Online Program Meets Chronic Migraine Patients Where They Are

Eight sessions of education and tailored counseling help patients cope

For patients suffering from chronic migraines — defined as 15 or more headache days a month — there is rarely a silver bullet to relieve their ordeal. Instead, according to Emad Estemalik, MD, Section Head of Headache and Facial Pain at Cleveland Clinic, “getting a patient’s life back” involves a multipronged approach drawing on targeted therapies and lifestyle modifications.

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To help patients better understand their condition and integrate proven therapies into their life, Cleveland Clinic has launched an Online Headache Education Program (OHEP). The novel approach mixes educational components and individual counseling over eight hour-long sessions conducted as two-way video-enabled virtual visits via Cleveland Clinic’s Express Care® Online app.

“The efforts and education required for a patient with chronic migraine to get better exceed what doctors can typically provide in an office visit,” explains Dr. Estemalik, who is overseeing the OHEP. “Our new online program gives us the time to educate patients and tailor strategies to their individual needs.”

A personalized, in-depth approach

The OHEP gives patients a thorough grounding in the current understanding and management of migraines. Sessions cover pathophysiology, treatment options (including traditional medications, nutraceuticals, botulinum toxin injections and nerve blocks), diet, sleep hygiene and stress management.

Each session is delivered by a program coach who presents the information by interacting face-to-face online and individualizing content. Written educational materials are provided for each topic, and homework — such as keeping a headache diary and practicing relaxation exercises — is given and discussed.

The eight sessions are held about once a week, according to the patient’s schedule and needs. Patients are billed at an out-of-pocket cost of $49 per session.

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“In addition to delivering a comprehensive overview of migraines, the OHEP provides a perfect venue for fine-tuning management,” says Jena Gustafson, PA-C, of the Section of Headache and Facial Pain, who serves as the OHEP’s program coach. “Talking to the patient for an hour every week or so gives me the opportunity to offer new solutions and quickly find out if they helped.”

Gustafson notes that, in general, she can adjust medications and treatment strategies as needed. For issues that require physician input, she consults with one of the neurologists on staff and gets back to the patient at the next session or more quickly if a problem is urgent.

Expanding options to meet patient needs

According to Dr. Estemalik, the OHEP provides an alternative to Cleveland Clinic’s IMATCH program (Interdisciplinary Method for the Assessment and Treatment of Chronic Headache), an intensive full-day outpatient program run daily for a three-week period that’s targeted to chronic migraine headache sufferers.

“We have many patients who cannot meet the time or financial commitment required for IMATCH or who live out of the area,” explains Dr. Estemalik. “The OHEP is a similar but condensed version, combining a comprehensive multidisciplinary strategy with education and a patient-centered, personalized approach.”

Entry into the OHEP requires an initial in-person evaluation with the Section of Headache and Facial Pain team; additionally, current patients of one of Cleveland Clinic’s headache clinics are eligible by referral. Dr. Estemalik says the patients best suited to the program are those with chronic headaches occurring several days a week that are interfering with family life, work or daily functioning.

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While it’s too early to tell how well the OHEP is helping patients cope with chronic migraines, the program team is collecting data on headache frequency and quality-of-life measures before and after program participation to evaluate its effectiveness.

Taking advantage of technology

Dr. Estemalik says he’s unaware of any other program of this type in the country. He notes that it’s relatively easy to adapt an existing intensive chronic headache program to the OHEP format. Developing the program involved about eight months of planning, he says.

Educational materials developed for the more intensive IMATCH program needed to be redesigned for the eight session topics. Google Classroom is used to confidentially share files between the program coach and each patient.

Gustafson and patients conduct sessions over the Express Care Online app’s secure face-to-face interface via smartphone, tablet or desktop computer. Relatives are welcome to join if the patient wishes, which she says can help with therapy as the patient learns more about the disease and ways to cope.

“There are many ways to deliver care,” says Dr. Estemalik. “We want to meet patients in places that work for them. New technologies open up myriad possibilities for creative management of chronic diseases.”