Sara Crystal1, Alexander Mauskop2, Alan Rapoport3, Robert Cowan4, Philip Bain5, Jessica Kiarashi6, Elizabeth Murdoch7, Adam Cohen8, Neil Parikh9
1NY Headache Center, KMG, Thirty Madison, 2NY Headache Center, 3David Geffen School of Medicine, UCLA, 4Stanford Neurosciences Health Center, 5Bozeman Health, 6UT Southwestern Medical Center, 7Thirty Madison, 8Yale New Haven Health System, The Johns Hopkins University Applied Physics Lab, 9Thirty Madison, UCLA
Objective:
To describe differences in access to migraine care between men and women prior to joining a telemedicine platform.
Background:
Migraine is three times more prevalent in women than men, and has been “feminized” due to this sex asymmetry, which may contribute to delayed care in men. Asynchronous telemedicine as an anonymized care option may reduce stigma, resulting in increased access to quality migraine care in men.
Design/Methods:
This study assessed patients who self-enrolled in a direct-to-consumer migraine telemedicine platform, Cove. The platform provides patients access to asynchronous evidence-based consultation, ongoing messaging, and e-pharmacy. Data from patients completing the comprehensive headache-focused intake, including demographics, treatment history, clinical assessments, and healthcare resource use were compared between males and females. Statistical differences between groups were assessed using chi-square and Kruskal-Wallis tests.
Results:
Data from 10,151 patients were analyzed (median age 38 years, 13% male). At intake, male and female patients reported the same monthly headache frequency (median: 10 days, p=.09) and similar median intensity (male 7 vs. female 8 on 10-point scale, p=.07).
Males were less likely than females to have sought migraine care from a primary care physician (68% vs. 77%, p<.01) or neurologist (33% vs. 39%, p<.01) prior to joining the platform. In addition, a lower proportion of males compared to females had received acute (39% vs. 44%, p<.01) and preventive (15% vs. 20%, p<.01) medications in the 6 months before intake.
After joining the telemedicine platform, all patients had increased access to migraine treatment; 88% of males (126% increase) and 92% of females (109% increase) received acute medications and 49% of males (227% increase) and 53% of females (165% increase) received preventive medications.
Conclusions:
Telemedicine platforms may contribute to increased access to evidence-based migraine treatment for men. Future studies should assess factors specific to telemedicine that contribute to increased access to underserved populations.