Disparities Across Sexual Orientation in Migraine Among US Adults

Migraine affects 1 in 6 adults and represents the fifth leading cause of emergency department visits in the US.¹ Despite an increasing recognition of disparities in migraine prevalence by race/ethnicity, sex, and socioeconomic status,¹ there is a paucity of research on disparities by sexual orientation. Sexual minority groups (eg, lesbian, gay, bisexual, and other nonheterosexual people) may experience unique discrimination, stigma, and barriers to health care access, thus leading to disparities in physical and mental health.^2,3 The objective of this study was to determine the association between sexual orientation and migraine in a nationally representative sample of US adults.

Cross-sectional, nationally representative data of US adults ages 31 to 42 years old from Wave V (calendar years 2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed from May 2020 to June 2020. The University of North Carolina institutional review board approved all study procedures, and written informed consent was obtained from all participants.

Migraine was measured based on self-report in response to the interview question, “Have you ever had five or more headaches that were at least four hours long; one-sided, pulsating, intense, or worsened by activity; and associated with nausea, vomiting, or sensitivity to light or sound?” which was consistent with the International Classification of Headache Disorders, third edition diagnostic criteria for migraine without aura.⁴ Sexual orientation was categorized into 3 categories: exclusively heterosexual; mostly heterosexual but somewhat attracted to people of one’s own sex; or lesbian, gay, or bisexual, as has been previously categorized.⁵ Logistic regression analysis was conducted using Stata version 15.1 (StataCorp) with sexual orientation as the independent variable and migraine as the dependent variable, adjusting for sex, race/ethnicity, age, education, income, smoking, and alcohol use¹ and incorporating national sample weighting.⁶

The diverse and representative sample consisted of 9894 adults, with a mean (SE) age of 37.33 (0.12) years, of whom 51.0% (n = 5705) were women and 49.0% men (n = 4189). Participants identified as exclusively heterosexual (n = 8426 [85.8%]), mostly heterosexual (n = 1062 [10.0%]), or lesbian, gay, or bisexual (n = 406 [4.2%]). The prevalence of migraine was higher among individuals who reported being mostly heterosexual (n = 327 [30.3%]) and lesbian, gay, or bisexual (n = 112 [30.7%]) compared with those who reported being exclusively heterosexual (n = 1631 [19.4%]) (Figure). (Percentages are calculated with weighted data to reflect the representative proportion in the target US population.)

Compared with individuals who were exclusively heterosexual, those who were mostly heterosexual had higher odds of migraine in an unadjusted model (odds ratio, 1.80 [95% CI, 1.49-2.18]; P < .001) and an adjusted model (adjusted odds ratio, 1.35 [95% CI, 1.10-1.65]; P = .004). Compared with individuals who were exclusively heterosexual, those who were lesbian, gay, or bisexual had higher odds of migraine in an unadjusted model (odds ratio, 1.83 [95% CI, 1.36-2.46]; P < .001) and an adjusted model (adjusted odds ratio, 1.58 [95% CI, 1.17-2.14]; P = .003). Results were similar in sex-stratified models.

The results from this study show disparities in migraine among US adults based on sexual orientation. While prior research has shown a high prevalence of migraine as well as other physical health outcomes among adults in sexual minority groups in California,¹ this is the first study (to our knowledge) to reveal these disparities among a nationally representative sample of US adults. Our findings show that adults in sexual minority groups, compared with heterosexual adults, had higher odds of experiencing migraine. Many members of sexual minority groups experience prejudice, stigma, and discrimination termed sexual minority stress,³ which could trigger or exacerbate migraine. Furthermore, members of sexual minority groups may encounter barriers to health care and experience greater physical and mental health problems, which could contribute to migraine.¹ It is notable that even people identifying as mostly heterosexual had higher odds of migraine compared with those who identified as exclusively heterosexual, in accordance with other physical health disparities noted among nonexclusively heterosexual populations.¹

Limitations include the use of self-report measures, inability to determine causality because of the cross-sectional design, inability to differentiate sexual identity from behavior, and inadequate power to analyze specific sexual orientations (eg, lesbian, gay, bisexual), which is an area of future research. Clinicians and researchers should be aware of health disparities in migraine, including sexual orientation, in addition to biological and behavioral risk factors.

Accepted for Publication: July 21, 2020.

Corresponding Author: Jason M. Nagata, MD, MSc, Department of Pediatrics, University of California, San Francisco, 550 16th St, 4th Floor, Box 0110, San Francisco, CA 94158 (jason.nagata@ucsf.edu; jasonmnagata@gmail.com).

Published Online: September 28, 2020. doi:10.1001/jamaneurol.2020.3406

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Nagata was a participant in the Pediatric Scientist Development Program (grant K12HD000850-33) and is supported by the American Heart Association (grant CDA34760281). Dr Murray is supported by the National Institutes of Health (grant K23 MH115184).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Samuel Benabou for editorial assistance. No compensation was received for these contributions.

Additional Information: This research uses data from Add Health, which is funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from grant P01-HD31921 for this analysis. The Add Health program project is directed by Kathleen Mullan Harris, PhD, and designed by J. Richard Udry, PhD, Peter S. Bearman, PhD, and Kathleen Mullan Harris, PhD, at the University of North Carolina at Chapel Hill. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth).