Is Telemedicine the Future of Migraine Management?

Patient Expert
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Do you have problems getting to the doctor who treats you for migraine? Many of us do. Whether it's an issue with distance, not being well enough to travel, or something else entirely, it's not always simple or easy to get to the doctor.

What if you could have an appointment with your doctor to discuss your migraines and treatment without having to leave home? This type of appointment may be a possibility sooner than we think.

Last month (June, 2015), a research poster presentation at the 57th annual scientific meeting of the American Headache Society (AHS) highlighted the results of two new studies on the usefulness of telemedicine in treating migraine patients. The studies showed telemedicine to be as effective as in-office visits, especially in patient follow-up evaluations and in improving a patient’s likelihood of getting the right medications. The studies, performed at Mercy Virtual in St. Louis, at UT Southwestern Medical Center in Dallas, and at Simon Business School at the University of Rochester, were presented to some 1,000 migraine specialists and researchers at the AHS meeting. Telemedicine, which uses telecommunication and information technologies to provide clinical health care at a distance and connect health professionals and patients in different locations, is increasingly popular as a way to extend medical services and improve efficiency.

Research Background:

"Migraine specialists provide optimal, world-class care but are not readily available to a large portion of the population. Telemedicine is a proven method for providing high quality care across various ambulatory domains, but there is a paucity of research evaluating its benefits for migraine care. It is possible that providing migraine care via TeleHeadache increases the likelihood of a patient receiving care consistent with evidence-based guidelines. The current study tested whether patients who received migraine care via TeleHeadache were more likely to be prescribed/recommended medication consistent with published acute and preventative evidence based guidelines relative to matched controls from the same geographic area who received migraine care from a local provider."1

In the Mercy Virtual study, investigators found that using Mercy’s Virtual TeleHeadache capability significantly improved the patient’s likelihood of being prescribed acute and preventative medication consistent with evidence-based guidelines.

Dr. Smith and his team found that 77.4% of those who received migraine care via TeleHeadache were prescribed or recommended evidence-based acute medication versus 27.0% of those who received care locally. In the UT Southwestern and Simon Business School study, patients were randomized to either receive in-person follow-up visits or follow-up visits via telemedicine. Investigators compared the feasibility, clinical effectiveness and patient satisfaction of telemedicine with that of in-person visits, and looked at the economic value of using telemedicine for patient care.

Research Conclusions:

"The findings from the current study suggest that delivering migraine care via Mercy TeleHeadache significantly improves the patient’s likelihood of being prescribed acute and preventative medication consistent with evidence based guidelines. Given its portability and scalability, telemedicine offers the possibility of expanding the reach of providers who can deliver world-class migraine care regardless of the patient ’s location."1

Comments from the researchers:

Timothy R. Smith, MD, Mercy Clinic Headache Center/Mercy Virtual, lead author of the Mercy study, commented:

"Given its portability and scalability, telemedicine offers the possibility of expanding the reach of providers who can deliver world-class migraine care regardless of the patient’s location."2

Deborah I. Friedman, MD, MPH, FAAN, Professor, Neurology & Neurotherapeutics and Ophthalmology, University of Texas Southwestern Medical Center, commented:

"We found that telemedicine is effective in conducting follow-up evaluations for patients with migraine, and we also believe telemedicine adds economic value for patients and results in a high degree of patient satisfaction."2

Abraham Seidmann, professor of operations management from Simon Business School at the University of Rochester, commented:

"Besides clinical efficacy, we are looking at various patient centered performance measures, as well as the overall economics of this approach. The initial results are very promising, and we have discovered some important counterintuitive lessons, which are critical for the successful deployment of this information technology on a larger scale."2

Summary and Take-Aways:

This research poster and the studies on which it was based are quite timely. Telemedicine mobile apps are already available, and the number of them is on the rise. Perhaps the best known is Doctor on Demand, developed by Dr. Phil McGraw and his son, Jay McGraw.

The services and medical advice received when using these apps are, of course, limited by the knowledge and experience of the doctors involved. With the apps currently available, migraine patients will most likely find the same problems they encounter when seeing doctors in person, specifically a general lack of knowledge and experience in treating migraine. The huge advantage and attraction of apps such as Mercy's TeleHeadache is that patients consult with actual migraine specialists.

Of course, nothing can completely take the place of "regular" appointments with our doctors, but telemedicine seems a logical platform for follow-up appointments, times when we have questions for our doctors, and some other situations. Especially given the shortage of qualified migraine and headache specialists, it will be extremely interesting to follow the further development and the deployment of telemedicine apps developed specifically for migraine and headache patients.


Sources:

1 Markwell, S. ; Smith, T.R.; Nicholson, R.A.; Dummitt, B.W.; Yount, B.W.; Stoneman, J.L. "TeleMedicine Improves Migraine Care Quality: Results of a
Pilot TeleHeadache Program." Research Poster. 57th Annual Scientific Meeting of the American Headache Society. June, 2015.

2 Press Release. "Telemedicine Proves Value In Managing Migraine." American Headache Society. Washington, D.C. June 17, 2015.

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