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      Cureus
      Cureus
      information technology, artificial intelligence, tension-type headache, online telemedicine, migraine, medication-overuse headache (moh), coronavirus disease 2019 (covid-19)

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          Abstract

          Background

          Since March 2020, the coronavirus disease 2019 pandemic has increased the need for telemedicine to avoid in-person consultations. Online clinics for most diseases officially started in Japan in April 2022. Here, we report the cases of eight Japanese headache patients treated by completely online telemedicine for three months from the first visit.

          Methodology

          From the medical records between July 2022 and October 2022, we retrospectively investigated eight consecutive first-visit primary headache patients who consulted our online headache clinic via telemedicine and continued to see us via telemedicine only. The Headache Impact Test-6 (HIT-6) score, monthly headache days (MHD), and monthly acute medication intake days (AMD) were investigated over the observation period.

          Results

          A total of eight women were included, and the median (interquartile range) age was 30 (24-51) years. The median HIT-6 scores before, one, and three months after treatment were 63 (58-64), 54 (53-62), and 52 (49-54), respectively. MHD before, one, and three months after treatment were 15 (9-28), 12 (3-17), and 2 (2-8), respectively. AMD before, one, and three months after treatment were 10 (3-13), 3 (1-8), and 2 (0-3), respectively. Significant reductions in HIT-6 and MDH were observed three months after the initial consultation (p = 0.007 and p = 0.042, respectively). AMD was not significantly decreased at three months (p = 0.447).

          Conclusions

          This is the first report of Japanese patients treated by completely online telemedicine for three months from the first visit. HIT-6 and MDH can be significantly decreased at three months by only telemedicine. Online telemedicine is expected to be widely used to resolve unmet needs in headache treatment.

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          Most cited references30

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          Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition

          (2018)
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            A six-item short-form survey for measuring headache impact: the HIT-6.

            Migraine and other severe headaches can cause suffering and reduce functioning and productivity. Patients are the best source of information about such impact. To develop a new short form (HIT-6) for assessing the impact of headaches that has broad content coverage but is brief as well as reliable and valid enough to use in screening and monitoring patients in clinical research and practice. HIT-6 items were selected from an existing item pool of 54 items and from 35 items suggested by clinicians. Items were selected and modified based on content validity, item response theory (IRT) information functions, item internal consistency, distributions of scores, clinical validity, and linguistic analyses. The HIT-6 was evaluated in an Internet-based survey of headache sufferers (n = 1103) who were members of America Online (AOL). After 14 days, 540 participated in a follow-up survey. HIT-6 covers six content categories represented in widely used surveys of headache impact. Internal consistency, alternate forms, and test-retest reliability estimates of HIT-6 were 0.89, 0.90, and 0.80, respectively. Individual patient score confidence intervals (95%) of app. +/-5 were observed for 88% of all respondents. In tests of validity in discriminating across diagnostic and headache severity groups, relative validity (RV) coefficients of 0.82 and 1.00 were observed for HIT-6, in comparison with the Total Score. Patient-level classifications based in HIT-6 were accurate 88.7% of the time at the recommended cut-off score for a probability of migraine diagnosis. HIT-6 was responsive to self-reported changes in headache impact. The IRT model estimated for a 'pool' of items from widely used measures of headache impact was useful in constructing an efficient, reliable, and valid 'static' short form (HIT-6) for use in screening and monitoring patient outcomes.
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              No adjustments are needed for multiple comparisons.

              K Rothman (1990)
              Adjustments for making multiple comparisons in large bodies of data are recommended to avoid rejecting the null hypothesis too readily. Unfortunately, reducing the type I error for null associations increases the type II error for those associations that are not null. The theoretical basis for advocating a routine adjustment for multiple comparisons is the "universal null hypothesis" that "chance" serves as the first-order explanation for observed phenomena. This hypothesis undermines the basic premises of empirical research, which holds that nature follows regular laws that may be studied through observations. A policy of not making adjustments for multiple comparisons is preferable because it will lead to fewer errors of interpretation when the data under evaluation are not random numbers but actual observations on nature. Furthermore, scientists should not be so reluctant to explore leads that may turn out to be wrong that they penalize themselves by missing possibly important findings.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                3 November 2022
                November 2022
                : 14
                : 11
                : e31068
                Affiliations
                [1 ] Neurology, Komuginomori Headache Clinic, Shiojiri, JPN
                Author notes
                Article
                10.7759/cureus.31068
                9719403
                36475218
                a8fbd34d-8963-4504-91da-9d01af03aa84
                Copyright © 2022, Katsuki et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 November 2022
                Categories
                Neurology
                Pain Management
                Healthcare Technology

                information technology,artificial intelligence,tension-type headache,online telemedicine,migraine,medication-overuse headache (moh),coronavirus disease 2019 (covid-19)

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