Migraine, Migraine Disability, Trauma, and Discrimination in Sexual and Gender Minority Individuals

Abstract

Background and objectives: This study sought to describe migrainous headache frequency and severity and to examine the relationship between trauma, discrimination, and migraine-associated disability in a sample of sexual and/or gender minority (SGM) adults.

Methods: We performed a cross-sectional study of SGM people in The Population Research in Identity and Disparities for Equality Study from August to October 2018. The primary exposure was any trauma or discrimination, regardless of attribution. The primary outcome was moderate-severe migraine disability, as defined by a Migraine Disability Assessment (MIDAS) Questionnaire score of ≥11. We performed descriptive analysis comparing respondents with any migrainous headache with those without. Multivariable logistic regression examined the association between trauma/discrimination and migraine disability, controlling first for sociodemographic and clinical factors and then for psychiatric comorbidities.

Results: Of the 3,325 total respondents, 1,126 (33.9%) screened positive for migrainous headache by ID-Migraine criteria. Most people with migraine self-reported moderate (n = 768, 68.2%) or severe (n = 253, 22.5%) intensity. The median MIDAS score was 11 (interquartile range 5-25). Most respondents with migraine (n = 1,055, 93.7%) reported a history of trauma or discrimination. In unadjusted analysis, exposure to both trauma and discrimination was associated with higher odds of moderate-severe disability (OR 1.76, 95% CI 1.34-2.32). After adjustment for self-reported psychiatric comorbidities of anxiety, depression, and posttraumatic stress disorder, this association lost statistical significance.

Discussion: Migrainous headache is common among our sample of SGM adults, and prior experiences with trauma and discrimination are associated with increased migraine disability. Our findings suggest that psychiatric comorbidities play a significant role in this relationship, identifying a potentially modifiable risk factor for disability in SGM people with migraine.