Telemedicine has grown in popularity since 2020. Now, you can visit your therapist, have a rash looked at, and even get medication prescribed, all without leaving home. But can this convenience help people with chronic migraine?

Several recent studies say yes. With a few exceptions, telemedicine can be an effective option for the evaluation and treatment of migraine headaches.

Here’s what you need to know about virtual healthcare for migraine.

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What Is Telehealth for Migraine?

Telehealth works by using technology like video chat, messaging, streaming, and phone calls to provide healthcare. There are different formats and types of telehealth, which can be used differently for migraine care.

Real-Time Telehealth

Using video chat, phone, or another platform, this format of telehealth allows for a live discussion with the doctor or specialist. In general, this kind of appointment can often replace in-person appointments for routine care, follow-ups, or counseling.

For migraine, some studies have shown that video visits can be just as effective as in-person visits for follow-up care.

A migraine first appointment, clinical assessment, or diagnosis can certainly be done via telehealth when necessary. However, many doctors are more comfortable using telehealth for follow-ups after they’ve already seen someone in person.

Asynchronous Telehealth

Many healthcare systems allow you to send a message to your doctor that they or another provider can read and reply to at a later time. You can ask your doctor questions or report any changes in your health. This makes it asynchronous.

Other kinds of asynchronous care include an e-visit, in which you answer a series of automated questions on your own time. You can also use an asynchronous system, like a migraine-tracking app or symptom diary, to track and store data and information about your health and symptoms.

Direct-to-Consumer Telehealth Companies

You may have seen ads on television, online, or even on buses and trains for direct-to-consumer telehealth companies.

Cove is a company designed especially for migraine telehealth. It directs users to answer questionnaires and create diagnostic videos on their own time, which are then shared with a migraine specialist who makes a treatment recommendation.

Pros of Telehealth for Migraine

There is a lot of research that supports the potential of telehealth to greatly improve migraine management. Some of the major benefits identified by these studies include the following:

Telehealth Reduces Costs and Improves Satisfaction

Many studies have shown that using telemedicine is widely reported to be more convenient, less time-consuming, and less costly than in-person medical care. People also report high levels of satisfaction with their care.

Studies that track outcomes have not been able to find any meaningful difference in the headache days or headache severity of people who do their appointments online compared to those who attend them in person.

Telehealth Improves Access to Migraine Care

Because you can see a doctor from anywhere, telemedicine may make it easier to get the care you need. Although migraine is extremely common, access to specialists has historically been very limited.

Telemedicine prevents people from having to take the time and expense to travel to a visit. For people living in areas where there is no specialist available, telemedicine for migraine might be the only way an appointment like that would be possible.

Symptom-Tracking Apps Help Reduce Headaches

E-diary or app-based symptom trackers are very effective. Research has shown they are more effective than more traditional monitoring efforts (like a paper journal) at reducing the number of days people have headaches, reducing the number of days people need to take painkillers, and increasing people’s ability to stick with their doctor’s recommendations.

Cons and Limitations of Telehealth for Migraine

While telehealth is great in many ways, there are some things that can’t be done over the phone or video.

Neurological Examinations

The most obvious limitation to receiving your migraine care online is that a doctor cannot examine you in person. One important first step for someone experiencing chronic migraine is a full neurological examination. These exams are traditionally done in person.

A neurological exam often includes evaluating:

• Mental health
• Head and face nerves function
• Strength and coordination
• Reflexes
• Perceptions of feeling and touch
• Spine
• Gait (the way you walk)

A complete neurological exam is recommended for migraine headaches to identify any secondary cause for headaches. Not every aspect of this exam can be done remotely. Some elements of it, though, can be done on video, like testing your cognitive function, cranial nerve function, motor strength, coordination, and gait.

A fundoscopic exam, an eye exam where a doctor shines a light in your eye, is a part of the neurological exam that can’t be replicated online. However, some telehealth advocates recommend having headache specialists partner with a local eye care clinic that can share the results.

Technology and Communication Issues

Difficulty with technology could be a barrier for many people in using telemedicine. It might be more challenging for people who are older, who don’t have access to an up-to-date computer or smartphone, or people with a poor internet connection.

Reimbursement and Licensing

Not all health insurance companies provide reimbursements for telemedicine care. Make sure to check your health insurance coverage before using a telehealth service.

Medicare does cover many telehealth visits, and current Medicare telehealth flexibilities have been extended through Dec. 31, 2027. These rules may change after that date, so check Medicare’s current telehealth coverage before making an appointment. Medicaid generally does reimburse for telehealth, but the rules vary by state.

There are also some limitations on when a provider can offer you care if they aren’t in the same state as you. Public policy advances might help resolve these issues over time.

When To See a Doctor in Person

Some situations require an in-person doctor visit. You might consider an in-person visit for your first complete assessment, especially if your doctor recommends a physical exam, or if you have anything in your medical history or family history that could point to a bigger problem. You usually also need to see a doctor in person for an eye exam.

Headache Red Flags

You are considered to be at higher risk and should see a doctor in person (at least for initial evaluation) if any of the following apply to you.

• Being over the age of 50 when you experienced your first migraine
• Having headaches that are increasing in frequency and severity
• Having risk factors for HIV or cancer
• Having had a recent head injury
• Experiencing new or unusual neurological symptoms, such as paralysis, numbness, tingling, speech problems, or coordination issues (aura is not considered to be a red flag symptom)
• Having a sudden, very severe headache, sometimes called a “thunderclap headache” or “the worst headache of your life”
• Experiencing other concerning symptoms that might indicate a broader illness

Join the Conversation

On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.

Have you considered telehealth for your migraine? Let others know in the comments below.