Racial disparities found in migraine diagnosis for children and teens

Children and young people who are Black or Hispanic are less likely to be diagnosed with migraine than those who are white when being seen for headache in a pediatric emergency department, according to a study published in the February 5, 2025, online issue of Neurology^®, the medical journal of the American Academy of Neurology. The study also found they received fewer tests and less intensive treatment.

Migraine is disabling and can significantly impact a young person's quality of life, leading to problems in school performance, social activities and more. Without a proper diagnosis, medications that can help reduce migraine may be delayed. Unfortunately, our study found racial and ethnic disparities in the diagnosis, testing and treatment of migraine."

Marissa Maliakal Anto, MD, MSc, author of the University of Pennsylvania, Philadelphia

For the study, researchers reviewed data on emergency department visits at 49 children's hospitals over a seven-year period. They included 160,466 visits for headache by people age five to 21. Of those visits, 25% were by Black participants, 26% were by Hispanic/Latino participants and 41% were by white participants.

Researchers reviewed medical data to determine the diagnosis, testing and treatment for each participant.

For diagnosis, researchers found that Black and Hispanic participants were less likely to be diagnosed with migraine, with 28% of Black and 28% of Hispanic participants receiving a migraine diagnosis compared to 46% of white participants.

Researchers reviewed data on testing including magnetic resonance imaging (MRI) brain scans. Of the group, 4% of Black participants, 4% of Hispanic participants and 9% of white participants had an MRI. After adjusting for factors such as age, sex, and insurance type, researchers found Black participants were 44% less likely and Hispanic participants were 46% less likely to have an MRI than white participants.

For treatment, they found Black participants were 37% more likely and Hispanic participants 54% more likely to receive only oral medications without any intravenous medications when compared to white participants. Black participants were 20% less likely and Hispanic participants 35% less likely to be admitted to a hospital than white participants. However, they found that similar percentages of participants in all three groups received no medication.

"Headache is one of the most common symptoms at children's hospital emergency departments," said Anto. "More research is needed to understand how disparities in migraine diagnosis, testing and treatment affect children, teens and young people in the long term. Research is also needed to develop interventions to reduce these inequities."

A limitation of the study was the data was from children's hospitals within the United States so the results may not be the same in other countries or in settings such as non-pediatric emergency departments.