Disparities Across Sexual Orientation in Migraine Among US Adults

Abstract

Migraine affects 1 in 6 adults and represents the fifth leading cause of emergency department visits in the US. 1 Despite an increasing recognition of disparities in migraine prevalence by race/ethnicity, sex, and socioeconomic status, 1 there is a paucity of research on disparities by sexual orientation. Sexual minority groups (eg, lesbian, gay, bisexual, and other nonheterosexual people) may experience unique discrimination, stigma, and barriers to health care access, thus leading to disparities in physical and mental health. 2,3 The objective of this study was to determine the association between sexual orientation and migraine in a nationally representative sample of US adults.Methods | Cross-sectional, nationally representative data of US adults ages 31 to 42 years old from Wave V (calendar years 2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed from May 2020 to June 2020. The University of North Carolina institutional review board approved all study procedures, and written informed consent was obtained from all participants.Migraine was measured based on self-report in response to the interview question, "Have you ever had five or more headaches that were at least four hours long; one-sided, pulsating, intense, or worsened by activity; and associated with nausea, vomiting, or sensitivity to light or sound?" which was consistent with the International Classification of Headache Disorders, third edition diagnostic criteria for migraine without aura. 4 Sexual orientation was categorized into 3 categories: exclusively heterosexual; mostly heterosexual but somewhat attracted to people of one's own sex; or lesbian, gay, or bisexual, as has been previously categorized. 5 Logistic regression analysis was conducted using Stata version 15.1 (Stata-Corp) with sexual orientation as the independent variable and migraine as the dependent variable, adjusting for sex, race/ ethnicity, age, education, income, smoking, and alcohol use 1 and incorporating national sample weighting. 6

Sex and Gender Considerations in Episodic Migraine

“…To our knowledge, there are no intersectional analyses of episodic migraine [ 116 ]. Prior studies have found disparate rates of self-reported migraine based on race/ethnicity [ 117 ], socioeconomic status [ 116 ], and sexual orientation [ 118 ]. In addition, factors including income, health insurance status, and gender influence access to adequate headache management [ 119 ].…”

Capturing the experiences of sexual and gender minorities with migraine headache

“…For instance, this pivotal study did not collect data on participants’ sexual orientation or diverse gender identities beyond biological sex, making it impossible to draw any meaningful conclusions about the unique experiences of SGM individuals with migraine. This limitation is particularly important given emerging evidence suggesting that SGM individuals may experience a greater burden of migraine than their cis‐heterosexual peers 2,5 . By not identifying SGM individuals, the American Migraine Prevalence and Prevention Study failed to capture important information about prevalence, predictors, and pain management strategies related to migraine in this key demographic.…”

“…According to a recent study by Nagata et al, 2 sexual minorities (i.e., lesbian, gay, and bisexual people) have a 58% greater adjusted odds of migraine compared to those who identify as "exclusively heterosexual" 2 ; however, sexual minorities are not represented in the published statistics from existing large-scale epidemiological studies on migraine. 3 Gender minorities (e.g., transgender and non-binary individuals) are also not represented in this research.…”

“…4 SGM exist in the data, but because large observational studies have not asked about them explicitly, their experiences have gone unaddressed. According to burgeoning literature, 2,4,5 there is a substantial gap in how SGM experience and manage a comparatively increased migraine burden, demonstrating the need to be more inclusive of this subgroup in our epidemiological research.…”

Migraine, Migraine Disability, Trauma, and Discrimination in Sexual and Gender Minority Individuals

“… 1 Migraine is associated with a number of comorbidities, including higher rates of ischemic stroke, gastrointestinal disorders, and psychiatric disorders, which can contribute to further disability. 2 , 3 Studies suggest greater odds of migraine in presumably cisgender lesbian women, cisgender gay men, and bisexual people of any gender 4 , 5 ; however, little is known about migraine prevalence and severity in transgender and gender nonbinary individuals. Risk factors for migraine-associated disability in sexual and/or gender minority (SGM) individuals (an inclusive term used to describe individuals whose sexual orientation and/or gender identity do not align with societal expectations based on their birth-assigned sex, including, but not limited to, those who identify as lesbian, gay, bisexual, transgender, and queer) are also unknown.…”