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Migraine Headaches, Black Men, And What Stands In the Way of Healing

False and outdated beliefs about pain perception in Black people have resulted in health disparities at every level.

Headaches, even severe ones like a migraine, are a common occurrence in the United States. While, 903,00 and 1.5 million African American men experience migraine disorder, it continues to be underdiagnosed in some patients of color. In fact, only 47% of African American patients with headaches have an official diagnosis compared with 70% of white patients.

Yet, a closer look at the numbers shows that prevalence rates are similar among Black and white populations "16.3% and 15.5% respectively—meaning currently there are between 7.3 -7.5 million African Americans with migraine disorder in the United States," says L. Charleston IV, MD, MSc, FAHS, director, Headache Medicine, and Facial Pain, Department of Neurology and Ophthalmology Michigan State University College of Human Medicine.

"While there's s no data to specifically indicate why there is misdiagnosis /underdiagnosis of migraine in African Americans; it is suggested that implicit/unconscious biases and perhaps false beliefs about pain may play a role," he says. Although that may sound like outdated narratives, a 2016 study found those opinions are still pervasive. Researchers noted that, among other things, white participants, including medical students and residents, believed Black people have thicker skin or less sensitive nerve endings than white people. Furthermore, the study stated, “that racial bias in pain perception is associated with racial bias in pain treatment recommendations."

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While the stats above are significant, since studies are limited for African American men and headaches, it is challenging to understand how many are truly affected. "It is also suggested that African American men are not seen in the ambulatory setting (outpatient) for headaches – either they are not receiving any care for headaches, or they are being disproportionately seen in emergency rooms," says Dr. Charleston. "At the same time, women are far more likely to be diagnosed with migraine disorder more than men, suggesting that gender bias in diagnosis may be an important barrier for men," he says.

Still, while hormones may play a role, there isn't 100% clarity as to the reasons for prevalence differences between sexes in different headache syndromes—additionally, representation matters. "We need more Black men as headache medicine providers and researchers," says Charleston.

Peeling Back the Layers

Here are the four phases of a migraine and the symptoms that accompany them.

Prodrome (pre-headache)

This phase can last a few hours and even continue for several days. Most people with a migraine headache will go through this phase but won’t necessarily do so every time.

Symptoms

  • depression or irritability
  • light and sound sensitivity
  • insomnia,
  • nausea, constipation or diarrhea
  • muscle stiffness
  • yawning
  • cravings for certain foods
  • frequent urination

Aura

About 25-30% of people who have a migraine experience the aura phase which can last from 5 to 60 minutes. However, it may not happen every time. According to the American Migraine Foundation, in about 20% of people, the aura may last longer than 60 minutes. Though it typically precedes a migraine, it can also occur after the headache has already started.

Symptoms

  • blurry vision, vision loss
  • blind spots in one or both eyes
  • appearance of geometric shapes, spots or stars
  • tingling or numbness in the face, body, hands, and fingers
  • unable to say the right words, slurring or mumbling

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Headache

During the headache phase of a migraine you may have pain on one or both sides of the head. “The headache phase usually lasts 4-72 hours if untreated or unsuccessfully treated,” says Dr. Charleston. The pain can feel like throbbing or pulsing, starting on one side and moving to the other.

Symptoms

  • pain
  • nausea
  • insomnia
  • anxiety
  • sensitivity to light, sound and smell
  • lightheadedness

Post-drome/ Resolution Phase

This phase is also referred to as the “migraine hangover,” and occurs 80% of the time. However, even though the headache is over, you are still having a migraine, and the American Migraine Foundation recommends avoiding triggers like bright lights and strong smells; you find relief during the postdrome phase by relaxing, meditation, yoga, or drinking water and avoiding stress.

Symptoms of postdrome

  • fatigue
  • body aches
  • trouble focusing
  • dizziness
  • sensitivity to light

“Migraine is a syndrome and a complex neurological disease for which there isn’t a cure, but there are treatments,” says Dr. Charleston. These include acute “abortive” (medications taken as soon as the migraine starts), preventive treatments, and traditional non-pharmacological methods such as behavioral treatments like cognitive behavior therapy, biofeedback and relaxation techniques. “A comprehensive plan may include all three treatment modalities,” he says. Since treatment may need to be individualized, it is best to speak with your doctor about what is best for you. “If headaches interfere with daily activities, it may be time to seek medical care.”

To learn more about migraines and other headache disorders or find a specialist, check out the American Migraine Foundation.

Editor's note: An earlier version of the article inaccurately stated that women are diagnosed at a higher rate for cluster headaches than men. BET.com apologizes for the error. 

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