ABSTRACT
Objective: To assess the practice of telehealth for headache visits in the US. Background: The rapid roll-out of telehealth during the COVID-19 pandemic impacted headache specialists. Design/Methods: American Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth. Results: 225 of 1348 (16.7%) AHS members responded. Most were female (59.8%;113/189). Mean age was 47.4±11.8 (N=154). The vast majority were MD/DOs (83.2%;158/190) and NP/PAs (14.7%;28/190), and most (65.1%;123/189) were in academia. Years in practice were: 0-3: 28;4-10: 58;11-20: 42;20+: 61. Mean number of telehealth visits was 199.4 ± 214.8 in prior 3 months. Respondents were "comfortable" or "very comfortable" treating via telehealth a (a) new patient with a chief complaint of headache (137/185);(b) follow-up for migraine (184/186);(c) follow-up for secondary headache (116/182). About half (51.1%;97/190) offer urgent telehealth. Beyond being unable to perform in-person procedures, top barriers cited were conducting parts of the neurologic exam (157/189), absence of vital signs (116/189), and socioeconomic/technologic barriers (88/189). The top positive attributes were patient convenience (185/190), reducing patient travel stress (172/190), patient cost reduction (151/190), flexibility with personal matters (128/190), patient comfort at home (114/190), and patient medications nearby(103/190). Only 20% (31/155) of providers said that telehealth visit length differed compared to in person visits and 55.3% (105/190) believe the no-show rate improved. Providers were "interested"/"very interested" (128/188) in digitally prescribing headache apps and "interested"/"very interested" (121/189) in the remote monitoring of patient symptoms. Conclusions: Respondents were comfortable treating migraine patients via telehealth They note positive attributes for patients and how access to care may be improved. Technology innovations (remote vital signs, digitally prescribing headache apps) and remote symptom monitoring are areas of interest for headache specialists and warrant future research.
ABSTRACT
Objective: To determine the efficacy and safety of a self-administered nasal spray targeting the sphenopalatine ganglion (SPG) for acute migraine treatment during the COVID-19 pandemic. Background: The SPG is a nerve bundle that lies in the pterygopalatine fossa with important parasympathetic outflow to the craniofacial structures. It is a known target for the acute treatment of migraine. Anesthetic blocking of the SPG may modulate sensory processes in the trigeminal nucleus caudalis, possibly reducing central sensitization of pain in headache. Blocks can be done via needle injection or catheter device insertion to deliver anesthetic to the SPG. During clinic closures due to COVID-19, visits were shifted to telemedicine and there was an increasing need for treatments that would minimize office and emergency room visits. Design/Methods: At the start of the pandemic, a nasal spray anesthetic targeting the SPG was prescribed to patients with migraine. Patients were prescribed 1% lidocaine, 2% lidocaine, or 0.5% ropivacaine spray. They were instructed to deliver 0.1cc per dose spray in each nostril and lie back with their head tilted towards the ipsilateral side, for use up to 5 times monthly as needed. A retrospective chart review of 53 patients receiving this treatment was conducted. Analysis included headache improvement and reported side effects. Results: Overall 76% of patients reported headache improvement acutely. Further, response to all 3 formulations demonstrated majority improvement (89% with 1% lidocaine, 68% with 2% lidocaine, and 81% with 0.5% ropivacaine). Few side effects were reported, only a brief episode of epistaxis in one patient on the 5th usage and transient headache exacerbation in one other patient. Conclusions: Self-administered anesthetic nasal spray targeting the SPG is likely an effective and safe home acute treatment for migraine attacks. This treatment was of particular benefit for patients during pandemic clinic closures.