Migraine Care During a Pandemic: Takeaways for the Future

Matthew Robbins, MD

This is the second of a 2-part interview. For Part 1 of this interview, click here.

As the director of the Neurology Residency Program at Weill Cornell Medicine, Matthew Robbins, MD, has seen first-hand how residents have responded to being thrown in an uncomfortable situation such like the COVID-19 pandemic. In the long run, the experiences that the pandemic has thrust onto not just residents, but all clinicians, will impact how clinical care moves forward.

At the 2020 American Headache Society (AHS) Annual Meeting, Robbins presented an overview on how COVID-19 impacted headache and neurological care, as well as thoughts on emerging clinical phenomenology of headache and the virus. Additionally, he outlined the role of telemedicine and the growing part it plays in providing care. For Robbins, the normalization of telemedicine into clinical care was needed in order to abide by social distancing guidelines, but after seeing how successful it was implemented, incorporating it as a main option is something that clinicians will seriously consider.

In part 2 of this interview, Robbins details the impact the pandemic has had on his residents, as well as the importance of telemedicine going forward, and understanding the line on what requires an in-person visit and what doesn’t.

NeurologyLive: How have you handled those in the residency program during this time? What do you think the long-term impact of this experience will be for them?

Matthew Robbins, MD: Undoubtedly, for our residents who’ve been extremely brave, selfless, and have worked extraordinarily hard in settings both family and unfamiliar to them during this time, have been a part of a signature event. They’ve seen great heroics and great tragedies as a result from the extraordinary volume and severity of this illness that has transformed our hospital care. I think that the neurology that emerges from this will teach them both about what COVID-19 can do, but other disorders as well.

It’s provided a great teaching opportunity and a great place for us to organize and how we think about our patients. The immediate transformation to telemedicine has required all of us to learn new skills and reach even more patients who might traditionally have their care be completely disrupted. In some ways, I’m hopeful that this immediate transformation of care in the outpatient medicine setting will let our residents reach even more undeserved patients, including people who have physical or cognitive disabilities that ordinarily might have their office visits cancelled or postponed indefinitely. I’m hoping that part of medical access for our patients with brain disorders enhances their learning in the long run.

What takeaways did you have from both the neurology and headache aspects of the pandemic? Do you foresee any long-term adaptations into your clinical practice?

I think we've already seen telemedicine and video visits be ingrained into our regular practice. That seems to be something that will be indefinite, although that might depend on federal and state level reimbursement for care and provisions for patients who might have noncommercial insurances to still use this modality to access their clinicians. I'm hopeful that that is a positive change that comes out of it.

Was there anything else you observed that people should take note of?

As a neurologist who’s also a headache specialist, the one issue we grapple with is how to define a visit that’s essential, and when should an in-person consultation be truly required. We have to be careful with that.

With a condition such as migraine, there is a risk of being undervalued in a time like this because there isn’t necessarily a physical manifestation of it. There isn’t a diagnostic test that shows that there’s something wrong, yet migraine can be a progressive brain disease that plagues up to 40 million Americans, including 2% of the population who suffer from chronic migraine. This also applies to those who have increased comorbidities who may have a diminished ability to be a functional person in society. We can’t forget that taking care of all these patients with migraine or other neurologic disorders is truly essential. In addition to that, going forward, we have to be careful not to marginalize patients who don’t have physical or respiratory illnesses in clinical care.

Transcript edited for clarity.