A new vision in headache medicine: A survey of headache specialists ' utilization of telehealth in their practice

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.