“According to the study results from Loder et al., racial and ethnic minorities in the U.S. may not receive adequate medical care for headache treatment compared with whites [82]. Even after accounting for demographic and insurance differences, black people are 40% less likely to be treated by a neurologist than whites. On the other hand, they are more likely to end up in emergency departments due to undertreated migraine [83].” —Tana et al.
The symptoms of a migraine can be devastating and debilitating. Medically, migraine symptoms can include head pain, nausea, vomiting, chills, and dizziness. However, migraines are highly individual, and people with migraines can describe the experience as:
- Similar to a minor stroke
- Feeling like their head is being crushed and stabbed
- Even more severe than the worst pain they’ve ever experienced, all located in their head
- Including nausea like seasickness and sensitivity to stimuli
- Similar to someone squeezing and stabbing their eye
- Including hallucinations, nausea, and occasionally an intense headache
While migraine symptoms can be debilitating for anyone, they can be especially difficult for underserved patients and communities who may lack access to medication. Migraine symptoms can also be so severe that they incapacitate people, but many people are not in a position to take time away from responsibilities in order to recover and cope with symptoms.
Hyeia Medical wants to ally with people to help them navigate their migraine journeys and overcome some of the health disparities that might prevent them from receiving a diagnosis or treatment.
What is Health Equity? What are Health Disparities?
It isn’t easy to get a diagnosis and treatment for migraines. It requires visiting a doctor, sometimes a specialist, and trial and error to determine the best treatment. For many people, getting a diagnosis and treatment is more complex when compounded with issues related to health insurance, taking time off of work, distance to medical providers, affording co-pays, and more that may prevent them from accessing healthcare.
According to Healthy People 2030, an organization run by the U.S. Department of Health and Human Services, health equity is “the attainment of the highest level of health for all people”
despite health disparities. This includes making sure people have fair access to health insurance, medical providers, treatment, and medications. They define health disparities as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.”
Healthy People 2030 defines these disadvantages as obstacles people may face related to their:
- Race
- Ethnicity
- Religion
- Gender
- Age
- Disability
- Sexual orientation
- Geographic location
- Socioeconomic status
- and/or “other characteristics historically linked to discrimination or exclusion”
An example of a health disparity is that many people with marginalized identities may experience additional difficulties due to the stress that comes with being marginalized. This extra stress can lead to an increase in mental health issues, including anxiety and depression (which can also cause people to experience health disparities); if left untreated, they can lead to physical health issues such as asthma and heart disease.
Health disparities are unique to individuals, and everyone’s experiences with them will vary, but there are many that are common among people who experience migraines.
Healthcare Barriers
For many people, one of the first barriers to visiting the doctor is cost and health insurance. According to the U.S. Census Bureau, in 2022, almost 11% of working-age (19-64) Americans did not have health insurance. Hispanic individuals faced the highest lack of insurance with 23.4% of Hispanic individuals in the U.S. lacking insurance, followed by 11.4% of Black individuals lacking insurance.
For people without health insurance, visiting the doctor may be too expensive. A 2015 study showed that individuals without insurance were quoted an average of $160 for a new patient visit to a primary care doctor. After adjusting for inflation, that is equivalent to almost $210 in 2024.
Unfortunately, even if patients can access healthcare appointments, the struggles are not over.
Even within the process of getting an official migraine diagnosis, there are health disparities across different demographics. For example, 70% of White patients who experienced headaches received an official medical diagnosis of migraine, compared to only 47% of Black patients.
Additionally, Hispanic patients were 50% less likely to receive an official diagnosis compared to White patients, although there is no difference in the prevalence of migraine across different races.
It is important to note that without a migraine diagnosis, a patient cannot receive migraine-specific treatments, which is why barriers in the diagnostic stage are harmful.
For people who live with migraines, if they can overcome barriers to accessing a doctor, it is common for doctors to be dismissive of their symptoms. Social media has many cases of people documenting frustrating interactions with doctors dismissing their migraine symptoms with one Reddit user stating, “This [forum on migraines] has helped me more than any doctor so far.”
A contributing factor in these health disparities is that women are three to four times more likely than men to experience migraines, but women’s symptoms are much more likely to be “misdiagnosed or dismissed by doctors as something less critical.”
Another barrier to visiting the doctor is time. Many doctors’ offices are only open during “business hours”; naturally, this coincides with the business hours of other industries, meaning people may need to take time off of work in order to visit the doctor. This may present an extra financial burden on top of the burden of paying for the visit itself.
A 2015 study found that patients spent an average of two hours receiving medical care, including time waiting in the clinic, receiving care, and traveling. However, the average time increased for people who were Black, Hispanic, had less education, were in rural areas, were unemployed, or went outside of regular business hours.
Seeing a Specialist
After a migraine diagnosis, patients are typically sent to a specialist such as a neurologist, or a physician who specializes in brain disorders. For patients of color and from marginalized backgrounds, access to specialized care can be a challenge.
According to research published in the American Academy of Neurology Journal, there are substantial racial and ethnic disparities in neurological care and access. Race plays a major role in the health disparities present for those suffering from migraines in specialized care. For example, Black individuals are 40% less likely to get treatment from a neurologist and yet more likely to end up in an emergency room from migraine pain.
Another significant barrier to neurological care is cost. Seeing a specialist is generally more expensive than seeing a non-specialist. Individuals with high deductible insurance plans, or no insurance, may face high out-of-pocket costs. Moreover, according to the American Academy of Neurology, neurologic testing and medicine prices are sharply rising.
Patients may also face frustration from the additional testing, waitlist times, and energy that being referred to a specialist can lead to. Some people who have gone through a migraine diagnosis express hope of meeting a specialist along with the grievances and hardships of the process. Notably, the average wait time to see a neurologist is 35 days with no-show patient rates increasing as wait periods increase.
Receiving a Diagnosis
The health disparities seen in migraine diagnostic data are likely due to a variety of reasons such as:
- BIPOC (Black, Indigenous, and people of color) mistrust in the medical community
- Past discrimination when receiving medical care
- Underrepresentation of BIPOC in migraine research
Having medical professionals dismiss or undermine symptoms while trying to get an official medical diagnosis can be incredibly demeaning and act as a barrier to proper care.
Accessing Treatment
Prescriptions are a common treatment for migraine pain and frequency though not everyone receives prescriptions. According to the American Migraine Foundation, compared to 37% of White headache patients, only 14% of Black patients get prescriptions for acute migraine medications.
Migraines are considered an invisible illness, which is an illness, disability, or condition that cannot be seen by just looking at a person; you often wouldn’t be able to tell that someone experiences migraines if you were to pass them on the street. The invisibility of migraines and their symptoms can make the disease isolating. Some insurance companies may not recognize migraines enough to cover certain treatments. Advocating for coverage from insurance companies can be a lengthy and complicated process.
Existing within a marginalized community can worsen the feelings of isolation that come from the migraine experience and treatment process. Hyeia Medical provides a bridge between healthcare providers and patients to combat health inequity. At Hyeia, our focus is on ways to lessen medical hardships and simplify treatment access.
