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Telehealth, mHealth Tools Help Providers, Patients Improve Migraine Care

New research finds that clinicians can use telehealth platforms and mHealth devices to improve care management for those dealing with migraines - including making sure they come back for follow-up care.

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By Eric Wicklund

- A telehealth platform offering virtual care for migraine sufferers not only improved care management – it also greatly improved the percentage of patients seeking follow-up care.

These results come from a study presented at the 2019 Annual Meeting of the American Headache Society in Philadelphia by Deborah I. Friedman, MD, MPH, FAAN, a professor of neurology, neurotherapeutics and ophthalmology at the University of Texas Southwestern Medical Center in Dallas.

Friedman set up a program by which patients who’d been treated for severe headache disability from migraine treated in a specialty care center in 2014 and 2015 were invited for follow-up care at four to six weeks and then at three, six, nine and 12 months, either by telemedicine or in-person. Of the 45 patients involved in the study, 95 percent of those opting to use video visits completed their care path, compared to less than half of those who chose in-person care.

In addition, Friedman said, those using telehealth showed higher improvement in MIDAS (headache disability) rating, reduced number of headache days and headache severity.

Friedman said the project offers value in areas where migraine specialists are scarce – which, in fact, consists of a large part of the country.

READ MORE: Virginia Health System to Use An App to Treat Headaches

“There are actually states where there are no board-certified UCNS specialists in headache medicine<” she said in a video interview with NeurologyLive following her presentation.Given the magnitude of the number of people who have headache, and in many cases disabling headache, it becomes a real challenge for those people to find someone who’s able to take care of them."

Friedman also pointed out that those using telehealth rated the sessions as more convenient than those who used in-person care, and the telehealth sessions were also shorter in length.

The study is one of several connected health efforts targeted at treatment of migraines, an often debilitating chronic condition that affects roughly 12 percent of the population and is the third most prevalent illness in the world.

At the Albert Einstein College of Medicine, researcher Elizabeth Seng is ready to embark on a year-long project aimed at using telehealth to help people manage their migraines. Participants will receive four monthly sessions with a doctoral psychology student in a clinical health psychology program covering early warning signs and triggers, relaxation techniques and stress management, medication adherence, impact reduction, biofeedback and relapse prevention.

Healthcare providers are also looking to digital therapeutics to improve care management.

READ MORE: Chronic Pain Study Focuses on mHealth Tracking, Care Management

In May, the US Food and Drug Administration granted De Novo pre-market approval to Theranica Bio-Electronics’ Nerivio Midra digital therapeutic platform. The non-invasive neuromodulation device is designed for the acute treatment of migraines with or without aura in adults who don’t suffer from chronic migraines. Company officials say they plan to market the product later this year.

“There is a large unmet need for new treatments in this population when these medications are not effective, are contra-indicated, or have non-tolerable side effects,” Stephen Silberstein, director of the Headache Center at the Jefferson University Hospital in Philadelphia and a member of Theranica’s advisory board, said in a press release issued by the company. “In addition, triptans and most current acute migraine medications, including over-the-counter drugs indicated for migraine, are associated with medication-overuse headache (MOH), which is associated with increased frequency of migraine attacks, and often results in chronic migraine. This new innovative FDA-authorized treatment is an important alternative to help our patients control this debilitating condition.”

Friedman’s latest study is an extension of research she presented to the AHS in 2015. At that time, she had partnered with the Simon Business School at the University of Rochester for a preliminary study on feasibility, clinical effectiveness and patient satisfaction.

“We found that telemedicine is effective in conducting follow-up evaluations for patients with migraine,” she said in presenting the results of that study at the AHS meeting that year. “And we also believe telemedicine adds economic value for patients and results in a high degree of patient satisfaction.”

At the same time, St. Louis-based Mercy Virtual presented the results of a separate study in which researchers found that Mercy’s Virtual TeleHeadache platform “significantly improved the patient’s likelihood of being prescribed acute and preventative medication consistent with evidence-based guidelines.”

READ MORE: In a Competitive Market, Telehealth Can Be a Valuable Commodity

Researchers found that almost 78 percent of those receiving treatment via telehealth were prescribed or recommended evidence-based acute medication, whereas only 27 percent of those getting in-person treatment saw that level of care.

“Given its portability and scalability, telemedicine offers the possibility of expanding the reach of providers who can deliver world-class migraine care regardless of the patient’s location,” Timothy R. Smith, MD, of the Mercy Clinic Headache Center at Mercy Virtual and lead author of the study, said.

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