Research Shows Treatment Disparities Affect Patients With Headache Disorders

A review of literature on headache and health care disparities shows how disparities in race, ethnicity, socioeconomic status, geography, and other factors contribute to the inequitable treatment of those diagnosed with headache disorders. The article was published in Neurology, the medical journal of the American Academy of Neurology.

To receive care for headache disorders, patients must be able to access a health care provider, receive an accurate diagnosis, and then be assigned an appropriate treatment plan. However, the percentage of patients who successfully navigate these steps and receive care is low, amounting to 26.3% for those with episodic migraine and less than 5% for those with chronic migraine.

Disparities that affect accessibility to headache-oriented treatment further impede patients seeking medical help, which impacts diagnoses, prevalence rates, treatments, and outcomes. These inequities worsen untreated health issues for those who fail to receive appropriate care.

Although the prevalence of patients experiencing severe headache and migraine is generally similar among White populations (15.5%), African American populations (15%), and Hispanic populations (14.9%), the degree to which each population receives care differs dramatically. African American and Hispanic patients, for instance, are 25% and 50% less likely to receive a migraine diagnosis than White patients, respectively.

Among racial and ethnic groups, American Indians and Alaska Natives (AIAN) have the highest prevalence of migraine and headache disorders, Latinos have the greatest headache and neurologic needs, and African American men receive the least care for headache disorders.

Populations of color from a low socioeconomic background are especially at risk of health disparities, as migraine prevalence is strongly associated with annual household income. Patients who have low incomes or who are uninsured are less likely to receive acute migraine treatment, while this lack of treatment can lead to the development of chronic migraine.

An unequal geographical distribution of headache specialists, fellowship programs, and practice locations leads to an inability to accommodate patients with headache across the nation. Urban areas are home to most headache fellowship programs, and many fellow graduates remain geographically close to the same region where they trained, resulting in a lower density of headache specialists in rural areas. As a result, rural Americans experience longer average wait times and a larger loss of income because of time taken off work to seek headache treatment.

The legal regulatory environment in which health care systems operate, the management of health care systems, and racial discrimination also perpetuate patterns of inequitable care for those seeking treatment for headache disorders. Over 33% of African Americans and more than 1 in 5 AIAN individuals report experiencing discrimination in clinical environments, while 22% of African Americans and 15% of AIAN individuals avoid seeking health care altogether due to anticipation of discrimination.

Exposure to adverse childhood experiences are disproportionately higher in communities of color and have detrimental effects on neurological outcomes, again contributing to treatment disparities. Exposure to physical abuse, emotional abuse, and sexual abuse can lead to more frequent headache and a higher risk of migraine.

The failure to recruit representative samples when conducting clinical trials has contributed to the paucity of research in health care disparities among different populations, as samples for research overwhelmingly include White, wealthy, and female participants. Experts recommended that researchers recruit individuals from underrepresented groups when conducting clinical trials to learn more about how treatment disparities limit individuals.

Experts proposed a series of other solutions for mitigating inequitable care practices, including utilizing telemedicine to ease geographic disparities, educating primary care physicians, screening patients for social determinants of health to better satisfy specific needs, addressing issues around health literacy, and increasing funding to support headache research.

Reference

Kiarashi J, VanderPluym J, Szperka CL, et al. Factors associated with, and mitigation strategies for, healthcare disparities faced by patients with headache disorders. Neurology. Published online June 9, 2021. doi:10.1212/WNL.0000000000012261