
==== Front
Medicine (Baltimore)
Medicine (Baltimore)
MD
Medicine
0025-7974
1536-5964
Lippincott Williams & Wilkins Hagerstown, MD

39312304
MD-D-24-07298
00005
10.1097/MD.0000000000039824
3
5300
Research Article
Observational Study
Quality and reliability analysis of migraine Botox treatment information on YouTube
https://orcid.org/0000-0002-2422-9470
Karacan Gölen Meltem MD a*
Işik Şaziye Melike MD b
a Department of Neurology, Baskent University Hospital Konya, Selcuklu/Konya, Turkey
b Department of Neurology, Konya Numune State Hospital, Selcuklu/Konya, Turkey.
* Correspondence: Meltem Karacan Gölen, Department of Neurology, Baskent University Hospital Konya, Selcuklu/Konya 42080, Turkey (e-mail: drmeltemkaracan@hotmail.com).
20 9 2024
20 9 2024
103 38 e3982427 6 2024
01 9 2024
02 9 2024
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

YouTube (YT) is one of the world’s most well recognized video-sharing platforms that appeals to large audiences and is used by individuals to educate themselves on disease diagnosis and treatment alternatives and to distribute health-related information. Videos were searched by typing the terms “migraine botox” and “botox treatment for migraine” on the YT search bar in English. A total of 50 videos were evaluated for each term. Two independent researchers viewed the videos and documented pertinent descriptive attributes of each video, such as the upload date, number of comments, number of dislikes, number of likes, and views. The videos were analyzed and the DISCERN Global Quality Scale (GQS), Journal of the American Medical Association (JAMA) quality, and reliability scores were recorded. A total of 100 videos were assessed. The mean DISCERN score was 3.09, the mean JAMA score was 2.11, and the mean GQS score was 3.25. According to the source, 32% of the videos were uploaded by university/nonprofit physicians or professional organizations. In addition, when the DISCERN, GQS, and JAMA scores of the videos uploaded by health professionals were examined, a statistically significant difference was observed (P = .002, P = .015, and P = .002, respectively). However, no statistically significant relationship was found for the Video Popularity Index score. The reliability and quality scores of the evaluated videos uploaded by healthcare professionals for migraine Botox treatment were high, but the frequency of viewership was low. In our analysis of migraine Botox treatment videos on YT, we observed that the information on migraine Botox treatment had a wide spectrum, high-quality content, and that there were videos that may mislead viewers. In conclusion, we believe that the platform is not sufficient in its entirety, and that it should be supported with renewed, fact-checked, easy-to-understand language, and video-duration optimized videos.

DISCERN
GQS
JAMA
Migraine Botox Treatment
VPI
YouTube
OPEN-ACCESSTRUE
==== Body
pmc1. Introduction

One of the most well-known and frequent types of headaches is migraine it also is the second most frequent cause of neurological disorders, which has approximately 15% prevalence annually. Botulinum Toxin A is an affordable option for treating various types of migraines, such as chronic, episodic, unilateral, and vestibular migraines. It can help decrease the frequency of migraine attacks each month and reduce the severity of pain.[1] Patients with chronic migraines need to search for different treatment options due to the frequency of pain, their significant limitations in performing daily life activities, and disability when pain intensity cannot be controlled despite medical treatment. Therefore, social media platforms are often preferred as a first point of contact. Internet has recently become a common source for medical information. Most individuals consider internet as a reliable and valuable source of knowledge in regards to health and use it prior to seeking medical help from professionals.

YouTube (YT) is a highly recognized global platform for sharing videos that attract a wide range of viewers. It is rapidly used to distribute health-related information. Not only the patients but also their relatives use websites, such as YT, to learn about the treatment and diagnosis options for diseases.[2–4] YT videos’ quality analysis has been performed in many fields, involving neurological diseases such as arteriovenous malformations, multiple sclerosis, hydrocephalus, narcolepsy, infantile spasms, and peripheral neuropathy.[5,6]

However, to the best of our knowledge, no investigation has been conducted to investigate the accuracy, adequacy, and usefulness of the information presented in YT videos regarding Botox treatment for migraine. Social media content about Botox treatment for migraines is likely to be of great interest to patients, their relatives, and healthcare professionals. This study, therefore, aimed to evaluate the usefulness, reliability, and quality of YT videos about migraine books using both qualitative and quantitative methods.

2. Methods

On March 31, 2024, video searches were performed by entering the following keywords into the YT search bar using the incognito mode in Google Chrome after removing the search history: “migraine botox,” and “botox treatment for migraine headaches.” No personal Google or YT account was used. For the “sort by” option, “relevance” was selected, and the top 50 videos listed for each search term were reviewed. The videos after the first 50 results were not reviewed because previous research indicates that 90% of people searching for YT videos do not move past the first 30 videos in the search results. Videos without audio, those published in a language other than English, repeated videos, and irrelevant videos (e.g., music and commercial videos) were excluded.

In this study, the videos were analyzed by 2 independent general practitioners with at least 5 years of experience in informatics and social media who had been working in different departments after having completed their neurology rotation. No permission was obtained from YT, as the data used in the study were open to the public and there was no need for special access to collect data. The videos were classified as reliable or unreliable by 2 neurologists based on scientifically proven accurate information. Detailed information regarding the reliable and unreliable groups is as follows: 1. Reliable: The videos were considered reliable if they contained scientifically proven information based on the most recent reviews and guidelines. Correct definitions and up-to-date treatment methods were considered as priorities. Consequently, we evaluated videos that included the recommended treatment methods according to the guidelines as reliable. 2. Unreliable: The videos were considered unreliable if they contained false or completely unproven information, suggesting treatments other than those mentioned in the reliability section.

Quantitative video characteristics, including the total number of views, the time elapsed since upload, the duration of the video, the number of subscribers to the channel, the number of comments, the number of likes and dislikes, the view ratio, the like ratio, and the video power index (VPI), were recorded using the “vidIQ Vision” plugin for YT. The VPI was used to evaluate the popularity of each video. The formula (number of likes × total number of views)/100 was used to calculate VPI.

The DISCERN is a useful tool developed by Charnock et al and consists of 15 questions, each scored from 0 to 5. DISCERN objectively evaluates the quality of the health information presented in videos. We used the short five-question DISCERN tool, which has been used in several studies[7,8] (Table 1).

Table 1 DISCERN, GQS, JAMA scores.

The DISCERN tool (5 questions); one point was awarded for each positive answer	
 1	Were the aims clear and achieved?	
 2	Were the sources of information reliable?	
 3	Is the information balanced and unbiased?	
 4	Are additional resources to learning provided?	
 5	Does the video address areas of controversy/uncertainty?	
Global Quality Scale score (GQS) criteria	
Description of quality	
Poor quality, information missing, technique misleading; unlikely to be useful for patient education	
Generally sparse quality, some information provided but majority lacking, technique poor; limited use for patients	
Moderate quality, important information provided but some lacking, technique mostly adequate; somewhat useful for patients	
Good quality, majority of information provided but some information lacking, technique adequate; useful for patients because most important topics are covered	
Excellent quality, full information provided, technique adequate; highly useful for patients	
Journal of the American Medical Association benchmark criteria	
Criterion	Description	
Authorship	Author and contributor credentials and their affiliations should be provided.	
Attribution	All copyright information should be clearly listed, and references and sources for content should be stated.	
Currency	The initial date of the posted content and dates of subsequent updates to the content should be provided.	
Disclosure	Conflicts of interest, funding, sponsorship, advertising, support, and video ownership should be fully disclosed.	

In addition to DISCERN, we used the Global Quality Scale score (GQS) to assess the overall video quality. Using this tool, the video quality, flow, and benefit of the information contained in the patients were scored from 1 to 5[9,10] (Table 1).

The narrators in the videos were classified as voiceovers, real persons, cartoons, or patient experiences. In addition, videos were classified according to their upload sources.

The uploaded sources are classified as follows: 1. University/nonprofit physicians or organizations, 2. health information websites, 3. individual users, medical advertisements, or for-profit organizations, and 4. patient experience.

The Journal of the American Medical Association (JAMA) tool is a 4-criteria assessment tool developed by JAMA. The Authorship item refers to fully stating the name and affiliation of the author on the website. The Attribution item measures the effectiveness of reference to the content offered on the website. The Currency item evaluates whether website developers provide the date of uploading and updating, and the disclosure category shows whether the site owner highlights potential conflicts of interest. Each item was scored between 1 and 4 points by the observers[11] (Table 1).

Ethics committee approval was not obtained, as in previous studies, since no animal or human data were used in the study, and all videos were publicly available.

2.1. Statistical method

The data were analyzed using IBM SPSS V23. Compliance with the normal distribution was analyzed using the Kolmogorov–Smirnov and Shapiro–Wilk tests. Chi-square test, Yates’ correction, and Fisher exact test were used to compare categorical variables between groups. The Mann–Whitney U test was used to compare non-normally distributed data according to the binary groups. The Kruskal–Wallis test was used to compare non-normally distributed data according to groups of 3 or more, and multiple comparisons were analyzed using Dunn test. The relationships between non-normally distributed continuous data were analyzed using the Spearman rho correlation coefficient. Analysis results are presented as mean ± standard deviation and median (minimum–maximum) for quantitative data, and as frequency (percentage) for categorical data. The significance level was set at P < .050.

3. Results

A total of 100 videos with descriptions of “migraine botox” and “botox treatment for migraine headaches” were analyzed. The quality and quantity of videos are listed in Table 2. Accordingly, the average number of views of the videos was 35,801.97. The average number of likes was 253.96, while the average number of dislikes was 0.04. The average number of comments was 17.85 and the average video length was 256.43 seconds. The average number of channel subscribers was 397,584.44. The average DISCERN score was 3.09. The mean JAMA score was 2.11 and the average VPI score was 567,970.86.

Table 2 Video characteristics of YouTube videos.

	Mean ± standard deviation	Median (min–max)	
Number of views	35,801.97 ± 153,997.63	3233.00 (84.00–1,414,061.00)	
Likes	253.96 ± 1049.74	27.50 (0.00–10,000.00)	
Dislikes	0.04 ± 0.40	0.00 (0.00–4.00)	
Comments	17.85 ± 46.52	0.00 (0.00–242.00)	
Video length (sn)	256.43 ± 248.90	150.00 (17.00–1000.00)	
Subscribers	397,584.44 ± 1,329,070.46	13,300.00 (30.00–9,840,000.00)	
DISCERN	3.09 ± 1.40	3.00 (0.00–5.00)	
GQS	3.25 ± 1.07	3.00 (1.00–5.00)	
JAMA	2.11 ± 0.88	2.00 (1.00–4.00)	
VPI	567,970.86 ± 2,764,675.05	727.13 (0.00–16,968,732.00)	
DISCERN: quality criteria for consumer health information.

GQS = Global Quality Scale score, JAMA = Journal of the American Medical Association, VPI = Video Power Index.

No statistically significant difference was found between the median values of the number of views, likes, comments, and VPI variables in the comparison based on the reliability and non-reliable status of the videos (P > .05). Analysis of the relationship between the values of the subscriber variable based on the video type revealed a statistically significant difference (P = .022). While the median value of the video type reliable was 36,800, the median value of the non-reliable video type was 10,300. A statistically significant difference was observed between the DISCERN, GQS, and JAMA total scores according to the video type (P < .001, P < .001, P < .001, P < .001, respectively).

There was a statistically significant relationship between video type and narrator (P = .003). Analyzing the types of videos using an external voice narrator, 59.1% were reliable and 40.9% were non-reliable. For real-person-narrated videos, 23.1% of the video types were reliable, and 76.9% were non-reliable. For the patient-narrator video type, 53.8% of the video types were reliable, and 46.2% were non-reliable. There was a statistically significant relationship between video type and source (P = .002). For videos that were narrated by university/nonprofit physicians or professional organizations, 87.5% of the video type was reliable, and 12.5% was non-reliable. For videos from health information websites, 64% of the video types were reliable, and 36% were non-reliable. For individual users, medical advertisements, and for-profit organizations, 55.6% of the video types were reliable, and 44.4% were non-reliable. Regarding patient experience, 66.7% of the video types were reliable, and 33.3% were non-reliable (Table 3). For reliable source types, the most common reliable source type was university/nonprofit physicians or professional organizations (n = 28). For non-reliable source types, the most common source type was individual users, medical advertisements, or for-profit organizations (n = 12) (Fig. 1). Considering the DISCERN, GQS, and JAMA scores according to source, a statistically significant (P = .002, P = .015, P = .002, respectively) relationship was found between the obtained scores (Table 4).

Table 3 Comparison of variables by video type.

	Video Type	Test statistics	P	
Reliable	Non-reliable	
Number of views	4139 (84–1,414,061)	3038 (97–50,050)	1056.5	.558	
Likes	32 (0–10,000)	27 (0–248)	1058.5	.568	
Comments	0 (0–61)	0 (0–242)	1104.0	.787	
Subscriber	36,800 (443–9,840,000)	10,300 (30–1,270,000)	819.5	.022*,**	
DISCERN	3 (1–5)	3 (1–5)	606.0	<.001*,**	
GQS	3 (1–5)	3 (1–5)	668.0	<.001*,**	
JAMA	2 (1–4)	2 (1–4)	587.0	<.001*,**	
VPI	1161,23 (0–16,968,732)	688,86 (0–124,124)	1062.0	.585	
Narrator					
 External sound	13 (59.1)*	9 (40.9)	11,704	.003†,**	
 Real person	15 (23.1)†	50 (76.9)	
 Patient	7 (53.8)*,†	6 (46.2)	
Source					
 Universite/NonProfit physicians or Professional organizations	28 (84.8)	5 (15.2)*	14,729	.002†,**	
 Health information websites	16 (64)	9 (36)*,†	
 Individual users, medical advertisement or for-profit organization	15 (55.6)	12 (44.4)†	
 Patient experience	5 (33.3)†	10 (66.7)†	
DISCERN: quality criteria for consumer health information.

GQS = Global Quality Scale score; JAMA = Journal of the American Medical Association; VPI = Video Power Index.

* Mann–Whitney U test.

† Pearson Chi-Square test.

** P < .01.

Table 4 Comparison of scores according to the sources.

Source	Test statistics	P *	
	University/nonprofit physicians or professional organizations	Health information websites	Individual users, medical advertisements or for-profit organizations	Patient experience	
Number of views	3977 (249–1,414,061)	6773 (97–157,809)	2468 (84–136,918)	3040 (92–14,893)	4763	.190	
Likes	40 (0–2700)	46 (0–10,000)	18 (0–753)	19 (0–133)	3167	.367	
Comments	0 (0–195)	7 (0–242)	0 (0–64)	0 (0–61)	6465	.091	
Video Length(Sec)	192 (27–1000)	157 (27–1000)	109 (17–699)	137 (104–670)	3795	.284	
Subscriber	10,300 (86–1,070,000)	13,300 (262–514,000)	9830 (30–5,750,000)	54,600 (443–9,840,000)	2882	.410	
DISCERN	4 (1–5)c	3 (1–5)bc	3 (0–5)ab	2 (1–4)a	15,387	.002**	
GQS	4 (1–5)b	3 (1–5)ab	3 (1–5)a	3 (2–4)ab	10,428	.015**	
JAMA	2 (1–4)b	2 (1–4)b	2 (1–3)a	2 (1–3)ab	1393	.003**	
VPI	1164,15 (0–16,968,732)	2250,85 (0–15,750,000)	333,72 (0–1,030,992.54)	498,52 (0–15,935.51)	3727	.292	
a–cThere is no statistical difference between the same letters.

DISCERN: quality criteria for consumer health information.

GQS = Global Quality Scale score; JAMA = Journal of the American Medical Association; VPI = Video Power Index.

* Kruskal–Wallis Test; Dunn test was performed for multiple comparisons; median (min–max).

** P < .01.

Figure 1. Distribution of sources by video type.

There was a statistically significant positive correlation between the DISCERN scores and GQS values (R = 0.757; P < .001). There was a statistically significant positive correlation between the DISCERN scores and JAMA values (R = 0.665; P < .001). There was a statistically significant positive correlation between the GQS and JAMA values (R = 0.796; P < .001) (Table 5).

Table 5 Examination of the relationship between scores.

		DISCERN	GQS	
GQS	r	0.757*	–	
p	<.001**	–	
JAMA	r	0.665*	0.796*	
p	<.001**	<.001**	
GQS = Global Quality Scale score; JAMA = Journal of the American Medical Association.

* Spearman rho correlation.

** P < .01.

4. Discussion

Migraine is a chronic disease that affects activities of daily living and causes severe disability in quality of life. This disability may lead to a reduced capability to take part in social activities, which affects the overall quality of life and social interactions.[12] Patients who do not benefit from medical treatment search for treatments that respond quickly and improve their QoL Recently, methods such as the Greater Occipital Nerve blockade, migraine Botox, migraine vaccines, and alternative medicine treatments have become more popular in addition to medical treatment options. YT videos can be used to evaluate treatment options on social media before consulting a physician regarding their preferred method. This allows the patient to access information quickly, understand the disease process, seek professional help as early as possible, and protect the patient from loss of quality of life. However, videos uploaded to YT may not provide adequate information about diseases and treatments and may even contain misleading information.[13] The YT algorithm has been regulated to standardize of this issue, increase the quality and efficiency of the information flow, and control it. The YT algorithm, designed to sift through nearly 4 billion videos on the YT platform to identify high-quality and relevant ones, is a multifaceted process that proceeds to evolve and the viewer feedback has had a significant role in this identification.[14]

In our study, we analyzed migraine Botox videos, and when we compared the video characteristics according to the type of video and whether it was reliable or unreliable, we found that reliable videos had more views and subscribers. It was also revealed that reliable videos had a statistically significant increase in the DISCERN, GQS, and JAMA scores. Most of these videos were from universities, nonprofit doctors, and professional organizations. Videos uploaded by universities/nonprofit doctors and professional organizations were more reliable than those uploaded by other groups. Videos uploaded to health information websites were also found to be highly reliable.

In our study, when a comparative evaluation was made according to the source of the uploaded video, we observed that the videos uploaded by authorized experts, such as universities/nonprofit physicians or professional organizations, had higher DISCERN, GQS, and JAMA scores. Similar to our study, in the study in which YT video analysis of restless leg syndrome was performed, it was reported that the JAMA, GQS, and DISCERN scores were high for videos uploaded by healthcare professionals and based on this situation, they reported that YT potentially contained accurate information.[15] In the study of Salman et al in which they evaluated YT videos related to urinary incontinence in women, it was reported that most of the videos (53.3%) were uploaded by the health channel and 23.3% were uploaded by the hospital channel and that the DISCERN and JAMA scores increased in the uploaded videos.[16]

Analysis of the correlation of DISCERN, GQS, and JAMA scores, which are quality scores in our study, showed that all scores were significantly positively correlated with each other (Table 5).

Although many studies have shown that videos that medical professionals upload are of better quality than those uploaded by non-health professionals, these videos have been noted to be less popular. and more frequently watched.[17] This finding may be because health professionals use academic language that they are accustomed to describing the disease to ensure quality and reliability, epidemiological data, academic information, videos with diagrams and radiological images, and long video durations. A mechanical thrombectomy YT analysis study reported that videos enriched with animations and short-duration videos had a wider audience. Therefore, we believe that speaking about academic information in a language that the public can understand and optimize video durations to reach wider audiences than health professionals while creating content will contribute to increasing video views.[18]

The VPI score is directly proportional to the frequency of video viewing and number of likes. In our study, when the VPI scores were compared according to reliable and non-reliable video types, although the VPI ratio was higher for reliable videos, no statistically significant difference was observed. This result suggests that the viewing frequency of non-reliable videos was high. Likewise, a study analyzing YT videos of mechanical thrombectomy in acute cerebrovascular patients reported that none of the videos with the highest VPI rate had excellent or good quality, in accordance to the DISCERN score.[18] The VPI rate may vary depending on many factors, such as the popularity of the channel and uploader and entertaining content. While the GQS, DISCERN, and JAMA scores were significantly higher, the lack of difference in VPI indicates that popularity, quality, and reliability are different entities.[18] In addition, another study reported a negative relation between average GQS and DISCERN scores and VPI.[5]

4.1. Limitations

Because of the nature of this study, some limitations are present. First, health information should be assessed by establishing consensus in the literature on how online videos are used. The YT platform is dynamic and constantly refreshed with new video streams; therefore, the data were obtained on a specific date and reflect the assessed time period.

Another limitation is that there is no universally accepted gold standard methodology for the quality assessment of YT videos. Although the GQS, DISCERN, JAMA, and metrics are not specifically intended for the quality assessment of YT videos, they have traditionally been utilized in a significant proportion of research efforts owing to their widespread adoption in this field.

5. Conclusions

YT has become a popular platform for both healthcare professionals and patients. It is remarkable that lower quality videos can have viewership comparable to that of superior quality. In particular, it is notable from the literature that there is no significant difference in the popularity and views of potentially misleading and helpful videos. For both doctors and patients, videos created by medical professionals are a better choice as a source of information for both patients and doctors. putting credibility of the content creator over factors such as video popularity and comment volume in video ranking will make this platform more valuable. It would also be useful to plan video content in an easy-to-understand language with an optimal duration to appeal to a wider audience.

On the other hand, we observed that there was a wide spectrum of information and high-quality content and that there were videos with insufficient information content that may mislead viewers. It would be more appropriate for viewers to select videos uploaded by medical experts rather than access reliable and accurate information.

In conclusion, YT is a frequently preferred platform for which individuals to access information easily. In this respect, it is thought that having information that is accepted as scientifically accurate by health professionals, health institutions, and official authorities whose content is audited and easily accessible will prevent the formation of information pollution that may occur during disease research by video viewers on the Internet.

Considering that our study is the first to evaluate the reliability and quality of YT videos for migraine Botox treatment, we believe that it will shed light on and guide new social media planning for migraine Botox treatment.

Author contributions

Conceptualization: Meltem Karacan Gölen.

Data curation: Meltem Karacan Gölen.

Formal analysis: Meltem Karacan Gölen, Şaziye Melike Işik.

Funding acquisition: Meltem Karacan Gölen, Şaziye Melike Işik.

Investigation: Meltem Karacan Gölen.

Methodology: Meltem Karacan Gölen.

Project administration: Meltem Karacan Gölen.

Resources: Meltem Karacan Gölen, Şaziye Melike Işik.

Software: Meltem Karacan Gölen.

Supervision: Meltem Karacan Gölen, Şaziye Melike Işik.

Validation: Meltem Karacan Gölen.

Visualization: Meltem Karacan Gölen.

Writing – original draft: Meltem Karacan Gölen.

Writing – review & editing: Meltem Karacan Gölen.

Abbreviations:

GON Greater Occipital Nerve

GQS Global Quality Scale

JAMA Journal of the American Medical Association

VPI Video Popularity Index

YT YouTube

The original article is not under simultaneous consideration by any other journal, and its content, including tables and figures, has not been previously published or submitted for publication elsewhere.

Ethics committee approval was not necessary for this study since it utilized publicly accessible data and did not involve human or animal subjects.

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are publicly available.

How to cite this article: Karacan Gölen M, Işik ŞM. Quality and reliability analysis of migraine Botox treatment information on YouTube. Medicine 2024;103:38(e39824).
==== Refs
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