Telemedicine in Pediatric Headache: A Review and Practical Implementation

DOI: https://doi.org/10.1007/s11910- 021- 01112- 3

Abstract-Summary The purpose of this review was to summarize the current literature about telemedi- cine its implementation.

to provide practical guidance for

in pediatric headache and

There are few studies dedicated to telemedicine in pediatric headache, and exist-

ing studies are small.

Patients and families report high levels of satisfaction with telemedicine, and

most are willing to continue telemedicine visits in the future.

Telemedicine demonstrated similar reductions in headache frequency, severity,

and duration as patients treated in-person.

Telemedicine in pediatric headache is a growing field. Headache-related outcomes, including frequency, severity, and duration, were

similar amongst telemedicine and in-person visits.

Introduction While headache clearly causes significant disability, only a small percentage of these individuals seek care in specialized clinics or hospital settings.

Telemedicine represents a mechanism to bypass regional disparities, the relative scarcity of pediatric neurologists, and numerous additional barriers to neurologic care [347].

Telemedicine is defined as the remote delivery of direct patient care via a tele- communications system which typically includes both audio and visual communi- cations [348].

Synchronous telemedicine may or may not involve a telepresenter, an individual

present at the patient’s location who is trained to aid in remote examination [348].

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5 Future Directions

In a “hub and spoke model”, a centralized “hub” provides specialized telehealth

to patients at a remote “spoke” medical care facility [349].

Telemedicine also disassembles numerous barriers experienced by families seek-

ing neurologic expertise.

Many families live in rural areas and must coordinate traveling vast distances to

receive care.

Prior Successes of Telemedicine Many studies have also demonstrated excellent accuracy of remote stroke examina- tions with strongly correlated telemedicine and in-person NIH Stroke Scales [350–352].

This is well supported by recent telemedicine studies in adult headache [353, 354]. A study of 30 individuals with migraine, randomized to in-person visits or tele- medicine, found equivalent reductions in headache severity, frequency, and migraine disability assessment scores (MIDAS) at 1 year.

A similar study of 102 individuals with medication overuse headache found no difference in headache frequency nor severity amongst those treated via telemedi- cine at 3- and 12-month follow-up [354].

The results of both of these studies are further supported by a large study of 402

new headache consultations randomized to telemedicine or in-person visits.

This study estimated that the number of telemedicine visits needed to miss 1

secondary headache was approximately 20,200 [355].

Telemedicine in Pediatric Headache To date, only a few studies have examined the use of telemedicine in pediatric head- ache; however, all have shown excellent promise [349, 356–359].

A prospective study of 51 established pediatric migraine patients, age 5–18 years, followed their outcomes and patient satisfaction with telemedicine over a 70-day period [358].

A similar study of 7 patients, age 7–17 years, evaluated new headache patients via an initial in-person visit and, subsequently, followed up monthly via a telemedi- cine hub and spoke model for 3 months [349].

While this study analyzed all pediatric neurology patients seen via telemedicine,

at least 594 of them were diagnosed with headache or migraines [359].

This study also found that there was no difference in the rate of subsequently performed in-person examinations nor hospitalizations when comparing new and established telemedicine patients [359].

This is in agreement with an adult study of 402 new headache patients random-

ized to telemedicine or in-person evaluation.

Conclusion The field of neurology had early success with the implementation telemedicine in stroke over 20 years ago; however, widespread adoption has been slow and even more so amongst pediatric neurology.

This slow adoption was compounded by the shortage of pediatric headache spe- cialists; however, the COVID19 pandemic has led to the rapid implementation and expansion of telemedicine.

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Tele-Medicine

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While the current literature on telemedicine in pediatric headache is quite lim- ited, current evidence suggests that telemedicine is effective in the treatment of headaches, is safe for new and established patients, and is well perceived by patients and their families.

Acknowledgement A machine generated summary based on the work of Rosenthal, Scott; Yonker, Marcy 2021 in Current Neurology and Neuroscience Reports.

Disruptions of neurological services, its causes and mitigation strategies during COVID-19: a global review