Robert E. Shapiro, MD, PhD

“I’m looking forward to getting this behind us—as we all are&mdash;and [the circumstances] allowing us to get back to seeing our patients.”

As a large majority of headache and migraine specialists, along with most of their patients, are forced inside, the primary care model for this population has shifted to delivery via telemedicine. While this has been accompanied by a number of adjustments, there have been some highlights to take away from the experience.

For Robert E. Shapiro, MD, PhD, professor of neurology, University of Vermont Larner College of Medicine, and founding president, Alliance for Headache Disorders Advocacy, one of those takeaways has been this “tectonic shift,” as he described it, in pushing telemedicine to the forefront of care—a change that Shapiro believes is here to stay in some form or another. As well, the easing of restrictions on access to certain therapies, such as oxygen therapy for patients with cluster headache, has been a positive, though it is not a change Shapiro is certain will stick around.

To find out more about this adjustment and what the clinical community can take away from this time at home, 

spoke with Shapiro about his experience. He discussed the changes brought on by the Centers for Medicare & Medicaid Services (CMS) restriction lifts, and how this model of care will impact which migraine preventives are utilized.

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The professor of neurology at the University of Vermont Larner College of Medicine detailed what lessons and highlights he’s learned from shifting his migraine care to a telemedicine-based model during the COVID-19 pandemic.

Robert E. Shapiro, MD, PhD: Takeaways From Migraine Telemedicine

“The post-mortem for how we’ve done collectively for this will probably be written in 6 to 12 months, but overall, the feedback I’ve gotten from my colleagues has been that they’re able to manage.”

Recently, a group of headache specialists working with the American Headache Society’s practice management committee came together to publish a special article in 

 to touch on a number of issues faced by physicians in their ability to conduct their medical practices in the midst of COVID-19.

That group, including Robert E. Shapiro, MD, PhD, professor of neurology, University of Vermont Larner College of Medicine, and founding president, Alliance for Headache Disorders Advocacy, offered a number of clinical strategies for the treatment of migraine that can be done without in&#8208;person visits to the clinic or the emergency department, and described methods for health insurance companies to undertake to remove the barriers to quality care for migraine. Additionally, they made pleas to insurers about loosening restrictions for patients to get access to medicines in this time.

To find out more about the reception he and colleagues have received from both payers and physicians, 

inquired with Shapiro about the paper. He expanded on the migraine community’s transition to telemedicine and the additional outreach they’ve done to the Centers for Medicare & Medicaid Services (CMS).

Szperka CL, Ailani J, Barmherzig R, et al. Migraine Care in the Era of COVID&#8208;19: Clinical Pearls and Plea to Insurers. 

. Published March 30, 2020. doi: 10.1111/head.13810

The professor of neurology at the University of Vermont Larner College of Medicine discussed the response from payers and physicians to the special article he and colleagues published in the journal Headache.

Robert E. Shapiro, MD, PhD: Response to AHS Special Article Pleas

“We were talking about all of the challenges we were experiencing, and how these undoubtedly translated to challenges for all of our colleagues in headache medicine and their patients.”

In mid-March, during a teleconference for the American Headache Society’s practice management committee, a number of headache specialists, including Robert E. Shapiro, MD, PhD, brought up a number of issues that were plaguing their ability to conduct their medical practices in the midst of COVID-19.

The special article that came about as a result of this conversation was published at the end of March in 

 touched on a number of clinical strategies for the treatment of migraine that can be done without in&#8208;person visits to the clinic or the emergency department, and described methods for health insurance companies to undertake to remove the barriers to quality care for migraine.

Shapiro, a professor of neurology, University of Vermont Larner College of Medicine, and founding president, Alliance for Headache Disorders Advocacy, spoke with 

about the paper and what the group hoped to achieve by compiling it. He expanded on the pleas the group made to insurers and highlighted the challenges which inspired the undertaking.

The professor of neurology at the University of Vermont Larner College of Medicine and founding president of the Alliance for Headache Disorders Advocacy discussed the special article he and colleagues published in the Headache journal on migraine care.

Robert E. Shapiro, MD, PhD: Migraine Care in the Era of COVID-19

“The good news is that since May 2018, we now have several outpatient medications that are approved for chronic migraine—these are the CGRP medications&mdash;that can be given as subcutaneous injections on a 3-month basis by people at home.”

Many patients with migraine and other headache disorders are currently limited to virtual telemedicine visits in the midst of the COVID-19 pandemic, and some have struggled to get access to their regular care, either because of those visit limitations or other challenges. This has led to a need for headache specialists like Robert E. Shapiro, MD, PhD, to attempt to find alternatives.

Shapiro, who is professor of neurology, University of Vermont Larner College of Medicine, and founding president, Alliance for Headache Disorders Advocacy, spoke with 

 about the ongoing push to transition patients with chronic migraine to the recently approved calcitonin gene-related peptide (CGRP) class of medicines from onabotulinumtoxinA (Botox) therapy. This move has been pushed for due to the ability for patients to administer these therapies on a less frequent, quarterly basis, as well as the fact that they can be administered by the patient themselves, at home.

One of the biggest challenges there has been convincing insurers to allow patients to bypass the normal requirements for these treatments, which often require patients to fail a number of other treatment options before they can get authorization. Shapiro shared his experience with overcoming these administrative barriers in a time of crisis.

The professor of neurology at the University of Vermont Larner College of Medicine and founding president of the Alliance for Headache Disorders Advocacy discussed the need to get patients with migraine access to medications during the COVID-19 pandemic.

Robert E. Shapiro, MD, PhD: Getting Patients Access to Migraine Care

“This is a time where I may be deployed [to a medical center in my region], which means that whatever telemedicine appointments I have in that time would have to be further postponed. Everybody has had to make a lot of adjustments.”

The novel coronavirus pandemic that has swept across the planet has infected almost 2 million worldwide—half a million in the US alone&mdash;has had a devasting impact on health care systems. Outside of the strain it has put on the hospitals in the areas most greatly affected, that stress has not been limited to high case-count areas alone.

In Vermont, where Robert E. Shapiro, MD, PhD, professor of neurology, University of Vermont Larner College of Medicine, and founding president, Alliance for Headache Disorders Advocacy, practices headache medicine, the case count has stayed low in comparison to nearby New York and New Jersey. However, Shapiro—who is signed up for surge deployment to his area medical centers to help at peak times of infection&mdash;told 

 that his practice, and many others like it, has not been unaffected.

Although, there has been some good news. Shapiro explained how his medical center at the University of Vermont as well as his patients have adjusted quickly and smoothly in the move to telemedicine. He detailed how this has changed his evaluation of patients and what challenges he has needed to overcome in this time of uncertainty.

The professor of neurology at the University of Vermont Larner College of Medicine and founding president of the Alliance for Headache Disorders Advocacy spoke about the impact the COVID-19 pandemic has had on his practice.

Robert E. Shapiro, MD, PhD

Articles

Robert E. Shapiro, MD, PhD: Takeaways From Migraine Telemedicine

Robert E. Shapiro, MD, PhD: Response to AHS Special Article Pleas

Robert E. Shapiro, MD, PhD: Migraine Care in the Era of COVID-19

Robert E. Shapiro, MD, PhD: Getting Patients Access to Migraine Care

Robert E. Shapiro, MD, PhD: Adjusting Migraine Care in a Pandemic

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