51 Practical experience with the use of electronic headache diaries 2 this electronic tool. It is essential to recognize that respondents may span a spectrum of motivations, making it challenging to definitively determine the impact of this bias on research results. Patients who expressed concerns, sought improvements, or expressed dissatisfaction may also have been more likely to participate in the questionnaire. Another limitation can be the relatively small population in the video consultation questionnaire, because many responders did not use this E-tool and therefore could not evaluate their satisfaction. A limitation of the E-diary is that it is currently only suitable for tension-type headache, migraine, and medication overuse headache, but not for trigeminal autonomic cephalalgias (TACs). However, this limitation can be addressed in future developments for E-diaries specifically designed for very short lasting and high frequent attacks such as cluster headache and other TACs. This study also has several strengths, including the use of a large, well-defined migraine patient population. Moreover, the validated E-diary has demonstrated to be useful for monitoring sex-specific aspects of migraine and new therapeutic options for migraine, such as calcitonin gene-related peptide (CGRP) receptor monoclonal antibodies which are expensive and require adequate monitoring.2, 15-18 By using an E-headache diary, patients and healthcare providers can gain reliable insights into the effectiveness of these treatments, preventing the continuation of ineffective medication and thereby potentially reducing costs.19 In this process, the E-diary also increases shared decision making. Thus, the E-diary represents a critical telemedicine tool for advancing healthcare and achieving financial benefits in new therapies. Video consultations are increasingly used especially when in-person visits are not feasible. Both patients and healthcare providers valued video consultation, which is in line with previous research.20 The most critical aspect of a consultation is the headache history, which can be obtained accurately through telemedicine.21 Patients are able to monitor their symptoms and communicate specific concerns or questions during E-consultations and video consultations. We advise conducting an initial in-person consultation for a physical and neurological assessment. It has been suggested patients with greater disability might prefer care provided by a neurologist in-person.22, 23 We did not find a difference in preference for chronic migraine patients in literature. Telemedicine can also be particularly beneficial for patients in rural areas, as it can improve cost and time efficiency.24 The typical patients who benefit from telemedicine resembles patients with migraine: young well-educated women.23, 25, 26 Additionally, telemedicine can be especially useful when in-person visits are not possible due to factors such as topography or a pandemic.21
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