Clinically Meaningful Improvements in Migraine Achievable With Synchronous Telemedicine

Brad Torphy, MD

Using a retrospective review that assessed Headache Impact Test-6 (HIT-6) scores over a year-long period, researchers concluded that clinically meaningful improvement in migraine can be achieved with the exclusive use of synchronous video telemedicine visits for migraine care.

These findings were presented at the 2021 Virtual American Headache Society (AHS) 63rd Scientific Annual Meeting, June 3-6, by Brad Torphy, MD, headache specialist, Chicago Headache Center and Research Institute. Torphy and colleagues evaluated the use of synchronous video telemedicine in the management of migraine from the initial visit onward for 73 patients who had a telemedicine visit from March 3, 2020, to March 18, 2021. Patients with incomplete initial or follow-up HIT-6 scores were excluded from the study. In-office follow-up visits were allowed for onabotulinumtoxinA (Botox; Allergan/AbbVie) administration and/or sphenopalatine ganglion block procedures only.

When comparing initial and follow-up HIT-6 assessment scores, researchers recorded a 6-point change (µ = 5.9; P <.001). An improvement in HIT-6 score was observed in 80% of patients who met screening criteria at follow-up. Notably, 60% of those patients with improvement had a reduction of at least 6 points or more, which the authors noted met a threshold that was previously identified as clinically meaningful in patients with chronic migraine. The 5 subgroups of patients, divided by follow-up length (<1 month, 1-3 months, 3-6 months, 6-9 months, and >9 months), displayed normal distribution of clinically meaningful results.

"We suggest that telemedicine in the management of migraine, like many other disease states, is best used in collaboration with the patient’s local primary care provider or neurologist,” Torphy et al wrote. “This is especially true in cases where the headache specialist is not located in proximity to the patient. Should the patient require urgent evaluation or inpatient treatment, having a local provider available to facilitate care will be helpful.”

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Improvements of 3 points were seen as early as less than 1 month after initial telemedicine visit. Between months 1-3 of follow-up, the mean improvement in HIT-6 scores was 5 points, while a mean improvement of at least 6 points or more was observed in follow-up visits at 3 months or later. Data was analyzed with SPSS version 27.

The findings from Torphy et al align with previous research conducted by Kai Muller, MD, published in 2017, which found no differences between telemedicine and traditional consultations in HIT-6 (P = .84) or visual analogue scale (P = .64) over 3 periods.² In that study, the absolute difference in HIT-6 from baseline was 0.3 (95% CI, –1.26 to 1.82; P = .72) at 3 months and 0.2 (95% CI, –1.98 to 1.58; P = .83) at 12 months.

Torphy and colleagues also noted that further research is needed to compare the clinically meaningful improvement seen in migraine from telemedicine with that seen using in-office visits. They also wrote that, “further research is also needed to compare the rates of imaging studies ordered, such as MRIs, in telemedicine to those in the traditional clinical setting.”

As the COVID-19 pandemic forced migraine specialists to transition their care to telemedicine, most of them took a liking to the new method. A survey presented at the 2021 American Academy of Neurology (AAN) Annual Meeting, April 17-22, found that most members of the AHS felt “comfortable” or “very comfortable” with treating a new patient with 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).³

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REFERENCES

1. Torphy B, Smith M, Calvillo A, Kovlari A. Migraine management with telemedicine visits only: can patients achieve clinically meaningful improvement? Presented at AHS 2021 Scientific Annual Meeting; June 3-6. Abstract LBP218

2. Muller KI, Alstadhaug KB, Bekkelund SI. A randomized trial of telemedicine efficacy and safety for nonacute headaches. Neurology. 2017; 89: 153-162.

3. 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