Chronic Migraine in Black Americans: How to Get Diagnosed and Treated

If you get frequent, disabling headaches, the most useful thing you can do this week is write them down: the date, how long each one lasts, which side of your head, and whether light and sound make it worse. That log turns a dismissed complaint into a migraine diagnosis, and the diagnosis unlocks treatment most Black patients never get offered. Migraine is about as common in Black adults as in white adults, near 15 percent. Yet only 7 percent of Black adults with frequent migraine take a preventive medication, against 20 percent of white adults.

Migraine is roughly as common in Black adults as in white adults. A 2021 review in Neurology reported migraine and severe headache in 15.0 percent of African American adults and 15.5 percent of white adults. What is not even is what happens next. The same review found African American patients are about 25 percent less likely than white patients to receive a migraine diagnosis, and that among people with headache, 46 percent of Black patients had used a health care setting for it compared with 72 percent of white patients.

The treatment gap is wider than the diagnosis gap. The national data in that review show 14 percent of Black patients with migraine were prescribed acute medication for an attack, against 37 percent of white patients. Prevention is worse. In the 2025 Migraine Report Card survey, 7 percent of Black respondents with frequent migraine used a preventive prescription versus 20 percent of white respondents, and 54 percent of Black respondents said they were very concerned about their current health versus 29 percent of white respondents, though insurance coverage was similar across groups. The burden is felt. The prescriptions are not written.

Migraine is a neurological disease. StatPearls puts it at about 12 percent of the population, up to 17 percent of women and 6 percent of men. An attack is usually a throbbing pain, often on one side, moderate to severe, made worse by routine activity, and it commonly comes with nausea and sensitivity to light and sound. Some people get aura first: visual flickers, blind spots, or tingling. An attack can last from a few hours to three days.

Migraine becomes chronic when you have headache on 15 or more days a month for more than 3 months, with at least 8 of those days carrying migraine features. That count is not a technicality. It is the line specialists and insurers use to approve stronger treatment, including Botox. Chronic migraine is often the endpoint of episodic migraine left untreated: about 2.5 percent of people with episodic migraine progress to chronic migraine each year, and leaning on over-the-counter painkillers to get through frequent attacks can speed that slide.

There is no blood test, scan, or scope that finds migraine. The diagnosis is clinical, built from the history you give and a normal neurological exam, which puts the story you tell at the center of whether you are believed. A written record is harder to wave off than a spoken complaint. Bring a headache diary covering at least four weeks: the dates, how long each attack lasted, one side or both, whether it throbbed, whether you had nausea or light and sound sensitivity, what you took, and whether it worked.

Say plainly what you think is happening: "I believe these are migraines. Here is my log. I have headache on this many days a month." Then ask two questions: do I meet the criteria for chronic migraine, and what acute and preventive options fit me. If a clinician dismisses the pain without looking at the log, ask for a referral to a neurologist or headache specialist. Referral and access gaps are a documented driver of the diagnosis disparity, so naming the referral you want is part of getting it.

Treatment has two jobs: stopping an attack that has started, and preventing the next ones. To stop an attack, the options are NSAIDs such as ibuprofen, naproxen, or aspirin; triptans such as sumatriptan, rizatriptan, and eletriptan; newer gepants such as rimegepant and ubrogepant; the ditan lasmiditan; and anti-nausea drugs. Triptans and gepants work better than another over-the-counter pill, and they work best taken early. Using acute painkillers on more than about 10 to 15 days a month can drive medication-overuse headache, so frequent attacks are a signal to add prevention, not more rescue doses.

Preventive treatment lowers how often attacks come. Standard options recognized by the American Headache Society include older daily drugs that were not designed for migraine but help: beta-blockers such as propranolol and metoprolol, the antidepressants amitriptyline and venlafaxine, and the anti-seizure drugs topiramate and valproate. For chronic migraine specifically, onabotulinumtoxinA, known as Botox, is an approved preventive, given as injections every 12 weeks. These are among the treatments Black patients are least likely to be offered, which is the exact reason to ask for them by name.

The newest class targets CGRP, a protein central to migraine attacks. It includes monoclonal antibodies given by injection or infusion, erenumab, fremanezumab, galcanezumab, and eptinezumab, and pills called gepants, rimegepant and atogepant. In 2024 the American Headache Society said CGRP-targeting therapies should be a first-line option for prevention, without requiring patients to first fail older classes of preventive medicine. That last part matters if you have been told to keep trying pills that do not work. Ask your clinician directly about a CGRP preventive.

Do four things. Start a headache log today and keep it for four weeks. Book a primary care or neurology visit and bring the log. Ask whether you meet the criteria for chronic migraine, and ask by name about acute treatment, a daily preventive, and a CGRP option if attacks are frequent. If you are brushed off, request a referral to a headache specialist. You can find a Black neurologist or primary care clinician in our directory to start with someone more likely to take your pain at its word.