AHS Members Are Comfortable With Treating Migraine Via Telehealth

Mia Minen, MD, FAAN

Using an anonymous email survey, a majority of members of the American Headache Society (AHS) reported they were comfortable treating patients with migraine via telehealth and provided recommendations on how access to care can be improved.¹

In total, 225 of 1348 (16.7%) AHS members who had logged 2 months of use or 50 or more headache visits via telehealth responded to the survey and were included in the analysis. Mia Minen, MD, FAAN, assistant professor of neurology, and director of Headache Services, NYU Langone, presented the data at the 2021 American Academy of Neurology (AAN) Annual Meeting, April 17-22.

Clinicians reportedly felt “comfortable” or “very comfortable” with treating a new patient with a chief complaint of headache through telehealth (137 of 185), as well as providing follow-up for migraine (184 of 186) and follow-up for secondary headache (116 of 182). Urgent telehealth was offered by a little more than half of the respondents (97 of 190; 51%). “Technology innovations (remote vital signs, digitally prescribing headache apps) and remote system monitoring are areas of interest for headache specialists and warrant future research,” Minen et al wrote.

They also gathered data on the most common barriers to telehealth outside of the frequently noted loss of in-person procedures. The top barriers cited were conducting parts of the neurologic exam (157 of 189), absence of vital signs (116 of 189), and socio-economic technologic barriers (88 of 189). On the other hand, patient convenience (185 of 190), reducing patient travel stress (172 of 190), patient cost reduction (151 of 190), flexibility with personal matters (128 of 190), patient comfort at home (114 of 190), and patient medications nearby (103 of 190) were the top positive attributes stemming from telehealth visits.

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Notably, 20% (31 of 155) of providers claimed that telehealth visit length differed in comparison to in-person visits and 55.3% (105 of 190) believed the no-show rate improved. In total, 128 of 188 respondents claimed they were “interested” or “very interested” in digitally prescribing headache apps, while 121 of 189 were “interested” or “very interested” in the remote monitoring of patient symptoms.

Minen has been on the forefront of efforts to understand and incorporate technology appropriately into migraine care. She conducted another study published in 2020 that aimed to evaluate publicly available reviews of headache apps to understand app features that motivate the consumers to use apps.² Among 15 apps that met study criteria, 4 themes emerged. They included (1) apps that allow users to track headache characteristics, potential triggers, and treatments; (2) app usability; (3) personalization and features to assess trends in data; (4) ease with exploration and viewing data.

In December 2020, data from a pilot study that was also headed by Minen suggested that smartphone-delivered progressive muscle relaxation (PMR) may be an acceptable and accessible form of therapy for patients with migraine after showing a small-moderate mean effect size in disability scores.³ The RELAXaHEAD smartphone application, which includes an electronic headache diary, had acceptability measures collected on satisfaction using 5-point Likert scale questions on the app’s ability, content, and functionality. Using that scale, those with migraine with ≥4 headache days/month found the app to be easy to use (mean, 4.2 [±0.7]) and stated they would be happy to engage in PMR intervention again.

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REFERENCES

1. Minen M, Strauss L, Kaplan K. A new vision in headache medicine: a survey of headache specialists’ utilization of telehealth in their practice. Presented at 2021 American Academy of Neurology Annual Meeting; April 17-22. Abstract P10.146

2. Minen M, Gumpel T, Ali S, Sow F, Toy K. What are headache smartphone application (app) users actually looking for in apps: a qualitative analysis of app reviews to determine a patient centered approach to headache smartphone apps. Headache. Published online June 13, 2020. doi: 10.1111/head.13859.Epub 2020.

3. Minen MT, Adhikari S, Padikkala J, et al. Smartphone-delivered progressive muscle relaxation for the treatment of migraine in primary care: a randomized controlled trial. Headache. Published online November 16, 2020. doi: 10.1111/head.14010