Telemedicine in headache care: A systematic review

Clausen, Tobias Christian; Greve, Nikolaos Kalogeropoulos; Müller, Kai Ivar; Kristoffersen, Espen Saxhaug; Schytz, Henrik Winther

doi:10.1177/03331024221111554

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…A multicenter RCT study found diagnostic accuracy to be favorable in 212 migraine patients via an online system [4]. Furthermore, RCT-studies have recently demonstrated good outcome for patients with headache treated via telemedicine at specialist [3]. This include dimensions such as treatment e cacy, patient satisfaction, safety, and feasibility, but there has so far been little focus on headache management in general practice after specialist consultation.…”

Section: Discussionmentioning

confidence: 99%

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Effect of video consultation for non-acute headache by neurologist on consultation rate in general practice during one-year follow-up. Randomized controlled trial

Bekkelund

2023

Preprint

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Background Patient´s access to headache specialists varies in the population. Video consultations may help, but the effect of using communication technology on headache management in the population is incompletely understood. This study determined whether use of video consultations for non-acute headache patients at specialist were noninferior to face-to-face consultations in the need for subsequent headache visits in general practice at follow-up. Methods Four hundred and two non-acute headache patients consecutively referred to neurologist from general practitioners in North Norway were included in a randomized controlled noninferiority trial. Frequency of patients consulting general practitioner for headache and median number of headache consultations 0–12 months after specialist consultation were compared between groups initially consulted by video or face-to-face consultations. Results Ninety-two (60.9%) of the patients in the video group and 93 (66.4%) in the face-to-face group consulted general practitioners for headache problems during the follow-up period, p = 0.274. The median (IQR range) number of consultations were 1 (IQR: 0–14) (video) and 1 (IQR: 0–15) (face-to-face), p = 0.154. Clinical characteristics including, headache impact, pain score and patients satisfied with headache information, communication, headache advice, diagnostic information, and headache medication at GP during follow-up were similar between the two groups. Conclusion Treating headache patients by using video consultations at neurologist did not result in higher consultation rate at follow-up in general practice. These data support use of video as a useful method in the treatment of headache at specialist in terms of organization of headache management in the population. Trial registration: Trial registration number NCT02270177. Registration date: October 2, 2014

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Section: Discussionmentioning

confidence: 99%

“…Thus, telehealth research for headache has grown [3,29]. Neither treatment outcome, safety nor patient satisfaction with telehealth were inferior to traditional consultation for headache patients seeing a neurological specialist [3,23]. Also, patients with di cult headache may bene t from telemedicine [7,11].…”

mentioning

confidence: 99%

Effect of video consultation for non-acute headache by neurologist on consultation rate in general practice during one-year follow-up. Randomized controlled trial

Bekkelund

2023

Preprint

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“…Previous studies suggest that telemedicine for headache management is non-inferior to traditional in-person consultations in effectiveness. Additionally, the advantages of remote healthcare services, particularly saved time and expenses, are especially significant for patients with limited access to healthcare ( 15 ). To evaluate the impact of telemedicine on migraine management, we conducted a national e-survey in Lithuania.…”

Section: Introductionmentioning

confidence: 99%

Evolving migraine management: Lithuania's telemedicine experience

Andruskevicius,

Petrosian,

Dapkute

et al. 2024

Front. Neurol.

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IntroductionCOVID-19 challenges have underscored the potential of telemedicine in migraine management. This study focuses on assessing patients' telemedicine experience for headache management in Lithuania and identifying key barriers and facilitators for its wider use.MethodsA nationwide e-survey was conducted in 2023 via the Lithuanian Association of Migraine Patients' website, social media platforms, websites of public and private healthcare facilities, and migraine self-help groups. The survey covered sociodemographics, migraine characteristics, previous experience with teleconsultations for headaches with neurologists and general practitioners (GP), perceived advantages and disadvantages of telehealth, and preferred future consultation types.ResultsEight hundred and forty seven respondents with a confirmed migraine diagnosis were analyzed. The majority were female (97.2%), with a median age of 35 (IQR 30–42) years and an average of 5 (IQR 3–9) monthly headache days (MHDs). 7.0% of respondents had chronic migraine (CM). Prior teleconsultations for headaches were reported by 35.2% of respondents, 26.2% with a GP and 17.0% with a neurologist (p < 0.0001). Teleconsultation outcomes included continuation of a prescribed treatment (84.7% for GPs and 83.3% for neurologists, p = 0.7295), initiation of new acute medications (12.2% for GPs with 70.4% reported as effective and 27.1% for neurologists with 84.6% effective, p = 0.0005 and p < 0.0001, respectively). Reasons for not undergoing remote neurology consultations: the lack of inquiry (69.7%), unavailability from neurologists (18.1%) and respondent's opposition to remote consultations (12.2%). Patients evaluated their experience with remote neurology services better than that of GPs (p = 0.0289). 67.3% of respondents preferred a mixed-mode approach for future consultations. In-person-only preference (29.0%) correlated with multiple factors, including history of remote primary neurology consultations (OR 5.89, p = 0.0022), lower education (OR 2.20, p = 0.0001), physically demanding work (OR 1.95, p = 0.0001), and number of drawbacks in telemedicine identified (OR 1.30, p < 0.0001), and worse experience of a prior remote GP consultation (OR 0.704, p < 0.0001). The main indicator of preference for remote-only consultations was the perception of fewer telemedicine disadvantages (OR 0.503, p = 0.0007).ConclusionsOur findings confirm that telemedicine contributes to effective migraine management and is used limitedly in Lithuania. Despite one-third of respondents having experienced teleconsultations, significant barriers remain. Our study highlights a clear preference for a hybrid consultation type.

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“…However, it should be noted that those reports dealt with selected patients, and did not include an assessment of patients excluded from the services due to feasibility reasons or refusal to access telemedicine. Besides, the high prevalence of headache disorders in the general population implies a rational use of telemedicine resources for headache care [ 29 ]. There is the risk that patients who could access lower layers of headache care are brought to unnecessary access to higher layers because of increased accessibility of services via telemedicine, therefore leading to a saturation of the system [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

“…Besides, the high prevalence of headache disorders in the general population implies a rational use of telemedicine resources for headache care [ 29 ]. There is the risk that patients who could access lower layers of headache care are brought to unnecessary access to higher layers because of increased accessibility of services via telemedicine, therefore leading to a saturation of the system [ 29 ]. In low- and middle-income countries, a further problem lies within the limited resources that can be allocated to telemedicine infrastructures and personnel training.…”

Section: Introductionmentioning

confidence: 99%

Health equity, care access and quality in headache – part 2

Raffaelli,

Rubio-Beltrán,

Cho

et al. 2023

J Headache Pain

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Background Headache disorders are a global public health concern affecting diverse populations. This review examines headache service organizations in low-, middle-, and high-income countries. It addresses global challenges in pharmacological headache treatment, with a focus on safety, tolerability, reproductive and child health, and outlines disparities in accessing innovative treatments worldwide. Main body Organized headache services are essential due to the wide prevalence and varying severity of headache disorders. The tiered headache service model is globally recognized, although its implementation varies based on financial and workforce considerations. Headache burden affects well-being, causing disability, economic challenges, and work limitations, irrespective of location or income. All nations still require improved diagnosis and treatment, and the majority of countries face obstacles including limited access, awareness, economic barriers, and inadequate health policies. Provided adequate internet availability, telemedicine could help improve health equity by expanding access to headache care, since it can offer patients access to services without lengthy waiting times or extensive travel and can provide healthcare unavailable in underserved areas due to staff shortages. Numerous health disparities restrict global access to many headache medications, especially impacting individuals historically excluded from randomized controlled trials, such as those with cardiovascular and cerebrovascular conditions, as well as pregnant women. Furthermore, despite advancements in researching migraine treatments for young patients, the options for treatment remain limited. Access to headache treatment relies on factors like medication availability, approval, financial coverage, and healthcare provider expertise. Inadequate public awareness leads to neglect by policymakers and undertreatment by patients and healthcare providers. Global access discrepancies are exacerbated by the introduction of novel disease-specific medications, particularly impacting Asian, African, and Latin American nations excluded from clinical trials. While North America and Europe experience broad availability of migraine treatments, the majority of countries worldwide lack access to these therapies. Conclusions Healthcare disparities, treatment access, and medication availability are concerning issues in headache medicine. Variations in national healthcare systems impact headache management, and costly innovative drugs are widening these gaps. Healthcare practitioners and experts should acknowledge these challenges and work towards minimizing access barriers for equitable global headache care in the future.

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Telemedicine in headache care: A systematic review

Cited by 10 publications

References 39 publications

Effect of video consultation for non-acute headache by neurologist on consultation rate in general practice during one-year follow-up. Randomized controlled trial

Effect of video consultation for non-acute headache by neurologist on consultation rate in general practice during one-year follow-up. Randomized controlled trial

Evolving migraine management: Lithuania's telemedicine experience

Health equity, care access and quality in headache – part 2

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