A large-scale study analyzing emergency department visits across 49 U.S. children's hospitals has uncovered significant racial and ethnic disparities in the diagnosis and treatment of pediatric migraine. The research, published in Neurology, examined 160,466 emergency department encounters between 2016 and 2022, revealing concerning gaps in care delivery among different demographic groups.
The study found striking differences in migraine diagnosis rates, with 45.5% of non-Hispanic White children receiving a migraine diagnosis compared to only 28.2% of non-Hispanic Black children and 28.3% of Hispanic/Latino children. These disparities persisted even after controlling for various demographic and clinical factors.
Diagnostic Testing Disparities
Analysis of diagnostic procedures showed marked inequities in access to advanced imaging. Non-Hispanic Black children had 44% lower odds of receiving an MRI scan (adjusted odds ratio [aOR] 0.56; 95% CI, 0.46–0.69) compared to their White counterparts. Similarly, Hispanic/Latino children showed 46% lower odds of undergoing MRI evaluation (aOR 0.54; 95% CI, 0.36–0.82).
"Migraine is disabling and can significantly impact a young person's quality of life, leading to problems in school performance, social activities, and more," explains study author Marissa Maliakal Anto, MD, MSc, from the University of Pennsylvania. "Without a proper diagnosis, medications that can help reduce migraine may be delayed."
Treatment Intensity Variations
While the study found no significant differences in the proportion of children receiving no headache-related medication across racial groups, important disparities emerged in treatment intensity. Non-Hispanic Black and Hispanic/Latino children were more likely to receive only oral medications instead of intravenous treatments. Black children showed a 37% increased likelihood (aOR 1.37; 95% CI, 1.2–1.56) and Hispanic children a 54% increased likelihood (aOR 1.54; 95% CI, 1.34–1.76) of receiving less intensive treatment options.
Additionally, both Black and Hispanic children had lower odds of hospital admission, with Black children showing 20% lower odds (aOR 0.80; 95% CI, 0.66–0.97) and Hispanic children 35% lower odds (aOR 0.65; 95% CI, 0.44–0.94) compared to White children.
Clinical Implications and Future Directions
The findings highlight a pressing need for targeted interventions to address these healthcare disparities. The study's patient population was predominantly female (59.8%) with a median age of 13 years, representing a crucial developmental period where proper diagnosis and treatment of migraine are essential for long-term health outcomes.
"Headache is one of the most common symptoms at children's hospital emergency departments," notes Dr. 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."
While the study's focus on children's hospitals may limit its generalizability to other healthcare settings, the findings provide compelling evidence for the need to address systematic disparities in pediatric headache care. The results call for immediate action to ensure equitable access to appropriate diagnostic testing and treatment options for all children, regardless of their racial or ethnic background.
