Telemedicine for headache disorders in real-world practice: from patient experience to health system impact.

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level; individual study statistics not synthesised

• Effect Size: Not quantified; no pooled effect size reported. Narrative synthesis describes outcomes as 'generally comparable' between telemedicine and in-person visits without statistical substantiation

• Primary Outcome: Clinical effectiveness of telemedicine in headache management, assessed via validated instruments (HIT-6, MIDAS, VAS), reported as generally comparable to in-person care in non-acute settings

• Nnt Or Sensitivity: Not applicable; no NNT, sensitivity, specificity, or hazard ratio calculated or reported. High patient satisfaction and willingness to continue telemedicine consistently noted across included studies, but without quantified summary statistics

• Confidence Interval: Not reported; no confidence intervals provided for any outcome

Clinical Application

Telemedicine for headache follow-up is technically feasible using existing video consultation platforms. Key implementation requirements include validated digital outcome collection (HIT-6, MIDAS), clinician training in remote neurological assessment, and organisational pathways for escalation to in-person care. Challenges include digital literacy disparities, reimbursement structures, and maintaining diagnostic rigour for new or changing headache presentations. In Australia, telemedicine for headache management is supported by MBS telehealth item numbers (introduced and expanded during COVID-19, with ongoing availability for specialist consultations). The RACGP supports telehealth as a complement to in-person care for chronic disease management, including headache disorders. Preventive migraine therapies listed on the PBS (including topiramate, amitriptyline, and CGRP monoclonal antibodies such as erenumab and fremanezumab under restricted PBS listings) can be initiated and monitored via telehealth in appropriate patients. TGA-approved digital health tools for headache diary monitoring may support remote follow-up. Equity considerations are particularly relevant for rural and remote Australian populations, where telemedicine may substantially improve specialist neurology access. The Australian Digital Health Agency's national telehealth framework provides relevant governance context. However, the absence of Australian-specific data in this review limits direct applicability without local validation. Adults with established headache disorders (particularly migraine) in non-acute settings requiring structured follow-up, medication titration monitoring, or specialist access in geographically underserved areas. Patients with adequate digital literacy and stable clinical status are most likely to benefit. Not applicable to acute headache presentations requiring neurological examination.

Abstract

BACKGROUND: Telemedicine has expanded rapidly in neurological care and is increasingly applied to headache management to improve access and continuity of follow-up. However, patient experience and healthcare system impact in real-world practice remain insufficiently explored. OBJECTIVE: The objective of this narrative review is to evaluate clinical effectiveness, patient experience, and healthcare system impact in the management of headache disorders. METHODS: A narrative review of the literature was conducted, including randomized controlled trials, observational studies, real-world evidence contributions, and reviews addressing telemedicine in headache care. Evidence was synthesized thematically, focusing on clinical outcomes, patient acceptance, and implementation aspects. RESULTS: Available evidence supports the clinical effectiveness and safety of telemedicine in selected headache patients, particularly in non-acute settings and structured follow-up pathways. Outcomes assessed using validated instruments (HIT-6, MIDAS, VAS) are generally comparable to in-person visits. High patient satisfaction and willingness to continue telemedicine are consistently reported, mainly due to convenience and time and cost savings. Real-world studies suggest telemedicine may improve access to specialist care and optimize healthcare resource utilization, although challenges related to digital literacy, organizational requirements, and equity remain. CONCLUSIONS: Telemedicine is a valuable component of contemporary headache management when integrated into structured clinical pathways. Beyond clinical effectiveness, patient experience and organizational context are critical for successful implementation. Future research should focus on standardized care models, larger populations, and long-term real-world outcomes.

References

1. 1.Grasso, R., Carapelle, E., Raunich, G., & Avolio, C. (2026). Telemedicine for headache disorders in real-world practice: from patient experience to health system impact. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. https://doi.org/10.2196/19361