Skip to main content


Log in

Unique Considerations for Special Populations in Episodic Migraine: the Underserved

  • Episodic Migraine (S. Nahas, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript


Purpose of Review

People with migraine disease face many challenges, and these challenges can be magnified when someone is part of an “underserved” population. We 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.

Recent Findings

Very little research has been performed to specifically evaluate underserved populations related to people with migraine disease. Recent research has shown 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.


Even the definition of “underserved” is not completely clear. We undertook to define this concept in the setting of migraine disease, breaking into different categories, including financial, geographic, and cultural/racial. Each underserved population has both shared and unique challenges, and in reality, given the paucity of medical expertise throughout the United States, one could make the argument that nearly all people with migraine disease are at risk for being underserved. In the future, 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Bigal ME, Lipton RB, Winner P, Reed ML, Diamond S, Stewart WF. Migraine in adolescents – association with socioeconomic status and family history. Neurology. 2007;69:16–25.

    Article  CAS  Google Scholar 

  2. Headache disorders. Accessed 20 June 2018.

  3. Medically Underserved Areas and Populations (MUA/Ps). Accessed 20 June 2018.

  4. • Mauser ED, Rosen NL. So many migraines, so few subspecialists: analysis of the geographic location of United Council for Neurologic Subspecialties (UCNS) certified headache subspecialists compared to United States headache demographics. Headache. 2014;54:1347–57 An excellent evaluation of the distribution of headache medicine certified specialists and the overall inadequacy in number.

    Article  Google Scholar 

  5. UCNS Diplomates Certified in Headache Medicine. Accessed 20 June 2018.

  6. AAN Press release. The doctor won’t see you now? Study: US facing a neurologist shortage. Accessed 20 June 2018.

  7. Migraine Research Foundation. Migraine fact sheet. New York: MRF; 2016.

    Google Scholar 

  8. Bonafede M, Sapra S, Shah N, Tepper S, Cappell K, Desai P. Direct and indirect healthcare resource utilization and costs among migraine patients in the United States. Headache. 2018;58(5):700–14.

    Article  Google Scholar 

  9. Hawkins K, Wang S, Rupnow MF. Indirect cost burden of migraine in the United States. J Occup Environ Med. 2007;49:368–74.

    Article  Google Scholar 

  10. Bloudek LM, Stokes M, Buse DC, Wilcox TK, Lipton RB, Goadsby PJ, et al. Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS). J Headache Pain. 2012;13:361–78.

    Article  CAS  Google Scholar 

  11. Schultz AB, Chen CY, Edington DW. The cost and impact of health conditions on presenteeism to employers: a review of the literature. PharmacoEconomics. 2009;27:365–78.

    Article  Google Scholar 

  12. Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med. 2004;46(4):398–412.

    Article  Google Scholar 

  13. Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: figures and trends from government health studies. Headache. 2018;58(4):496–505.

    Article  Google Scholar 

  14. Friedman BW, Serrano D, Reed M, Diamond M, Lipton RB. Use of the emergency department for severe headache. A population-based study. Headache. 2009;49:21–30.

    Article  Google Scholar 

  15. Wilper A, Woolhandler S, Himmelstein D, Nardin R. Impact of insurance status on migraine care in the United States: a population-based study. Neurology. 2010;74:1178–83.

    Article  Google Scholar 

  16. • Loder S, Sheikh HU, Loder E. The prevalence, burden, and treatment of severe, frequent, and migraine headaches in US minority populations: statistics from national survey studies. Headache. 2015;55:214–28 A good evaluation of migraine disease prevalence in minorities in the US.

    Article  Google Scholar 

  17. Luan Erfe BM, Siddiqui KA, Schwamm LH, Kirwan C, Nunes A, Mejia NI. Professional medical interpreters influence the quality of acute ischemic stroke care for patients who speak languages other than English. J Am Heart Assoc. 2017;6(9):e006175.

    Article  Google Scholar 

  18. Tschurtz BA, Koss RG, Kupka NJ, Williams SC. Language services in hospitals: discordance in availability and staff use. J Healthc Manag. 2011;56:403–17.

    Article  Google Scholar 

  19. Hsieh E. Not just “getting by”: factors influencing providers’ choice of interpreters. J Gen Intern Med. 2015;30:75–82.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to David Watson.

Ethics declarations

Conflict of Interest

Umer Najib, David Watson, and Melissa Moore declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Episodic Migraine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Najib, U., Moore, M. & Watson, D. Unique Considerations for Special Populations in Episodic Migraine: the Underserved. Curr Pain Headache Rep 23, 9 (2019).

Download citation

  • Published:

  • DOI: