getting diagnosed with migraine in my practice?

• Are my treatment recommendations equitable across racial and income lines?

• Who is getting referrals to specialists?

Practical Tip: Use your EHR system to analyze headache-related visits by demographic data. If you notice gaps, bring the team together to discuss why and how you can close them.

Conclusion: It’s Not Just About Migraine. It’s About Equity.

When you listen differently, you lead differently. Migraine care isn’t just a neurological issue it’s a justice issue. By being more intentional, inclusive, and transparent in how we approach head pain in marginalized communities, we don’t just treat a disease we affirm dignity, strengthen trust, and make medicine work better for everyone.

At Irons Consulting Group, we help physicians and hospital leaders close the gap between symptom and story, checklist and care. When Iron Sharpens Iron, everyone gets stronger—together.

Stay tuned for next weeks blog as I continue sharing this journey of perseverance setbacks, small victories, and hope. Schedule a consultation here: https://ironsconsultinggroupllc.com/contactus

visit us @ironsconsultinggroupllc.com and follow us on social media.