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            1. Can Telemedicine Help Migraine Sufferers?

              Companies like Nurx believe virtual visits will make treatment more accessible and convenient.

              Telemedicine may not be right for all people with migraine, but it can make treatment available to many more patients.iStock

              The coronavirus pandemic has forced healthcare providers across the country to make telemedicine an integral part of their practice. Private telemedicine companies are also moving into the migraine space — offering virtual care to their subscribers. This is good news for the 39 million Americans living with migraine. Headache providers have never been so accessible.

              With telemedicine demand high, companies are expanding their services to reach more patients. Earlier this month, Nurx, a health tech company that has been providing virtual healthcare to women since 2015, announced it was expanding its services to include headache and migraine care.

              “Prior to the pandemic, telemedicine pretty much didn’t exist in the headache world,” says neurologist Charisse Litchman, MD, who serves as medical director of neurology for Nurx. Its use was largely limited to caring for people in rural communities, far away from migraine specialists, who are few and far between.

              But social distancing orders and fear of exposure to the virus that causes?COVID-19?has forced many medical providers to fast track their telemedicine capabilities, and it doesn’t look like it’s going to slow down.

              RELATED: Your Everyday Guide to Telemedicine

              “Virtual healthcare services are predicted to reach one billion encounters by the end of the year,” said Teshamae Monteith, MD, associate professor of clinical neurology at the University of Miami Miller School of Medicine, in a recent commentary in U.S. News and World Report.

              “There is nothing like feeling alone or helpless because you have a headache that won’t let you interact well with your colleagues, children, or partner; and the only option for care is to go to the ER because you don’t have access to a specialist,” says Dr. Litchman.

              Telemedicine, or telehealth, solves the problem of accessibility, and online telemedicine platforms can make getting care convenient and tolerable for people with migraine, especially those who experience severe headache pain, light sensitivity, and nausea during an attack, says Litchman.

              How It Works

              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.

              Other Telemedicine Options for Migraine Sufferers

              Amwell is another telemedicine company that treats people with migraine.

              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.

              “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,” said Ravitz.

              Does it work? 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. In addition, studies have shown that most patients are just as satisfied with virtual care as they are with in-person visits.

              Is Telemedicine Right for Every Migraine Patient?

              Recent changes to federal and state regulations allowing for expanded coverage of and less restrictions by private insurers have made it easier for healthcare providers to offer telemedicine. No one knows for sure if the easing of restrictions will remain post COVID-19. But telemedicine isn’t going away, says Litchman. “By most predictions, telemedicine may occupy 30 to 40 percent of outpatient healthcare encounters, in general, going forward,” she says.

              Before the pandemic, Dr. Monteith wasn’t totally onboard as far as virtual care was concerned.

              “I hesitated to adopt telemedicine because I felt it would not be an equivalent experience to an in-person patient encounter,” says Monteith. “Now, I'm convinced telemedicine is a valuable option that needs to stay because it makes it easier for people with migraine to get care."

              Monteith points out that telemedicine may not be right for all people with migraine. It requires diligence on the part of the patient, who may be asked to track his or her blood pressure, weight, migraine frequency and intensity, and medication usage, she explains.

              “If there are new and worrisome signs or symptoms, the patient may need to come in person or be advised to go to an ER,” Monteith says. “If a patient has warning symptoms or signs such as visual loss, weakness, change in speech or gait, it’ll be important to see the patient for a complete exam and evaluation.”

              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 for some aspects of the examination. This can sometimes be difficult if you are at work or at home with children.”

              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.