Prevalence and consequences of stigma associated with migraine in a rural Indian headache clinic

Objectives Migraine, a prevalent neurological disorder, remains under-recognized and stigmatized, potentially impeding optimal management. This study aimed to quantify migraine-related stigma and its associations in a rural Indian setting, addressing a critical knowledge gap in low-resource contexts. Primary objectives: This study was to assess the prevalence and patterns of perceived stigma among migraine patients in a rural neurology clinic. Secondary objectives: This study was to examine the relationship between stigma levels and headache impact severity and to identify sociodemographic factors associated with higher stigma. Materials and Methods This cross-sectional study enrolled 100 migraine patients diagnosed per International Classification of Headache Disorders, 3 rd edition criteria at a rural tertiary care hospital in Gujarat, India. Perceived stigma was measured using the culturally adapted stigma scale for chronic illness (SSCI-8), and headache impact was assessed using the headache impact test (HIT-6). Correlations and regression analyses were performed to evaluate associations. Results The mean total SSCI-8 score was 16.77 (standard deviation = 5.98), indicating moderate perceived stigma. A significant positive correlation was observed between total SSCI-8 and HIT-6 scores (r = 0.25, P = 0.014), persisting after adjustment for confounders (adjusted r = 0.22, P = 0.027). Participants with only primary education reported significantly higher enacted ( P < 0.001) and internalized ( P = 0.027) stigma compared to those with higher education. Regular clinic follow-up was associated with lower stigma scores ( P = 0.001). Conclusion This study revealed substantial perceived stigma among migraine patients in rural India, with a novel finding of a non-linear relationship between education levels and stigma. The significant association between stigma and headache impact underscores the need for targeted interventions. These insights can inform the development of culturally sensitive, community-based anti-stigma initiatives and support services, potentially improving migraine management and outcomes in underserved rural populations.