Objective: To examine the associations between perceived lifetime discrimination and discrimination in medical settings with migraine-specific quality of life in Black/African Americans with migraine.
Background: Perceived discrimination negatively impacts health outcomes and quality of life, particularly in minoritized populations. African Americans with migraine disease face compounded challenges due to limited access to specialized treatments and discrimination in medical settings, leading to disparities in migraine care and outcomes. However, few studies have investigated how perceived discrimination affects migraine-specific quality of life in this population. This study evaluated whether higher levels of perceived lifetime discrimination and discrimination in medical settings were associated with worse migraine-specific quality of life in Black/African Americans with migraine.
Methods: Black/African American adults with a migraine diagnosis (N = 91) were recruited from a tertiary headache center between October 2023 and April 2024 for this cross-sectional study. Participants underwent testing using validated research tools to measure migraine-specific quality of life (Migraine-Specific Quality-of-Life Questionnaire), lifetime perceived discrimination (Perceived Ethnic Discrimination Questionnaire-Community Version [PEDQ-CV]), and discrimination in medical settings (Discrimination in Medical Settings Scale [DMS]). Headache frequency and pain intensity were assessed via Migraine Disability Assessment items (MIDAS Item A and B). Associations between discrimination measures and migraine-specific quality of life, controlling for headache pain, frequency, and sex at birth were examined.
Results: Higher levels of lifetime perceived discrimination and discrimination in medical settings were significantly associated with worse migraine-specific quality of life (PEDQ-CV: β = -0.30, p = 0.004, 95% confidence interval [CI] -0.49 to -0.10; DMS: β = -0.27, p = 0.016, 95% CI -0.47 to -0.06), independent of headache frequency and sex at birth. Headache pain intensity was also significantly associated with poorer quality of life across models (β = -0.43, p < 0.001, 95% CI -0.63 to -0.23). Headache frequency and sex at birth were not significantly associated with outcomes. Together, discrimination measures and pain intensity accounted for 28.3-31.6% of the variance in migraine-specific quality of life.
Conclusions: Experiences of discrimination, both across the lifetime and within the medical setting, significantly impact migraine-specific quality of life in Black/African Americans. These findings highlight the critical need for interventions that reduce bias in migraine care, improve pain management, and address the psychosocial stress linked to discrimination. Future research should focus on investigating the pathways through which discrimination exacerbates health disparities and on developing multidisciplinary, culturally competent strategies to improve care and reduce inequities for minoritized populations.
Keywords: chronic pain; discrimination; disparities; health equity; migraine; quality of life.
© 2025 American Headache Society.