One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial

Abstract

Background Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177

Telemedicine in headache care: A systematic review

“…Nine studies (20 –26,28,29) reported on treatment efficacy and headache status using a broad variety of parameters. This included headache days per month, medication use, Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6), Visual Analogue Scale (VAS), subjective changes in headache status and remission rate of chronic headache.…”

“…The study investigated follow-up teleconsultations in an outpatient setting. Another study (26) looked at a subgroup of patients who had remission from chronic headache 12 months after they took part in either a teleconsultation or a traditional consultation. This study found that patients who took part in traditional consultations more often consulted a general practitioner for headache during a one-year follow-up period (26).…”

“…Only one study (32) investigated the use of telemedicine on hospitalized patients in acute care, while the remaining studies (20 –31) investigated the use of telemedicine in outpatient settings. The initial consultation was via telemedicine in six studies (20 –24,26), while telemedicine was used for follow-up consultations in five studies (25,28 –31).…”

“…Seven studies (20 –26), of which six were based on the same trial, were open-label randomized controlled trials (RCTs). Of the additional studies, one collected data retrospectively (27), and the remaining studies had a prospective design (26,28 –32).…”

“…In one study (29), teleconsultations were performed by a physician and nurse specializing in headache care, while teleconsultations were conducted by a nurse practitioner alone in another study (28). In additional studies, teleconsultations were carried out by physicians (20)(21)(22)(23)(24)(25)(26)(27)(30)(31)(32). -Chronic daily headache (n…”