Study Examines Relationship Between Sexual Orientation, Migraine Prevalence

New research published in JAMA Neurology highlights disparities in migraine based on sexual orientation in the United States.

Disparities in migraine prevalence based on race/ethnicity, sex, and socioeconomic status have previously been established. However, there is a lack of research on disparities based on sexual orientation, researchers said.

“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,” authors wrote.

To better understand the relationship between sexual orientation and migraine, researchers analyzed data from Wave V of the National Longitudinal Study of Adolescent to Adult Health. The cross-sectional, nationally representative sample consisted of adults aged 31 to 42 and data analysis took place between May 2020 and June 2020.

The sample consisted of 9894 adults with a mean age of 37.33. Migraine was determined based on self-reported responses to an interview question consistent with the International Classification of Headache Disorders diagnostic criteria for migraine without aura: “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?”

Participants were classified into 3 groups: exclusively heterosexual; mostly heterosexual but somewhat attracted to people of one’s own sex; or lesbian, gay, or bisexual.

Fifty-one percent (n = 5705) of the sample were women and the majority (n = 8426 [85.8%]) identified as exclusively heterosexual. Ten percent (n = 1062) identified as mostly heterosexual while 4.2% (n = 406) identified as lesbian, gay, or bisexual.

Researchers found:

• 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%])
• Compared with individuals who were exclusively heterosexual, those who were mostly heterosexual had higher odds of migraine in an unadjusted model (odds ratio [OR], 1.80 [95% CI, 1.49-2.18]; P < .001) and an adjusted model (adjusted OR, 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 (OR, 1.83 [95% CI, 1.36-2.46]; P < .001) and an adjusted model (adjusted OR, 1.58 [95% CI, 1.17-2.14]; P = .003)

Previous research has also shown a high prevalence of migraine and other physical health outcomes among adults in sexual minority groups in California, but the current study is the first to the authors’ knowledge to reveal theses disparities among a nationally representative sample.

Authors hypothesize the combination of prejudice, stigma, and discrimination, defined as sexual minority stress, may contribute to increased odds of experiencing migraine in this cohort. Members of sexual minority groups can also encounter barriers to health care and may experience greater mental and physical health problems compared with the general population.

Due to limited power, researchers were unable to analyze the association of migraine prevalence with specific sexual orientations (lesbian, gay, bisexual), marking a limitation to the study. Additional limitations include self-reported measures and inability to differentiate sexual identity from behavior.

“Clinicians and researchers should be aware of health disparities in migraine, including sexual orientation, in addition to biological and behavioral risk factors,” authors concluded.

Reference

Nagata JM, Ganson KT, Tabler J, Blashill AJ, Murray SB. Disparities across sexual orientation in migraine among US adults. JAMA Neurol. Published online September 28, 2020. doi:10.1001/jamaneurol.2020.3406