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Headache is a leading reason for medical consultation and yet remains underdiagnosed. 1 Headache diseases are highly prevalent and disabling. Migraine alone affects 1 billion people and is the second leading cause of disability worldwide. 2 There still remains a dearth of information surrounding how the headache diseases affect underserved populations and most importantly how this can be addressed. Migraine prevalence studies based in the United States indicate that the prevalence is highest in Native Americans, followed by White Americans, Black Americans, Hispanics, and Asian-Americans. 3,4 Black Americans are less likely to be diagnosed with migraine, in part because they are less likely to endorse full criteria for migraine, and are also less likely to access the medical system for treatment. 3,5 Black men receive the least care for headache diseases nationwide and are less likely to present for ambulatory care for migraine compared with Whites. 6,7 Black patients are less likely to be given pain medications than White patients despite similar self-reports of pain. 8-10 To our knowledge, there are no examples of headache researchers addressing the challenges to inclusion of diverse populations in headache clinical trials. The authors are aware of only three research studies published that specifically examined for racial health disparities in headache medicine. [11][12][13] These studies could be classified as first-generation health disparity research. 14,15

Background: Lymphovenous anastomosis (LVA) is a microsurgical treatment for lymphedema of the lower extremity (LEL). This study systematically reviews the most recent data on outcomes of various LVA techniques for LEL in diverse patients. Methods: A comprehensive literature search was conducted in the Ovid MEDLINE, Ovid EMBASE, and Scopus databases to extract articles published through June 2021. Studies reporting data on objective postoperative improvement in lymphedema and/or subjective improvement in quality of life for patients with LEL were included. Extracted data comprised demographics, number of patients and lower limbs, duration of symptoms before LVA, surgical technique, duration of followup, and objective and subjective outcomes. Results: A total of 303 articles were identified and evaluated, of which 74 were ultimately deemed eligible for inclusion in this study, representing 6260 patients and 2554 lower limbs. The average patient age ranged from 22.6 to 76.14 years. The duration of lymphedema before LVA ranged from 12 months to 11.4 years. Objective rates of improvement in lymphedema ranged from 23.3% to 100%, with the greatest degree of improvement seen in patients with early-stage LEL. Conclusions: LVA is a safe and effective technique for the treatment of LEL of all stages. Several emerging techniques and variations may lead to improved patient outcomes.