Headache disorders among Indigenous communities: A scoping review undertaken with knowledge keeper guidance

We performed a scoping review of literature on headache etiology, classification, prevalence, and treatment in Indigenous communities in Canada, the United States, Australia, and New Zealand.

In the United States, analysis of national prevalence indicates that Indigenous Americans lead all other racial/ethnic groups in headache prevalence. Risk factors associated with headache burden, including diabetes, head injury, psychological trauma, environmental exposures, and lack of access to appropriate diagnosis and treatment, have been documented in Indigenous communities across the geographies studied.

A systematic search of literature in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Informit Indigenous Collection was conducted through January 2026 using descriptors of headache, migraine, and Indigenous populations across Canada, the United States, Australia, and New Zealand. Of the 616 citations identified, 30 publications from 1981 to 2024 were included in the present review and analyzed under the following areas of inquiry: (1) headache classification, (2) headache etiology, (3) headache prevalence, (4) headache treatment, and (5) barriers to headache care.

Analysis of national data in the United States indicates a higher prevalence of headache in Indigenous communities in comparison to all other communities. In Canada, evidence from smaller studies suggests a similar pattern. Prevalence data for Indigenous communities in Australia and New Zealand remains limited. Ethnographic data and expert informant data from Indigenous communities demonstrate conceptualization and treatment of headaches within biopsychosocial models that relate individuals to the life of their community and land. There were no data from medical headache treatment trials or intervention studies specific to or inclusive of Indigenous patients with headache. Barriers to headache care for Indigenous peoples were identified prior to diagnosis, at the point of assessment, and in treatment. Addressing these barriers demands system level changes as well as development of individual relations of respect and care for Indigenous patients.

Included studies from Canada, the United States, Australia, and New Zealand reported a high prevalence of headache in some Indigenous communities and suggest that this burden may result from or be associated with a combination of intergenerational trauma, adverse childhood experiences, lower socioeconomic status, head injury, environmental contaminants, and systemic racism resulting in barriers to diagnosis and care. Despite this apparent burden, the literature reveals a paucity of quality, headache-specific research conducted with Indigenous peoples across all four regions of study. To close gaps in headache diagnosis, treatment, and prevention, research and program development must be led by, or conducted in meaningful collaboration with, Indigenous communities in a manner that recognizes and uplifts Indigenous knowledge systems, healing, and conceptualizations of headache.