Should you go for telemedicine for migraine care?

According to the American Association of Family Physicians, telemedicine is “the practice of medicine using technology to deliver care at a distance”. In the context of the migraine condition and treatment, it means that you meet with your medical provider over a video call or something similar, and get your heath care without meeting your physician in person. In this COVID-19 world, where we have to watch our health and practice good social distancing, telemedicine is a safe alternative to receiving face-to-face medical services. After all, you still get to meet your doctor!

What does the Migraine Buddy community say?

We sent out a survey to establish an interest in this type of health care, especially for people who suffer from migraine. We especially wanted to know the pain points of our community members and how we could help you manage your doctor visits while at the same time being as safe as possible. Over 2500 people responded to our survey!

What are the results?

Our community members are willing to try tele-consultation and telemedicine for their migraine management if:

• They can consult a doctor or their health care professionals almost immediately (72%)
• The technology is easy to use (69%)
• Can schedule their telemedicine clinical appointments online (56.1%)

And when asked why the interest in this new form of consultation, the consensus amongst our community was overwhelming. This new interest in telemedicine and tele-consulting was triggered by the COVID-19 pandemic and its restrictions.

COVID-19 was especially dangerous for the patients who were immunocompromised, as they could not afford to take the vaccine and they felt unsafe leaving the house. Their normal medical routine and consults were affected by the pandemic, and wait-lists also started to stretch the longer the pandemic wore on.

With all this information, we reached out to one of our partners who specialises in migraine healthcare (Nurx) to see if they could help support our users. We spoke to Dr Charisse Litchman, a neurologist, headache specialist, and medical advisor to Nurx.

• What is Nurx?
• How does it work?
• I’m not very digitally savvy! Can I still use Nurx’s services?
• How can I make the most out of my appointment?
• How long do I have to wait to get an online appointment?
• What do you mean by lifestyle change? How much can lifestyle changes help with headaches
• What are the treatment options for migraine and headaches?

What is Nurx?

Dr. L: Nurx is a telehealth company that will connect you with a medical provider who is specially trained in migraine care. After you complete an online evaluation any time, at your convenience, a medical provider licensed in your state will create your personalized migraine treatment plan. Finally, the Nurx pharmacy will send prescription medication to your door. You don’t need to move from the house, or even lift a finger!

How does it work?

Dr. L: It’s fast and easy to get started. Download the Nurx app here and answer questions about your migraines and your health history. Next, you’ll have to film a few short videos of yourself performing simple motions. (Psst, you can use your phone or computer!) The videos allow the medical team to make sure they can treat you safely through telehealth. You can complete the assessment any time: no need for an appointment. After you submit your information and request treatment, a Nurx medical provider will message you within a day or two to ask any follow-up questions and review your treatment plan. If you have tried certain migraine medications in the past that have worked for you, you can request that your medical provider prescribe you those, or they will create a personalized treatment plan tailored to your needs. 

Your treatment plan may consist of medication to stop a headache when you feel one coming on, a medication you take to prevent migraines in the first place and anti-nausea medication if nausea is one of your symptoms. Nurx will bill insurance (if you have it) for your medication and offers affordable out-of-pocket prices for those without insurance. Medication is sent to your door with free shipping and automatic refills for one year. The entire process is made to be as streamlined and easy for you as possible!

After the appointment, your Nurx medical provider will check in with you to make sure that your treatment is working and adjust your prescriptions as needed. You can message the medical team any time with questions. 

I’m not very digitally savvy! Can I still use Nurx’s services?

Dr. L: Yes — all you need is a computer or smartphone with an internet connection. The written part of the assessment is similar to the questions you would answer at an in-person doctor’s appointment and the video portion comes with simple instructions.

How can I make the most out of my appointment? 

Dr. L: When you submit your online evaluation, share as many details as you can about your headaches. Your medical provider needs to understand the frequency, length and severity of your migraines. Don’t rely on memory—keep a record to ensure you’re giving your doctor the most accurate data. Protip: you can use Migraine Buddy with Nurx doctors! The tracking function on Migraine Buddy and the corresponding records can be provided to Nurx for the most accurate diagnosis and analysis. Remember to track your migraines and identify triggers as that will help you share accurate information with the Nurx medical team. Understanding whether your migraines are triggered by hormones, certain foods or something else, and whether you experience aura symptoms, will help your doctor create the best plan for you.

How long do I have to wait to get an online appointment?

Dr. L: There are no appointments necessary, so no waiting at all. You can complete your assessment and request treatment any time at all and a Nurx medical provider will respond within a day or two with questions or to review your treatment plan.

What do you mean by lifestyle change? How much can lifestyle changes help with headaches?

Dr. L: Medication can do a lot, but usually getting migraines under control requires a multi-faceted approach. Knowing and avoiding your food triggers and avoiding excess caffeine and alcohol can reduce headaches significantly. Sticking to a regular eating and sleep schedule, learning to manage stress and avoiding too much screen time can really help. But for many people a healthy lifestyle and avoiding triggers won’t eliminate headaches entirely.  The appropriate prescription medications can stop migraines and give patients their lives back.

What are the treatment options for migraine and headaches?

Dr. L: Headache sufferers need to know that there is help out there — this is a new era in migraine medicine. Since triptans came to market in 1991 there wasn’t a medication designed specifically to treat migraines until the monoclonal antibodies came out in 2018. Botox, which was developed for other medical conditions and which was approved  for migraine over ten years ago, revolutionized migraine treatment by identifying the root cause of migraines: the release of the chemical CGRP. The monoclonal antibody treatments like Aimovig and Emgality which were developed with the sole purpose of targeting CGRP and its receptors have changed the lives of many migraine sufferers by preventing migraines.   Then along came the gepants, Nurtec and Ubrelvy, which are truly a big deal . They block CGRP and in that sense they’re similar to the way monoclonal antibodies like Aimovig and Emgality, but they don’t require an injection. Both can be used to stop an acute migraine and Nurtec to prevent them as well.  The bottom line is that anybody who experiences migraines should feel empowered in seeking care and demanding the best treatments available.

About Dr Charisse Litchman:

Dr Charisse Litchman MD, FAHS, is a neurologist, headache specialist, and medical advisor to Nurx. Dr. Litchman received her medical degree at Yale School of Medicine. After completing her internship at Yale New Haven Hospital, she completed her neurology residency at Cornell-New York Hospital. She began a solo private practice in general neurology and became board certified in headache medicine in 2008. A former Assistant Professor of Clinical Neurology at Yale School of Medicine, Charisse has published articles on headaches and multiple sclerosis and edited the first textbook on a rare soft tissue tumor. Dr. Litchman has experienced migraines as have many members of her family, and she is passionate about helping people find solutions to migraines and get their lives back.