Agreement between initial in-person and follow-up telemedicine assessment in patients presenting with first-time headache

Remote healthcare services have markedly increased in recent years. Telemedicine is increasingly considered a practical alternative to in-person evaluations of chronic neurological disorders, including primary headache syndromes. However, prospective data examining its reliability during first-time consultation are limited.

This study assessed the consistency between initial in-person examination and subsequent telemedicine follow-up in patients presenting with headache for the first time, and compared costs, time burden, loss of work capacity, and patient and physician satisfaction. Sixty patients (49 women and 11 men) aged 20–40 years who presented with headaches for the first time to six specialized headache clinics were enrolled in this study. Each patient underwent an initial in-person examination, followed by a video-based telemedicine consultation at the same center 45 days later.

Demographic data, clinical characteristics, and diagnoses were recorded during interviews. Patients completed cost and burden assessment questionnaires, and both groups completed satisfaction questionnaires. Analyses examined the concordance between the two examination methods and factors influencing them.

Headache history showed excellent agreement between in-person and telemedicine assessments (ICC = 0.928, 95% CI 0.882–0.956), while headache frequency and duration demonstrated moderate agreement. Localization and lateralization were consistent in more than 80% of cases, headache intensity in 77.8%, and overall diagnostic concordance reached 95%, with the highest agreement observed for migraine with and without aura. In-person outpatient examinations resulted in a mean time loss of 208.05 ± 119.78 min, whereas telemedicine reduced work-capacity time loss by 87.4%.

Patient satisfaction with telemedicine was high (86.2% very satisfied), and physicians rated the overall telemedicine consultation favorably (69% excellent). Patients also expressed greater willingness than physicians to use telemedicine for future follow-up visits (60% vs. 39.7%). Telemedicine shows high consistency with in-person assessments, particularly for migraine patients, and has reduced time, cost, and work loss.

These findings support telemedicine as a reliable follow-up approach after an initial face-to-face assessment, particularly for patients with primary headache disorders requiring limited physical examination. The authors would like to thank Prof. Güven Özkaya for statistical analyses, and the research assistants at the relevant research centers for their assistance with documentation.