Background: New acute and preventive treatments have expanded migraine care options, highlighting the need for integrated, personalized management strategies. Telemedicine and telemonitoring support multidisciplinary approaches and are essential tools in optimizing patient outcomes. Objectives: This study aims to demonstrate the usability and user-friendliness of a validated E-diary and a self-administered electroencephalogram (EEG) telemonitoring setup for migraine care and research. Methods: E-diary data were collected from adult migraine patients at the Leiden Headache Center to assess compliance, with patient satisfaction evaluated through questionnaires. In a separate component of the study, the user-friendliness of a home-based EEG setup for migraine research was examined. Participants completed two measurement sessions on different days, with varying intervals between sessions. Evaluation measures included the System Usability Scale (SUS), task completion time, electrode connection success, and overall user experience. Results: Migraine patients (n = 753) were followed for a median of 353 [IQR 128–697] days. Compliance was 96.7 % [IQR 88.1–99.6]. The E-diary received a median score of 7/10, 66.0 % of patients reported being (very) satisfied with the E-diary app. The EEG setup was tested by 20 participants and awarded a high SUS-score of 91.2 [IQR 86.2, 95.0]. Conclusion: Telemedicine and telemonitoring offer scalable, effective solutions for advancing both migraine care and research. Telemedicine with the E-diary may enhance personalized, integrated migraine care. Compliance and satisfaction with the E-diary are high. Self-administered telemonitoring using remote EEG setups demonstrates the feasibility of conducting complex studies in home-based settings.

Introduction: Migraine is associated with enhanced visual sensitivity during and outside attacks. Processing of visual information is a highly non-linear process involving complex interactions across (sub)cortical networks. In this exploratory study, we combined electroencephalography with bi-sinusoidal light stimulation to assess non-linear features of visual processing in participants with migraine.

Methods: Twenty participants with migraine (10 with aura, 10 without aura) and ten non-headache controls were measured (outside attacks). Participants received bi-sinusoidal 13 + 23 Hz red light visual stimulation. Electroencephalography spectral power and multi-spectral phase coherence were compared between groups at the driving stimulation frequencies together with multiples and combinations of these frequencies (harmonic and intermodulation frequencies) caused by non-linearities.

Results: Only at the driving frequency of 13 Hz higher spectral power was found in migraine with aura participants compared with those with migraine without aura and controls. Differences in phase coherence were present for 2nd, 4th, and 5th-order non-linearities in those with migraine (migraine with and without aura) compared with controls. Bi-sinusoidal light stimulation revealed evident non-linearities in the brain’s electroencephalography response up to the 5th order with reduced phase coherence for higher order interactions in interictal participants with migraine.

Discussion: Insight into interictal non-linear visual processing may help understand brain dynamics underlying migraine attack susceptibility. Future research is needed to determine the clinical value of the results.

Migraine is a highly prevalent brain condition with paroxysmal changes in brain excitability believed to contribute to the initiation of an attack. The attacks and their unpredictability have a major impact on the lives of patients. Clinical management is hampered by a lack of reliable predictors for upcoming attacks, which may help in understanding pathophysiological mechanisms to identify new treatment targets that may be positioned between the acute and preventive possibilities that are currently available. So far, a large range of studies using conventional hospital-based EEG recordings have provided contradictory results, with indications of both cortical hyper- as well as hypo-excitability. These heterogeneous findings may largely be because most studies were cross-sectional in design, providing only a snapshot in time of a patient’s brain state without capturing day-to-day fluctuations. The scope of this narrative review is to (i) reflect on current knowledge on EEG changes in the context of migraine, the attack cycle, and underlying pathophysiology; (ii) consider the effects of migraine treatment on EEG features; (iii) outline challenges and opportunities in using EEG for monitoring attack susceptibility; and (iv) discuss future applications of EEG in home-based settings.