Telemedicine: Successes and Challenges in Treating Migraine During COVID-19

In this video, Stephanie Nahas, MD, MSEd, discusses the pros and cons of telemedicine for the management and treatment of migraine during the ongoing pandemic.

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Stephanie J. Nahas, MD, MSEd, is an Associate Professor of Neurology, and Director of the Headache Medicine Fellowship Program at Thomas Jefferson University in Philadelphia, Pennsylvania.

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Stephanie Nahas, MD:  I'm Dr. Stephanie Nahas. I am a neurologist and a headache specialist working at Thomas Jefferson University at the Jefferson Headache Center in Philadelphia, Pennsylvania.

Many of our patients have been successful in leaping those hurdles to get the care that they need over a virtual platform. We've had great support from our staff and from our information technology department at our institution to help patients transition to this new normal.

Most of our patients do have a computer, or a tablet, or a smartphone, which is required to perform these video visits, that, a little bit of tech savviness to be able to download the software properly and interact with it correctly, and then just to be able to connect. Having a stable WiFi connection is also essential.

But it's not always that all of these little pieces come together. Most of the time, they do. I can tell you our patients are extremely grateful for the fact that we can continue to provide care even in this situation.

Even when it doesn't work out perfectly, we can usually find some workarounds and some ways to at least provide some of that care that we need. Even if we don't have the video connection, for example, we can still at least talk to our patients, and talking to them is mostly what we get.

When you're lacking the video or the in‑person interaction, that presents a challenge of not being able to read the non‑verbal cues as easily. Usually, you're seeing just one person on the screen.

But when we have an in‑person interaction often, the patient will bring a family member, or a friend, or somebody else to help advocate for them and to be an extra set of eyes and ears receiving the information that we're trying to impart for them, the education that we're trying to give, the recommendations for their plan of care.

There are a lot of ups and downs, but I think that the ups outweigh the downs. We've had more successes than we've had trip‑ups. On the whole, it's been a very positive silver lining, again, because of the advantages that patients don't necessarily have to travel. They can do it from the comfort of their home. It's very quick.

Another advantage is that we usually stay on time with our schedule. In the clinic, lots of things can happen. Patients can be held up by traffic. They can have a problem in the parking lot. They may get to the office and check in late. There may be lots of patients who were late and ahead of them.

Even if they show up on time, they might not go through the process of checking in and getting to see their provider at the time of their appointment. They may not know when they're going to be done, and so they worry, "OK. How much money do I have to put in the meter?" Or, "How much do I have to plan to pay for parking? Do I have to worry about the train schedule if I'm taking the train or public transportation, etc.?"

For the most part, we pretty much stay on time because it's a matter of turning on the computer and connecting. Here we go. We're ready to go, and we can be much more efficient in certain ways than we can in the office.

There are challenges. There are successes, but the balance, I think, is in our favor. Hopefully, we can continue to provide this kind of care for the patients when it's appropriate.