Is Telemedicine an Effective Way to Treat Migraine?
For some people with migraine, virtual visits have improved access to headache specialists.
Even in the best of times, getting good migraine care can be a challenge. According to the Migraine Research Foundation, in 2020, there were only 700 headache specialists in the United States — and an estimated 39 million Americans who have migraine.
Those specialists are not evenly distributed around the country, either, meaning that one person may have many specialists nearby to choose from, while another may have to travel hundreds of miles to see a specialist.
Ironically, the coronavirus pandemic that started in 2019 may have made seeing a headache specialist easier for many people with migraine.
When nonurgent in-person visits were paused in the spring of 2020, medical practices around the country did a quick pivot from in-person doctor’s appointments to telemedicine. Additionally, many private telemedicine companies formed or expanded services to meet the increased need for remote healthcare.
For many Americans living with migraine, remote access to headache providers was truly life-changing; getting migraine treatment no longer required scheduling childcare, arranging for transportation, or missing several hours — or even days — of work.
Telemedicine Saw Huge Jump During Pandemic
Over 42 percent of Americans used telehealth during the pandemic, and insurance claims data from the summer of 2019 to the summer of 2020 shows a 6,000 percent increase in telehealth claims, according to Definitive Healthcare, a healthcare data company.
Telemedicine for migraine and other headache disorders has certainly evolved since the start of the pandemic, but it existed pre-pandemic, says Emad Estemalik, MD, section head for headache and facial pain at the Center for Neurological Restoration at Cleveland Clinic in Ohio.
“Here at the Neurological Institute at the Cleveland Clinic, we have already been doing virtual visits for three to four years now. It gained momentum in the spring of 2020, when a lot of care temporarily shifted to be completely remote as hospitals prepared for possible surges of COVID-19 patients,” he says.
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Experts Say It’s Here to Stay
Changes to federal and state regulations that allowed for expanded coverage and fewer restrictions by private insurers made it easier for healthcare providers to offer telemedicine during the pandemic.
It’s not clear if the easing of restrictions will remain post COVID-19; in April 2021, the U.S. Department of Health and Human Services renewed the declaration that a public health emergency still exists, which means that Medicare and Medicaid will cover telemedicine for now, and most private insurance companies will continue to follow suit.
Telemedicine isn’t going away, says Charisse Litchman, MD, a neurologist in Norwalk, Connecticut, who also serves as medical director of neurology for Nurx, a health tech company that has been providing virtual healthcare to women since 2015 and recently expanded its services to include headache and migraine care.
“By most predictions, telemedicine may occupy 30 to 40 percent of outpatient healthcare encounters, in general, going forward,” Dr. Litchman says.
Telemedicine Can Be Effective for Much of Migraine Treatment
“The right patient will find this opportunity to be very valuable,” says Dr. Estemalik. “In the headache world, over 98 percent of headaches are benign or due to primary headache disorder, and so we have a big patient population that could be managed between some hybrid model of in-office and virtual visits,” he says.
For things like simple follow-up care or a medication refill, a remote visit can work great, Estemalik says.
Another plus is that telemedicine platforms can make getting care convenient and tolerable for people with migraine, especially those who experience severe headache, light sensitivity, and nausea during an attack, says Dr. Litchman.
And the evidence so far suggests that treating migraine virtually works. A study published in 2017 in the online issue of Neurology found that for people with headache, seeing a neurologist by video may be as effective as an in-person visit.
It also appears that most patients are just as satisfied with virtual care as they are with in-person visits. Research published in June 2017 in the European Journal of Neurology found that headache patients were just as satisfied with telemedicine as they were with a traditional doctor’s appointment.
That being said, sometimes in-person visits are more appropriate and even medically necessary.
“There are situations and certain symptoms that would warrant a detailed neurologic exam, for example, if there is a concern for a sudden secondary cause of a headache,” says Estemalik.
There are also procedures or infusions that are sometimes used in migraine treatment that would require an in-person visit, he says.
You could describe a change in your headache symptoms during a telemedicine visit that signal a need for you to come in and see the doctor in person, he says.
“Telemedicine isn’t replacing in-office visits; it’s purely optimizing treatment,” says Estemalik.
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Treating Migraine Remotely May Require Extra Input From the Patient
Although it’s more convenient to meet a healthcare provider in the comfort of your own living room, in some respects, it can require a little more commitment from the patient, says Teshamae Monteith, MD, associate professor of clinical neurology at the University of Miami Miller School of Medicine in Florida.
For example, people with migraine may be asked to track and report on their blood pressure, weight, migraine frequency and intensity, and medication usage in virtual appointments, she explains.
Even the convenience of long-distance care may have drawbacks. “Limitations include if a patient establishes care far away from home and cannot follow up for an in-person visit or procedure,” Monteith says.
“Also, patients have to be prepared for the time and rigor of a neurological history and examination. A family member or friend may need to help with some aspects of the examination. This can sometimes be difficult if you are at work or at home with children,” she says.
While telemedicine fills a gap, it shouldn’t be the only means for obtaining healthcare. “You should always have a primary care doctor for routine medical care,” says Monteith.
Telemedicine Options for People With Migraine
If you already have a primary care provider or headache specialist, call or check their website to find out about options for virtual appointments.
Below are a few of the private companies that offer telemedicine for migraine.
Nurx Subscribers to Nurx pay $60 annually to utilize their services, which include a comprehensive online medical consultation and video exam, a personalized treatment plan and daily headache tracker, and regular check-ins with a trained and licensed medical provider. Subscribers can reach out to their assigned provider as often as needed, says Litchman.
Home delivery of medication is also included in the plan, but patients must pay for the medicine out of pocket or through their insurance.
Cove Cove specializes in treating migraine. Their doctors are all board-certified and have experience treating migraine. Patients subscribe to the service and pay $4 every month, which includes unlimited access to a doctor.
Medications aren’t included in the subscription price, though you can pay an additional monthly cost and have your migraine medicine mailed to you, or you can have your prescription filled at your local pharmacy. Cove estimates that your subscription and your medications together will cost about $20 to $79 a month. Right now, the service doesn’t accept insurance, so all costs would be out-of-pocket.
Modern Migraine MD Risa Ravitz, MD, a neurologist in private practice in New York City, founded Modern Migraine MD to make migraine care more accessible and convenient.
“I have patients who see me in the office and then want the convenience of a follow-up with a virtual visit,” said Dr. Ravitz in an Association of Migraine Disorders blog. Modern Migraine MD offers in-person visits in New York City and telemedicine appointments in 11 states.
“Overall, telemedicine can replace the office visit model completely, and in the majority of cases, patients can get a diagnosis and most treatments via telemedicine,” Ravitz said.
Amwell This telemedicine company offers appointments for a long list of conditions, including migraine. Most appointments last for about 10 minutes, and the cost is $79. An Amwell visit may be covered by insurance, but you should check with your insurance company first. Any needed prescriptions aren’t included in the visit price.
Sesame This telemedicine service offers migraine consultations and prescription refill visits with doctors in your area. The average price for an appointment ranges from $39 and $55, though a more detailed or diagnostic appointment may cost more. Any needed prescriptions aren’t included in the price.
You pay Sesame directly — they don’t accept insurance. If you have a health savings account (HSA) or a flexible spending account (FSA), you may use your funds in the account to pay for your care. If your insurance covers out-of-network care, you may be able to get reimbursement, but you’d have to check with your specific insurance company to be sure.
Additional reporting by Hedy Marks.