Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
J Natl Med Assoc. 2021 Apr;113(2):223-229. doi: 10.1016/j.jnma.2020.09.148. Epub 2020 Nov 5.
The goal of this paper is to give a narrative review of the racial/ethnic disparities in African-Americans (AA) found in headache medicine and provide plausible responses to the National Institute of Neurological Disorders and Stroke (NINDS) issued Request for information (RFI); "Soliciting Input on Areas of Health Disparities and Inequities in Neurological Disease and/or Care in the United States (US)" as it relates to AA and headache medicine.
On March 31, 2020 the NINDS issued a RFI "Soliciting Input on Areas of Health Disparities and Inequities in Neurological Disease and/or Care in the US Across the Lifespan", RFI-NOT-NS-20-026, with response date ending June 15, 2020. However as of June 13, 2020, a PubMed search with key terms "African American Headache disparities" yielded few results.
Multi-database search and literature review.
RESULTS/DISCUSSION: As of June 13, 2020, a PubMed search with key terms "African American (or Black) Headache disparities" yielded 13 results. Searches of "Migraine Disparities Race" and "Migraine disparities African American" both yielded three results with one non-specific for migraine. In, "Headache disparities race" yielded one result in the PsycINFO database and 23 results in Web of Science database. Key areas of adult headache disparity and/or inequity were health care services for migraine treatment are less utilized, follow-up appointments are terminated more regularly, inaccurate diagnoses are more common, acute migraine attack medications are prescribed less frequently, mistrust and lower quality communication with physicians is reported, mistrust, increased migraine burden, frequency, and severity and risk for progression more associated depression and lower quality of life in AAs compared to non-Hispanic Whites. Literature on race-based disparities is even more scarce in pediatric populations, however it has been shown that white children are significantly more likely to receive neuroimaging than others which may indicate biases in pediatric populations. Potential determinants of these race-based disparities, research strategies and approaches vary and are discussed.
Race-based disparities exist in headache medicine in the US. Research is needed. Research strategies and approaches currently with limited use in neurology and headache medicine may be warranted and appropriate to address race-based headache disparities. Funding is paramount.
本文旨在对非裔美国人（AA）在头痛医学领域的种族/民族差异进行叙述性综述，并对美国国立神经病学与卒中研究所（NINDS）发布的信息请求（RFI）“就美国神经疾病和/或护理中的健康差异和不平等领域征求意见（美国）”做出合理回应，该 RFI 与 AA 和头痛医学有关。
2020 年 3 月 31 日，NINDS 发布了 RFI“就美国全生命周期神经疾病和/或护理中的健康差异和不平等领域征求意见（美国）”，RFI-NOT-NS-20-026，截止日期为 2020 年 6 月 15 日。然而，截至 2020 年 6 月 13 日，使用关键词“非裔美国人头痛差异”在 PubMed 上进行的搜索结果很少。
多数据库搜索和文献综述。
结果/讨论：截至 2020 年 6 月 13 日，使用关键词“非裔美国人（或黑人）头痛差异”在 PubMed 上进行的搜索结果为 13 项。搜索“偏头痛差异种族”和“偏头痛差异非裔美国人”均产生了 3 项结果，其中一项与偏头痛无关。在“头痛差异种族”中，PsycINFO 数据库中有一项结果，Web of Science 数据库中有 23 项结果。成人头痛差异和/或不平等的主要领域是偏头痛治疗的医疗保健服务利用率较低，后续预约更频繁地终止，诊断不准确更常见，急性偏头痛发作药物更频繁地开处方，报告与医生的信任度和沟通质量较低，非裔美国人与非西班牙裔白人相比，报告的信任度、偏头痛负担增加、频率、严重程度和进展风险增加、抑郁和生活质量较低。关于基于种族的差异的文献在儿科人群中更为稀缺，然而，已经表明白人儿童接受神经影像学检查的可能性明显高于其他儿童，这可能表明儿科人群存在偏见。这些基于种族的差异的潜在决定因素、研究策略和方法各不相同，并进行了讨论。
美国头痛医学中存在基于种族的差异。需要进行研究。目前在神经病学和头痛医学中使用有限的研究策略和方法可能是必要的，并且适合解决基于种族的头痛差异。资金是至关重要的。
