Diversity in Migraine 


Considerations for addressing current limitations in the diagnosis and management of migraine in black, indigenous, and people of color.

Jill Dehlin, RN: Dr Starling, does medical care differ for people who are Black, indigenous, or other people of color? If so, how?

Amaal J. Starling, MD: Yes, it does, and this has been demonstrated time and time again in studies. It has also been demonstrated specifically within headache medicine and migraine care. Especially in the pain literature, it has been demonstrated that people of color, and specifically Black Americans, have been found to be perceived as having less pain compared to white Americans. In headache medicine, people who are Black are being prescribed less aggressive migraine care, have less diagnosis of migraine, and thus are having poorer outcomes and higher amounts of burden and disability with respect to migraine. How do we address this as physicians and health care providers? We need to be aware of our implicit biases. It is very important for us, as physicians, to all have taken an implicit bias test to be aware of what our implicit biases are. It’s also crucial for us to understand the literature and the history of racism and medicine. 

A great book that I recommend is Medical Apartheid, by Harriet Washington. It’s a very difficult book to read, but it is important to read about the history of racism in medicine so that we understand what Black people in health care are dealing with and what their mindset is when they come to a physician. We need to know the things they’re thinking about, so that we can address both our biases, as well as patient concerns appropriately during that appointment. When we do that, hopefully, we can improve our diagnosis and be more aggressive in our treatment plans for Black, indigenous, or other people of color. 

The other area where it’s quite lacking is in research, and again, that’s 2-fold. We have to understand the history of Black people in America, how ugly medical research history has been, and why Black people are hesitant to participate in medical research. We also need to understand why it is so important for Black people to participate in headache medicine research. We have to troubleshoot and figure out how we can come to a solution to move forward, so that we can better address those social determinants of health care and improve migraine care in all individuals, including Black, indigenous, and other people of color.

Jill Dehlin, RN: Thank you. I have a lot of friends in the migraine community, and some of them are people who are Black, people of color. I’m always so fascinated to hear their stories. It hurts my heart to know that they’re not being treated the same as others in the migraine and health care space. It’s tough enough to get the care you need as a person with migraine, and then add to that these other stigmatizing things such as the color of your skin. It’s hard for me to wrap my head around.

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Transcript Edited for Clarity

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