Race, psychiatric comorbidity, and headache characteristics in patients in headache subspecialty treatment clinics

Heckman, Bernadette Davantes; Merrill, Jennifer C.; Anderson, Timothy

doi:10.1080/13557858.2012.682219

Cited by 9 publications

(11 citation statements)

References 58 publications

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“…We found concordant results with the African American race being independent predictor of pLOS compared to the Caucasians. 12 Anxiety, mood, and personality disorders are known to be associated with migraine in prospective studies. [13][14][15] Prevalence of depression in migraine has been reported as high as 28.1%.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Prolonged Hospital Stay in Status Migrainosus

Modi

Dharaiya

Katramados

et al. 2016

The Neurohospitalist

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We were able to identify several factors associated with pLOS in status migrainosus. Most of the factors we found were similar to those known to increase the prevalence and severity of migraine in the general population. Knowledge of these factors may help physicians identify high-risk patients to institute early migraine abortive and prophylactic treatment in order to shorten the length of hospital stay.

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Section: Discussionmentioning

confidence: 99%

“…We found concordant results with the African American race being independent predictor of pLOS compared to the Caucasians. 12…”

Section: Discussionmentioning

confidence: 99%

Predictors of Prolonged Hospital Stay in Status Migrainosus

Modi

Dharaiya

Katramados

et al. 2016

The Neurohospitalist

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“…Yet in AA, health care services for migraine treatment are less utilized, follow-up appointments are terminated more regularly, inaccurate diagnoses are more common, acute migraine attack medications are prescribed less frequently, and mistrust and lower quality communication with physicians is reported (7). Moreover, the burden of migraine is increased in AA: Migraine is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to NHW (8,9). Given that, when treated, AA appear to respond to medications as well as NHW (9,10), high quality treatment may reduce these disparities.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the burden of migraine is increased in AA: Migraine is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to NHW (8,9). Given that, when treated, AA appear to respond to medications as well as NHW (9,10), high quality treatment may reduce these disparities.…”

Section: Introductionmentioning

confidence: 99%

Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care?

Charleston

Burke

2017

Cephalalgia

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Background Racial disparities in migraine have been reported in the US. Migraine in African Americans (AA) is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to non-Hispanic Whites (NHW). It is possible that racial differences in prescribing practices contribute to these differences, but little is known about the quality of migraine prescribing patterns in the US or whether racial differences exist. Objective To determine if racial differences in quality of migraine medical prescription care exist. Methods We used data from the National Ambulatory Medical Care Survey to estimate differences in the use of migraine prophylactic and abortive medications by race. Quality of migraine care was defined using the American Academy of Neurology Headache Quality Measure Set (AAN-HQMS). Patients were assigned to one of four categories representing the overall quality of evidence for their abortive and prophylactic medications using the AAN-HQMS. We hypothesized that there would be suboptimal migraine treatment in minority populations. Racial comparisons were made using descriptive statistics after applying NAMCS survey weights. Results Two thousand, eight hundred and sixty visits were included in the study, representing approximately 50 million migraine visits in the US from 2006-2013. In all, 41.3% of AA, 40.8% of NHW, and 41.2% of Hispanic (HI) patients received no prophylactic treatments ( p = 0.99). A total of 18.8% of AA patients, 11.9% of NHW patients, and 6.9% of HI patients received exclusively Level A prophylaxis ( p = 0.30). A total of 47.1% of AA patients, 38.2% of NHW patients, and 36.3% of HI patients received no abortive treatments ( p = 0.23). In total, 15.3% of AA patients, 19.4% of NHW patients, and 17.7% of HI patients received any Level A abortives (i.e. triptans or Dihydroergotamine; DHE, p = 0.64). A total of 15.2% of all patients had a prescription for opiates, but there were no racial differences. Conclusions Migraine may be undertreated with prophylactic medications. Level A acute analgesics may be underused and opiates overused. No major racial/ethnic differences in abortive or prophylactic treatment were identified.

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“…41 In a multi-headache specialty clinic study, AAs with chronic headache disorders were more likely to be diagnosed with major depressive disorders and anxiety than White counterparts. 42 We are unaware if microaggression is an underlying factor to this headache disparity or if this relationship has been investigated. Explicit biases are thoughts and feelings that people deliberately think about and can make conscious reports about.…”

Section: Inherent and Potential Challengesmentioning

confidence: 99%

Equity of African American Men in Headache in the United States: A Perspective From African American Headache Medicine Specialists (Part 1)

2020

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Migraine and severe headache affect approximately 1 in 6 U.S. adults and migraine is one of the most disabling disorders worldwide. Approximately 903,000 to 1.5 million African American (AA) men are affected by migraine in the United States. Racial disparities in headache medicine exist. In addition, there are limited headache studies that attest to the inclusion of or have robust data on AA men in headache medicine in the United States. Racial concordance between provider and patient may ameliorate some aspects of care disparities. Moreover, it has been demonstrated that diversity and inclusion particularly in leadership of organizations has consistently produced positive change, increased innovation, and long‐term success. Most national headache organizations strive to improve the care and lives of people living with headache disorders yet only ~0.5% of their physician members are AA men. Herein, we provide an observation of equity issues from the perspective of AA men in the headache medicine subspecialty. Part 1 of this manuscript explores inherent and potential challenges of the equity of AA men in headache medicine including headache disparities, mistrust, understudied/lack of representation in research, cultural differences, implicit/explicit bias, and the diversity tax. Part 2 of this work offers possible solutions to achieve equity for AA men in headache including: (1) addressing head and facial pain disparities and mistrust in AA men; (2) professionalism and inclusion; (3) organizational/departmental leadership buy‐in for racial diversity; (4) implicit/explicit and other bias training; (5) diversity panels with open discussion; (6) addressing diversity tax; (7) senior mentorship; (8) increased opportunities for noteworthy and important roles; (9) forming and building alliances and partnerships; (10) diversity leadership training programs; (11) headache awareness, education, and literacy with focus to underrepresented in medicine trainees and institutions; and (12) focused and supported the recruitment of AA men into headache medicine. More work is needed for equity of AA men in headache medicine.

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Race, psychiatric comorbidity, and headache characteristics in patients in headache subspecialty treatment clinics

Abstract: Additional research on race, psychiatric comorbidity, and headache characteristics is needed that can inform culturally contextualized interventions for persons with severe headache disorders.

Cited by 9 publications

References 58 publications

Predictors of Prolonged Hospital Stay in Status Migrainosus

Predictors of Prolonged Hospital Stay in Status Migrainosus

Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care?

Equity of African American Men in Headache in the United States: A Perspective From African American Headache Medicine Specialists (Part 1)

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