A Case of Migraine Treated Through Hybrid Consultation via In-Person and Online Telemedicine at an Occupational Health Nurse’s Office

An occupational doctor cannot perform medical procedures, such as diagnosis and prescription. They can only give advice to the workplace. Online telemedicine facilitates workplace-doctor collaboration and may solve this problem. We present the first case of migraine treated by hybrid consultation via in-person and online telemedicine at the occupational health office. In the present case, a 36-year-old male had experienced headaches since age 15 and had been diagnosed with migraine. He was on prophylactic treatment with 10 mg of lomerizine, experiencing one monthly migraine attack, often relieved by 50 mg of sumatriptan. His Headache Impact Test-6 (HIT-6) score was 56 at the consultation. He visited the occupational health nurse's office due to a migraine attack. An occupational doctor assessed him and diagnosed a migraine attack. The patient requested triptans, but only over-the-counter acetaminophen was available, and the doctor could not prescribe medication because the doctor was just an occupational doctor, and the nurse's office was not a clinic under the Japanese Medical Act. The occupational doctor, who was also hired by the other clinic as a physician, conducted an online consultation via the clinic at the nurse's office, diagnosed a migraine attack, and prescribed 50 mg of sumatriptan. The prescription was sent to a nearby pharmacy, and the patient found relief within 15 minutes after taking the triptan. Regular online consultation at the nurse's office has been continued, and prophylactic medications were strengthened. His migraine frequency decreased once in five months, and the HIT-6 score improved to 50. Performing online telemedicine at the workplace, such as the occupational nurse's office, could overturn the conventional wisdom that occupational physicians cannot perform medical treatment at non-medical institutions and can only refer patients to other clinics based on the Japanese Medical Act. Our case suggested the importance of strategic collaboration between occupational doctors and telemedicine-enabled medical facilities in ensuring seamless healthcare delivery, particularly for busy workers.