UrbanUpdate

One of the countless ways COVID-19 transformed the world, and specifically, the world of medicine, was revealing that a doctor’s appointment sometimes required little more than internet connection. While many procedures, including check-ups, still take place in person, social distancing helped an alternative, remote communication between healthcare providers and their patients become commonplace. Some of the greatest beneficiaries have been among the 40 million Americans who suffer from migraine. Aided by video call, conversations with healthcare providers are much more convenient and, crucially, much quicker to arrange. If someone is suffering from a torrential succession of episodes or particularly disruptive acute migraine, the importance of an added option to call from home may be fundamental.

After ringing up a clinic, patients could be seeing a headache specialist in minutes without a painful or distant drive. “There’s a speed element,” says Dr. Wade Cooper, a neurologist at the Memorial Healthcare Institute for Neuroscience in Owosso, Michigan. “You can make that call at 3:20 and be seen at 4pm.”

The list of ways a more nimble point of service can help migraine patients is long. Often, an actual appointment is not. Whether for a scheduled appointment or a direct response to a headache episode, the various steps of a visit to the doctor can become a rigamarole. A long drive, sitting in the waiting room, having vitals checked: “It’s more of an ordeal than to hop on telehealth,” says Dr. Cooper. That’s a lot of steps for an appointment that could only run for 10 minutes. Contrarily, the easy set up of a video call feels more logistically aligned to such a brief conversation.

From the doctor’s perspective, that more efficient use of time that telemedicine enables increases both their scale and speed of service. According to Dr. Cooper, the effect of a single provider is multiplied. “You can see two or three times more people with the telehealth model” under ideal circumstances, he says, noting that health systems are still sorting out how to best integrate the tool.

More casual modes of communication between patient and clinician also have the potential to speed up the search for the right treatment, empowering the migraine patient as part of the process. A traditional treatment process might involve a patient leaving an appointment with a new medicine to test out for several months until their next appointment. Through telehealth, whether by an ad hoc video call or direct message, “I don't need to wait three months for them to say it didn't work,” says Dr. Cooper. “They can tell me in four weeks,” allowing a speedier advance to other options—and the patient to indicate when they’re ready to try a different treatment.

The improvements that telehealth offers couldn't come at a better time. According to a 2019 review from the American Association of Neurology, “In nearly every US state today, a large mismatch exists between the need for neurologists and neurological services and the availability of neurologists to provide these services.” The disparity is especially severe in rural parts of the nation, where around 80 percent of those in need of a neurologist lack access to one. With geography mostly out of the equation, medical systems can reach those patients more easily.

Telehealth may be able to cross physical ground no problem, but administrative boundaries still create limits. Licensure to provide medical service in the US is largely a state-by-state matter. That was a big problem during the more acute moments of the pandemic. Healthcare providers, notably nurse practitioners, couldn’t travel to COVID-19 hotspots and offer certain essential services, like writing prescriptions. Similarly, someone who offers telehealth services in one state may not be able to take a patient in another—even if they’re just a few miles from each other.

Another blocker is insurance companies, which typically covers a smaller slice of patient costs for telehealth appointments compared to physical ones. An effect is that clinicians are more hesitant to adopt the service. The double-barrelled outcome is that the service is artificially more expensive and less available than it needs to be. Thus, patients in a poor, rural area who stand to benefit most from the technology could have less access to it.

Still, Dr. Cooper says that’s not enough to halt a transformation in headache medicine that’ll expand access and quality of care. “As we get more and more savvy, we're going to move away from this structured 30-minute block and to more of these breakthrough sessions with a physician,” he says. “I can only see this expanding, and I can see it helping in lots of ways.”

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