Different Experiences in Chronic Migraine Etiology, Treatment and Comorbidities of Hawaii’s Ethnic Groups
Michelle Lu1, Kacey Yamane1, Dane Keahi1, Michael Tong1, Connor Goo1, Devashri Prabhudesai2, John Chen2, Vimala Sravanthi Vajjala1, Enrique Carrazana1, Jason Viereck1, Kore Liow3
1Headache and Facial Pain Center, Hawaii Pacific Neuroscience, 2JABSOM Biostatistics Core Facility, Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, 3University of Hawaii, John A. Burns School of Medicine
Objective:
To determine racial disparities in CM treatment and comorbidities of patients in Hawaii, a state characterized by its a majority-minority patient population. We hypothesize that minority populations are under-treated.
Background:
Chronic migraine (CM) is a debilitating condition with negative repercussions on the socioeconomic status of patients; compounded by under-diagnosis and treatment in minority populations. Identifying treatment and comorbidity characteristics of CM patients in Hawaii will guide treatment of migraines.
Design/Methods:
We performed a retrospective chart review on patients diagnosed with CM at a headache and facial pain center in Honolulu, Hawaii. 743 patients with a clinic visit from January 27, 2022 to April 27, 2022 were retrieved from eClinicalWorks. Patients without sufficient data were excluded, yielding 298 patients fulfilling inclusion criteria of a) ICD-10 code diagnosis of CM b) lack of secondary migraine etiology and c) fulfilling IHCD-3 standards of CM. Socioeconomic demographic variables were collected including self-reported race, age, obesity, number of medications and public/private health insurance. Patient treatment modalities were recorded: botulinum toxin (BoNT), pharmacologic treatment, monoclonal antibodies, and physical therapy.
Results:
Native Hawaiian/Pacific Islander (NHPI) patients reported the highest prevalence of obesity (60.9%) at >30% compared to other race groups (p<0.001). History of diabetes was low across all race groups (7.7%). However, NHPI patients had a higher history of diabetes (14.5%) (p= 0.004), hypertension (37.7%), >13% higher than other race groups (p= 0.01). Significantly more white patients received BoNT as therapy (73.9%), >25% compared to other race groups (p= 0.02). Public insurance was significantly more common in NHPI patients (59.4%) followed by other minorities (57.1%), with a 9-11% difference compared to other race groups. (p=0.02)
Conclusions:
Our findings suggest barriers to BoNT treatment in minority patients. Comorbidities in NHPI patients, such as obesity, diabetes and hypertension, differ from other ethnic groups.