Managing Migraine During the COVID-19 Pandemic
Nina Riggins, MD, PhD, explains safe and effective alternative treatment plans for migraine in the era of telemedicine
With the COVID-19 pandemic shifting many in-person visits to telemedicine, healthcare providers are developing effective protocols for telehealth visits and treatment. AHS Member Nina Riggins, MD, PhD, a neurologist at the University of California San Francisco, hosted a Facebook Live where she discussed alternatives to in-person migraine treatments like injections and infusions.
“We need alternatives to procedures and safe options for treatment for people living with migraine,” Dr. Riggins explained. Learn more about safe and effective treatment plans that physicians can implement with headache patients in the video below.
Choosing which Medication to Prescribe
Before the appointment begins, Dr. Riggins recommends thoroughly reviewing the patient’s medical chart and history and creating a tentative plan that eliminates the need for treatments administered in-person, such as BOTOX® injections.
“Take an excellent medical history at each appointment and review all the patients’ medications when appropriate,” Dr. Riggins advises. This preliminary treatment plan should then be discussed with the patient during the call, providing options that are both helpful and safe. She says providers should also ask if there is a plan for pregnancy or the patient is using contraception. If the latter, providers should find out which one, as this can help inform a physician’s decision.
Self-Administered Migraine Treatment
Dr. Riggins outlines options for managing migraine that patients can access and administer during COVID-19 without needing an in-office appointment with their healthcare provider. According to Dr. Riggins, gepants and ditans are newer alternatives for migraine treatment that can be self-administered by patients in the form of an oral tablet. Other acute preventive medications, such as NSAIDs, triptans, ergots, antiemetics, muscle relaxants and antihistamines, can be self-administered as well.
However, providers should thoroughly review a patients’ medical history to check for contraindications as well as discuss any side effects before making adjustments to their treatment plan. Physicians can also teach patients the administration of CGRP monoclonal antibody injections through telemedicine visits.
Dr. Riggins says that neuromodulation devices can also be used for acute and preventive treatment of headache disorders. What’s more, patients can’t run out of medication when using them. The FDA has so far approved four devices for migraine management that physicians can consider when developing a headache treatment plan:
- Remote Electrical Neuromodulation (REN)
- Supraorbital Transcutaneous Neurostimulation of Trigeminal Nerve
- Single-Pulse Transcranial Magnetic Stimulation (STMS)
- Non-Invasive Vagal Nerve Stimulator
Other Considerations
Providers should take steps to flatten the curve through the use of telemedicine and by limiting in-person visits whenever possible. “Discussing what an emergency is with patients can help to keep them safe and out of emergency rooms,” says Dr. Riggins. She goes on to explain that providers should also communicate with their patients regarding the signs that signal an emergency, including new onset focal neurologic symptoms.
Physicians should also emphasize that certain lifestyle choices can also help prevent headache attacks. “We recommend a regular balanced diet, hydration, exercises, sleep. It is important to address stress. We are all in this together,” Dr. Riggins says.
The American Headache Society is committed to providing support for headache clinics and practitioners during the COVID-19 pandemic. For more on the latest headache information and studies, visit the AHS News page and join us on the American Headache Society’s Facebook page for more videos on telemedicine in the headache clinic.