Objective: To evaluate racial and sex-based differences in route of medication administration for emergency department migraine treatment, using parenteral versus oral medication administration as a proxy for more rapid acute treatment. Background: Each year, migraine affects over 1 billion people and are the second leading cause of disability worldwide. Of those affected, migraine are present in women nearly 3 times more than men, leading to the stigma of migraine being “a woman’s complaint”. This sexual disparity is compounded by racial inequality. Studies have found that African American patients are often undertreated for pain. However, there is a gap in the literature about how this disparity translates to migraine treatment, specifically considering patient sex. Methods: This was a retrospective database analysis, extracted from the Cerner Health Facts database (Cerner Corporation, Kansas City, MO), consisting of patients aged 12-25 who presented to the emergency department for migraine treatment within the years 2015 and 2016. Among the dataset of 1000 randomly de-identified patients, 729 patients presented to the emergency department only once within the time frame. Additionally, we conducted a statistical analysis to determine the significance of the association between more rapid acute treatment with race and sex. Results: African American patients were 37% less likely to receive parenterally administered medication compared to Caucasian patients (Odds ratio, 0.63; 95% confidence interval, 0.45-0.88; P=0.01). Furthermore, female African American patients were 46% less likely to receive parenterally administered medication compared to their female Caucasian counterparts (Odds ratio, 0.54; 95% confidence interval, 0.37-0.78; P=0.001). Our results indicated no statistically significant difference in route-based treatment differences between African American males and Caucasian males. Conclusions: Significant racial disparities exist in the administration of parenteral migraine medication, with African American patients, particularly female African American patients, being less likely to receive parenteral treatment compared with their Caucasian counterparts. By establishing where racial disparities exist in the health setting, we can work towards closing the gap and moving towards equity. Plain Language Summary: Migraine is a common and disabling condition, but little is known about whether race and sex influence how rapidly patients receive treatment in the emergency department. In this retrospective study of patients aged 12–25 years with migraine-related emergency department visits, African American patients, especially African American female patients, were less likely than Caucasian patients to receive parenteral administered medication. These findings suggest that racial and sex disparities may affect acute migraine treatment and highlight the need for more equitable emergency department pain-management practices.