Ethnicity Influences Migraine Care Quality Among Diverse Patients — Evidence Review

People from ethnic minority backgrounds in the UK are more likely to report poor migraine care and discrimination, according to a new survey by the Migraine Trust. Most related studies confirm persistent disparities in headache and pain care by ethnicity, though the magnitude and nature of these disparities can vary by setting and condition.

• Several studies indicate that Black and minority ethnic patients are less likely to receive certain migraine treatments, such as opioid analgesics, and report poorer communication with healthcare providers compared to White patients 1 2.
• Some research finds no major racial differences in the prescribing of recommended migraine medications, but overall migraine care remains suboptimal for all groups, with undertreatment and misdiagnoses common 5 6.
• Broader literature consistently documents ethnic disparities in healthcare access and use across various conditions, suggesting that the new findings reflect a wider pattern of inequities in the healthcare system rather than being unique to migraine care 7 8 10 11.

Study Overview and Key Findings

Inequities in healthcare access and treatment for chronic conditions are a well-documented concern in the UK and globally. Migraines affect about one in seven people in the UK, and appropriate care is essential for quality of life and reducing disability. This new survey by the Migraine Trust highlights not only differences in treatment experiences based on ethnicity, but also concerns about discrimination, career impact, and the intersection of gender and social status with migraine care. These findings come at a time of increasing focus on health equity and the need for system-wide changes.

Property	Value
Organization	Migraine Trust
Population	People with migraines from various ethnic backgrounds
Sample Size	n=2200
Methods	Observational Study
Outcome	Impact of ethnicity on migraine care and treatment experiences
Results	23% of mixed-ethnicity and 19% of Asian respondents reported negative care

Literature Review: Related Studies

To situate these findings within the broader research context, we searched the Consensus paper database, which indexes over 200 million research papers. The following queries were used:

1. migraine care ethnicity disparities
2. negative migraine care experiences
3. ethnic differences in healthcare access

Summary Table of Key Topics and Findings

Topic	Key Findings
Do ethnic disparities exist in migraine care and pain management?	- Physicians are less likely to prescribe opioids for migraines to Black patients, especially for conditions with fewer objective findings 1. - Disparities exist in healthcare utilization, diagnosis, and perceived physician communication between Caucasian and African American migraine patients 2.
How do racial and ethnic disparities in healthcare access and use affect chronic disease management?	- Racial and ethnic disparities in healthcare access have persisted and, for some groups, increased over time, despite socioeconomic and insurance adjustments 7 8 10 11. - Disparities in pediatric readmission rates for migraines are present but show complex patterns across conditions and ethnicities 4.
Is migraine care suboptimal or undertreated for certain groups, regardless of ethnicity?	- Migraine is often undertreated across populations, with low use of recommended prophylactic and acute medications, but no major racial/ethnic differences in abortive or prophylactic treatment detected in some US studies 5 6. - Patients commonly report reluctance to seek care and frequent misdiagnosis 6.
What are the patient-reported experiences and barriers to migraine care?	- Many migraine patients, particularly from minority backgrounds, fear not being believed, discrimination, or negative career impacts 2 6. - Mistrust in the healthcare system and poor perceived communication are more common in minority groups 2.

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Do ethnic disparities exist in migraine care and pain management?

Multiple studies have explored whether ethnic minorities receive the same quality of migraine and pain care as White patients. The evidence indicates that disparities exist, particularly regarding the prescription of opioid analgesics and overall satisfaction with care. The Migraine Trust's findings that ethnic minority patients report poorer care and discrimination are consistent with these studies.

• Black patients are less likely to be prescribed opioid analgesics for migraines and back pain compared to White patients, suggesting provider bias in conditions where symptoms are less objectively measurable 1.
• Disparities are not limited to prescriptions; minority patients also report less effective communication and greater mistrust towards healthcare providers 2.
• Some single-institution studies find no significant difference in the overall administration of analgesics for migraine, but disparities may still be present in specific clinical scenarios 3.
• Disparities in migraine care are part of a broader pattern observed in other pain-related conditions, reinforcing the need to address systemic biases 1 2 3.

How do racial and ethnic disparities in healthcare access and use affect chronic disease management?

Research consistently demonstrates that ethnic disparities in healthcare access and utilization persist across many chronic diseases, including migraine. These disparities are only partially explained by socioeconomic factors or insurance status and may be widening for some groups.

• Longitudinal data show that healthcare access gaps by ethnicity have increased for some groups, particularly Black and Hispanic populations, even after accounting for income and insurance 7 8.
• Disparities in readmission rates for chronic pediatric conditions, including migraine, vary by condition and do not always consistently disadvantage one group, but ethnic differences remain evident 4.
• Policy interventions such as the Affordable Care Act have improved access for some groups but have not eliminated disparities, especially for Black patients 11.
• These patterns suggest that the inequities in migraine care reported by the Migraine Trust are part of a larger, persistent challenge in the healthcare system 7 8 10 11.

Is migraine care suboptimal or undertreated for certain groups, regardless of ethnicity?

Several studies highlight that migraine care is suboptimal for many patients, with issues like underdiagnosis, undertreatment, and poor adherence to guidelines seen across all ethnic groups. However, the presence and size of ethnic disparities in the quality of migraine management vary between studies and settings.

• In US ambulatory care, the use of both prophylactic and acute migraine medications is generally low for all groups, with no statistically significant differences across major racial/ethnic groups in some analyses 5.
• Patient-reported experiences consistently show high rates of misdiagnosis, reluctance to seek care, and dissatisfaction with provider response, regardless of ethnicity 6.
• Gender and age can intersect with ethnicity, compounding barriers to care for certain populations, as highlighted in both the Migraine Trust survey and related research 6.
• While the magnitude of disparities can differ, the overall quality of migraine care remains a concern for all patients 5 6.

What are the patient-reported experiences and barriers to migraine care?

Patient-reported barriers—including fear of not being believed, concerns about discrimination, and the impact of migraine on employment—are significant for people with migraine, especially from ethnic minority backgrounds. These qualitative aspects are less often captured in large administrative datasets but are highlighted by both the new study and recent qualitative surveys.

• Minority patients more frequently report worries about discrimination and skepticism from providers regarding their symptoms 2 6.
• Many patients, regardless of ethnicity, delay seeking care due to prior negative experiences or perceptions that providers will not take their symptoms seriously 6.
• The Migraine Trust study underscores the added burden for ethnic minority and female patients, who may face both gender and race-based stereotypes about pain tolerance [news article context].
• Addressing these barriers requires not only clinical improvements but also broader changes in provider training and healthcare culture 2 6.

Future Research Questions

Despite growing recognition of disparities in migraine care, several important questions remain. Future research should address the underlying causes of these disparities, evaluate interventions, and explore patient experiences in more depth to inform policy and clinical practice.

Research Question	Relevance
What are the underlying causes of ethnic disparities in migraine care?	Understanding whether disparities stem primarily from provider bias, systemic factors, patient mistrust, or access issues is essential for designing effective interventions 1 2 7 8.
Which interventions effectively reduce racial and ethnic disparities in migraine treatment?	There is limited evidence on which policies or clinical strategies close care gaps, and rigorous evaluation of interventions is needed to guide practice and policy 11.
How do gender, age, and socioeconomic status intersect with ethnicity to influence migraine care?	The combined impact of multiple identities on healthcare experiences is underexplored and may reveal unique patterns of disadvantage requiring tailored solutions 2 6.
What are the long-term outcomes of migraine patients from different ethnic backgrounds receiving current UK care?	Longitudinal studies are needed to assess whether disparities in care translate into differences in health outcomes, disability, or quality of life over time 4.
How do patient perceptions of discrimination and trust in providers affect healthcare-seeking behavior for migraine?	Qualitative research can clarify how fear of discrimination or mistrust shapes patients' willingness to seek care, which may perpetuate disparities in diagnosis and treatment 2 6.