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COVID-19 - crisis and migraine management?

The current COVID-19 pandemic provides short‑term challenges for migraine management, but can these be turned into longer‑term interventions? The presenters at this satellite symposium at EAN2020 discussed the role of telemedicine and calcitonin gene-related protein (CGRP) based therapies.

With hospitals focusing on the acute care of COVID-19 patients, management of less life‑threatening conditions, such as migraine, has had to change. Patricia Pozo‑Rosich (Vall d’Hebron University Hospital, Barcelona, Spain) introduced this session by raising the question ‘how we can still provide continuity of care and meet the needs of our patients, as virtual consultations have become the norm?’.

Short‑term challenges are being turned into longer‑term gain

The current crisis has revealed important areas where short‑term challenges may be  turned into longer‑term gain. For example, the switch of focus from physician‑dependent to more patient‑centered management.

Interest in telemedicine amongst physicians has increased markedly during the COVID­‑19 crisis. Andreas Gantenbein (RehaClinc Bad Zurzach, Switzerland) presented data from trials of telemedicine for migraine management. In one study, patients rated convenience higher and visit times were shorter in the telemedicine group1. A randomized study in 402 patients with nonacute headaches found a one‑time telemedicine consultation to be as efficient and safe as a traditional consultation, with no significant differences in change from baseline in Headache Impact Test‑6 or pain intensity2. Telemedicine has particular advantages in countries or settings where patients have to travel long distances to access healthcare services. Dr Gantenbein explained how apps are available for both patient monitoring (eg electronic symptom diary) and self‑support (eg relaxation techniques), empowering patients to take greater control.

Empowering patients to take greater control

Pascal Proot (University Hospital UZ Ghent, Belgium) highlighted the challenges with existing acute drugs, leading to up to 83% of patients being non‑adherent with treatment within 1 year3. Stewart Tepper (Dartmouth Medical School, New Hampshire, US) presented his experience using CGRP monoclonal antibodies as preventative therapies. ‘The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice’4 states that these preventive therapies may achieve treatment effects over days to weeks, and are effective in patients who have failed prior preventive treatments.

Continued demand for telemedicine in the future

The panel discussion concluded there will be a continued demand for telemedicine in the future, as patients are embracing its benefits. Face‑to‑face consultations can be reserved for those with ‘red flag’ symptoms or a need for clinical examination or investigation.

 

Educational financial support for this Satellite symposium was provided by Novartis.

 

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Friedman D, et al. Cephalalgia 2019:39:1577‑85
  2. Muller KI, et al. Neurology 2017;89:153-62
  3. Hepp Z, et al. Cephalalgia 2015;35:478-88
  4. American Headache Society. Headache 2019;59:1-18
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