How Telemedicine can Bridge Care Gaps

By Sara Crystal, MD

I’ve had headaches as long as I can remember. As a kid, I would cry in my mom’s car. They’ve come and gone over the years and despite identifying the triggers, I had never found relief. Truth is, my doctor and I only talked about it a couple times a year, during regular check-ups.

This real patient story is one of countless I’ve heard from my patients. Even though they suffer from migraine all their lives, work to identify their triggers, and speak to their doctors about their condition, they can’t find treatment that works.

The treatment gap is related to a few major forces in American healthcare. First, as always, is affordability. Receiving treatment from a headache specialist may not be covered under a patient’s insurance, or it may be under-covered, leaving the patient to shoulder a heavy financial burden.

Even more pressing than affordability in the migraine space, though, is access to a specialist in the first place. There is only one headache specialist per 80,000 migraine sufferers in the US, a dramatic shortage that results in many migraine sufferers seeking treatment from their primary care doctor — who may not be as familiar with the complexities of migraine — or not seeking treatment at all. This represents a remarkable disparity for the number two cause of years lived with disability.

A recent study I led with Dr. Alexander Mauskop, Dr. Alan Rapoport, Dr. Robert Cowan, and Dr. Philip Bain, the abstract of which was published recently in Headache, a leading journal of headache medicine, confirmed that migraine patients lack an easy way to access the right combination of information and proven treatment to properly manage their migraines.

Our study reviewed the records and survey data of 31,000 migraine patients who use the migraine-focused telemedicine platform Cove, part of Thirty Madison. We found that 46% of these patients did not have access to a single headache specialist in their county; 72% had access to 2 or fewer. Given such disparities, the fact that many migraine patients report never having received a diagnosis of migraine from any healthcare professional (even though migraine patients report high numbers of physician interactions) becomes more poignant.

We found that telemedicine can help bridge that gap. By connecting patients to doctors deeply familiar with migraine and well-versed in the latest migraine treatments, telemedicine can bring specialist-level care right into the patients’ home. In our study, we found that 73% of patients did not have access to any other headache specialist except over the telemedicine platform, and 38% didn’t have access to any other provider, period.

Patients who have access to the appropriate migraine care experience a marked decrease in symptoms. Patients on the Cove platform with 1–14 headache days per month were treated with acute prescription medications at higher rates than the general population of migraine sufferers (84% compared to 50%), and patients with 9–14 headache days per month were treated with preventative medications at higher rates than the general population of migraine sufferers (58% compared to 46%).

In short, telemedicine is an essential tool to bring specialist-level care to patients — especially patients who suffer from a debilitating condition like migraine that requires nuanced treatment. The conclusion of the patient’s story above is illustrative of how telemedicine can dramatically improve patients’ lives:

I have been tracking my migraines for years and suddenly, have a dedicated doctor with whom I can communicate at any time of the day in regards to them. To have my own personal headache specialist, without awkward office hours and visit co-pays — what a game changer. We even got the medications right on the first try!

Sara Crystal, MD, is the Cove Medical Director and a board-certified neurologist practicing in New York. As a headache specialist, Dr. Crystal cares deeply about managing patients’ pain. She has deep expertise in headache management; following a fellowship in Headache and Facial Pain at the Albert Einstein College of Medicine, she was a Clinical Assistant Professor at the New York University School of Medicine. She is also a current practicing neurologist at the NY Headache Center.