Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Episodic Migraine and Underserved Populations

Curr Pain Headache Rep; ePub 2019 Feb 21; Najib, et al

Recent research has shown that the overall limitations of limited numbers of physicians with specialty training in headache disorders, and the socioeconomic implications of migraine disease have long been reported. With this in mind, researchers set out to examine various categories of underserved populations, consider the unique challenges faced by these groups, and discuss mechanisms to mitigate these challenges as much as possible. Key findings include:

  • The concept of “underserved” in the setting of migraine disease was broken into different categories, including financial, geographic, and cultural/racial.
  • Each underserved population has both shared and unique challenges and given the paucity of medical expertise throughout the US, the argument could be made that nearly all people with migraine disease are at risk for being underserved.
  • Therefore, epidemiologic, as well as therapeutic, research should incorporate analyses of these and any other underserved population to improve the application of study results across broad and varied populations whose commonality, in many cases, ends with sharing the same disease.

Najib U, Moore M, Watson D, et al. Unique considerations for special populations in episodic migraine: The underserved. [Published online ahead of print February 21, 2019]. Curr Pain Headache Rep. doi:10.1007/s11916-019-0749-1.


Migraine is a disease of lower socioeconomic status, with few available trained providers to treat this demographic. This study analyzes issues of poor care and lack of care by demographics, geography, economics, and distribution and training of providers. The investigators—who are headache medicine specialists at the West Virginia University Medicine Headache Clinic—specialize in caring for a rural underserved population. They found that the average distance their patients travel to see a provider was 70 miles one way; only 17.4% live locally and about a third of them were on Medicaid. A vicious cycle occurs when migraine itself makes a patient too sick to travel and when they do travel, costs incurred (gas, automobile maintenance, parking, food, and sometimes lodging) worsen their economic disadvantage. The physicians provide simple steps to take to try to lessen the current predicament, but improvements in access and care will require persistent thought and multi-pronged actions.—Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.