Most of us are used to going to doctor’s appointments in person, and seeing a doctor virtually may at first seem like it might be lacking something.  What are the advantages and disadvantages of a telehealth portal for headache doctors?

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Prior to the global coronavirus pandemic, there were few options available for virtual doctor’s appointments.  Congress passed legislation in spring 2020 in response to stay-at-home orders that mandated insurers to cover virtual appointments the same way they would cover in person appointments.  This led to a complete change in how medical care was performed and monitored.  

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In addition to the added safety of being able to avoid exposure to covid, being able to see your doctor from home (or wherever you happened to be) was a major convenience for most people, and decreased waiting times and travel expenses associated with going to a doctor’s office.  An entire field of medical research on telehealth has started to flourish and provides insights into what kind of appointments are most appropriate virtually or in person.  

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Headache medicine is a unique field and was noted early on to be one of the most ideal for telehealth.  The vast majority of serious conditions associated with migraine can be determined quickly and those patients can appropriately be referred to see a doctor in person. Most patients who see a headache medicine specialist have had their problem for an extended period of time already, a serious diagnosis would therefore also be much less likely. 

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Access to a headache specialist can be extremely difficult, especially if you don’t live in a major city.  Even in most major cities, the wait to see a specialist can take months.  Telehealth has the ability to broaden access to headache providers significantly, wherever you live.  It can even shorten waitlists as visits often are more quickly expedited and focused.  This is especially true when you can include a tracker feature in the telehealth app, and your physician can more quickly recognize triggers and patterns. Additionally, telehealth treatment can have a unique approach to your treatment, such as care coaching, which allows you to track your progress and have a trained specialist support you throughout your journey.

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One major telehealth limitation is not performing a hands-on exam.  The neurological exam appropriate for headache medicine can be modified appropriately to be performed virtually, and a number of neurological tests can even be administered on a smartphone device.  In the end, if concern arises, your doctor will be able to refer you to a local neurologist or will order an imaging test if appropriate.  

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When is telehealth not appropriate?

Telehealth does have limitations, and may not be ideal in all situations.  Some patients will need an in person exam for concerning signs on a telehealth neurological exam.  Some will need referrals for injections or infusions for their headache if appropriate.  Most importantly, telehealth shouldn’t be relied on in case of a medical emergency.  

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We like to use the acronym SNOOPPP to help remember the medical emergencies be concerned about with headache. In these situations we recommend a thorough in person evaluation, and likely other tests like an MRI:

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• Systemic symptoms -  A headache that presents or worsens at the same time as a fever, infection, unintended weight loss, night sweats or with a known cancer or HIV. 
• Neurological symptoms - A headache that presents with new neurological changes, such as vision change, weakness, numbness, word finding difficulties or anything else that you haven’t experienced before. 
• Onset - A headache that feels like a thunderclap, worsening over seconds, suddenly. 
• Older Age - A new headache in someone older than 50. 
• Prior Headache - A headache that feels different than anything you have previously experienced. 
• Pregnancy - A headache that started or is worsening in pregnancy. 
• Positional change - A headache that changes when changing positions - either when lying down or when standing up. 

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Overall, telehealth is a great way to meet and follow up with a headache specialist, but it isn't always appropriate for every situation.  If you're curious to give it a try, you can sign up for Neura membership on the Neura Health website and set up a same-day or next-day video appointment.

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Here is a link to a Facebook Live that Neura's Medical Director, Thomas Berk, MD, did with Facebook patient support group Migraine Meanderings about telemedicine for migraine and headache disorders.

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