Abstract text (incl. figure legends and references)

Objective:

During the past two and 1/2 years there has been a marked increase in the use of telemedicine in the treatment of migraine. The purpose of this study was to assess whether there was greater utilization of neuroimaging when initial patient visits for migraine and other headache conditions were conducted via synchronous video telemedicine compared to when such initial visits were conducted in-person.

Methods:

We performed a retrospective chart review of all initial patient visits from September 1, 2021 to August 31, 2022 at a tertiary headache center in the United States (U.S.). We compared the percentage of visits conducted via telemedicine which resulted in an order for neuroimaging to the percentage of visits conducted in-person which resulted in an order for neuroimaging.

Results:

A total of 398 new patient visits were conducted at the tertiary headache center, 109 (27%) of which were telemedicine, and 289 (73%) of which were in-person. Neuroimaging studies were ordered during 19.3% of visits conducted via telemedicine and during 27.3% of in-person visits.

Conclusions:

Neuroimaging studies were ordered 41.5% more frequently during in-person initial visits than during telemedicine initial visits for migraine and other headache conditions at a tertiary headache center. More research is warranted to determine if this phenomenon is due to selection bias, with more severe cases having a greater potential to be secondary headaches being seen in-person rather than via telemedicine, or if other factors are involved. More research is also needed to assess if this phenomenon is unique to tertiary headache centers or if it is also applicable to general neurology and primary care practice settings. As more specialties, inlcuding primary care, are caring for even more patients via telemedicine, a clearer understanding of the utilization of neuroimaging in this setting can have important clinical as well as economic implications.