PHILADELPHIA — Long-term follow-up care for the management of migraine with severe disability using telemedicine was found to have comparable efficacy compared with in-office visits and was considered more convenient by patients, according to study results presented at the 61st Annual Scientific Meeting of the American Headache Society, held July 11-14 in Philadelphia, Pennsylvania.
“Telemedicine, in general, allows providers to expand the reach of our expertise to people who may not have access to the type of care they need,” study author and presenter, Deborah I. Friedman, MD, MPH, of the University of Texas Southwestern Medical Center in Dallas, told Clinical Pain Advisor. “Its use is increasing and will certainly play a growing role in patient care moving forward.”
A total of 45 consecutive patients (95% women; n=30 completed the study) from the researchers’ practice who met the International Classification of Headache Disorders-2 criteria for migraine were enrolled in the study and randomly assigned to receive telemedicine (n=18) or in-office (n=12) follow-up care. Participants were assessed at 4 to 6 weeks and at 3, 6, 9, and 12 months. Telemedicine was conducted using online video conferencing. Questionnaires delivered online were administered prior to and after each visit in both groups.
The primary outcome of the study was the percentage of scheduled visits completed using telemedicine. Secondary outcomes were headache disability assessed using the Migraine Disability Assessment test (MIDAS), visit time, and perceptions of telemedicine.
Telemedicine was found to be non-inferior to in-office visits in terms of improvements from baseline to 12 months in MIDAS scores, number of headache days, and average headache severity. Participants in the telemedicine vs in-office visit group reported greater convenience and shorter visit duration.
According to Dr Friedman, the advantages of telemedicine include the shorter face-to-face visit time, as well as the much shorter total time required for each visit, including the time it takes for patients to travel to the clinician’s office. Disadvantages of the technology include the inability to get acute treatment of a migraine in the office, lack of human touch, and technical difficulties with audio or video.
“It would be interesting to determine the impact of having a telemedicine link with the emergency room, mostly interacting with other providers, for second opinions of acute headache presentations and seeing whether important diagnoses get missed when telemedicine is used for the initial visit,” noted Dr Friedman. “The technology is easily applicable for any disorder that does not require an exam or procedure.”
Friedman D. A randomized trial of telemedicine for migraine management. Presented at: 61st Annual Scientific Meeting of the American Headache Society, July 11-14, 2019, Philadelphia, Pennsylvania. Abstract 679616.