Telemedicine for headache disorders in real-world practice: from patient experience to health system impact

Background: Telemedicine has expanded rapidly in neurological care and is increasingly applied to headache management to improve access and continuity of follow-up. However, patient experience and healthcare system impact in real-world practice remain insufficiently explored. Objective: The objective of this narrative review is to evaluate clinical effectiveness, patient experience, and healthcare system impact in the management of headache disorders. Methods: A narrative review of the literature was conducted, including randomized controlled trials, observational studies, real-world evidence contributions, and reviews addressing telemedicine in headache care. Evidence was synthesized thematically, focusing on clinical outcomes, patient acceptance, and implementation aspects. Results: Available evidence supports the clinical effectiveness and safety of telemedicine in selected headache patients, particularly in non-acute settings and structured follow-up pathways. Outcomes assessed using validated instruments (HIT-6, MIDAS, VAS) are generally comparable to in-person visits. High patient satisfaction and willingness to continue telemedicine are consistently reported, mainly due to convenience and time and cost savings. Real-world studies suggest telemedicine may improve access to specialist care and optimize healthcare resource utilization, although challenges related to digital literacy, organizational requirements, and equity remain. Conclusions: Telemedicine is a valuable component of contemporary headache management when integrated into structured clinical pathways. Beyond clinical effectiveness, patient experience and organizational context are critical for successful implementation. Future research should focus on standardized care models, larger populations, and long-term real-world outcomes.