Jennifer McQueeny,1 Seth Heller,1 Natalie Toma,1 Kendal Nakaoka,1 Emma O’keefe,1 Rishika Isanaka,1 Olivia Mahera,1 Tyrone Sumibcay,1,2 Matthew Kao,1,2 Janette Bow-Keola,1,2 Eonjung Angeline Kim,1 Darren DuGas1
1 Hawaii Headache and Facial Pain Center, Hawaii Pacific Neuroscience, Honolulu, HI
2 John A. Burns School of Medicine, University of Hawaiʻi, Honolulu, HI
Background: This retrospective study investigates the early administration of onabotulinumtoxinA (Botox) for chronic migraine without aura, intractable, with status migrainosus (ICD-10 G43.711), focusing on Native Hawaiian and Pacific Islander (NHPI) patients. While standard care typically begins with oral preventatives (e.g., topiramate, propranolol, amitriptyline), clinical patterns suggest deviations within this population. We hypothesize that high comorbidity rates in the NHPI population contribute to deviations from standard treatment pathways. Hispanic/Latinx (H/L) patients were included as a comparison group due to similar comorbidities.
Objective: To assess whether NHPI patients receive Botox earlier than H/L patients, we identified socioeconomic factors influencing such trends. Early administration was defined as Botox use prior to documented trials of at least two oral preventive medications. This aims to inform more equitable, population-sensitive approaches to migraine management in underserved, high-comorbidity groups.
Methods: Electronic health record (EHR) data from Hawaiʻi Pacific Neuroscience (HPN) (2018–2024) were reviewed for patients diagnosed with G43.711. Variables included treatment progression, comorbidities, insurance type, and demographics. Descriptive statistics and comparative analysis were used to assess associations between ethnicity, comorbidities, insurance status, and early Botox use.
Findings: NHPI patients demonstrated a statistically significant trend toward early Botox use, correlated with higher rates of obesity, hypertension, diabetes, and psychiatric conditions; contraindicating oral treatments. Socioeconomic barriers (public insurance reliance, limited follow-up access) further influenced treatment sequencing.
Conclusion: Findings suggest early Botox use reflects clinician adaptation to NHPI patients’ complex profiles. Limitations include incomplete documentation of medication trials and a single-center cohort, limiting generalizability.
