The quality and reliability of online video resources concerning patient education for migraine treatment in China Mainland: an electronic media-based study
As a highly prevalent and debilitating primary neurological disorder, migraine is characterized by recurrent episodes of moderate to severe unilateral throbbing headaches, along with a variety of physical and mental comorbidities . It impacts over one billion individuals worldwide annually  and causes far more disability than all other neurological disorders combined . Although mounting research has identified numerous risk factors and triggers related to migraine and has shed light on its specific pathophysiological mechanisms , this disease remains largely under-recognized, under-diagnosed, and under-treated . This lack of recognition and treatment places a significant burden on patients and their caregivers, adversely affecting their productivity  and the economy of their society . Therefore, proper patient education is increasingly considered an essential factor in achieving better migraine management around the world . Various forms of educational resources, including brochures , standardized courses led by trained instructors , and CD-ROMs , have been shown to significantly enhance patients’ confidence and adherence to treatment, while also curtailing unnecessary medical resource expenditure. Fortunately, the rapid growth of the internet in recent decades has notably transformed the methods of health-related education, creating new opportunities for patient learning. Emerging electronic social media platforms, such as Google , are progressively playing an important role in headache management and the communication of relevant scientific information . Among these, online video platforms like YouTube and TikTok offer a distinct advantage over traditional text-based media, presenting graphical contents that can be more readily absorbed and remembered by audiences. Although online video platforms have provided an abundance of freely accessible information regarding headaches, it remains a challenging and complex task for many migraine sufferers to thoroughly assess the overall quality and trustworthiness of the videos that are algorithmically suggested by search engines . Furthermore, it is important to acknowledge that some of these videos may be produced by individuals lacking adequate medical training and expertise, which could lead to the dissemination of various rumours, hoaxes, and misinformation . In fact, several previous investigations have revealed that the reliability of headache-related content on platforms like YouTube was generally poor and had ample room for improvement, even when the material was sourced from healthcare professionals . In light of this, a timely and thorough evaluation of online videos concerning headache information has become essential. However, following Google’s withdrawal of its operations from the Chinese market, YouTube has been unavailable in China Mainland since 2010. Instead, some Chinese domestic video-sharing platforms, such as TikTok, have quickly gained tremendous popularity with their engaging content and convenient interactions, attracting over one billion users nationwide. As a result, in this study, by searching and collecting data from four most popular local video sites, our research team aimed to explore the overall quality and reliability of online video resources concerning patient education for migraine treatment in China Mainland.   Search strategy and data collection In this cross-sectional study based on electronic media, the search terms “偏头痛” (“Migraine” in Chinese) and “治疗” (“Treatment” in Chinese) were adopted to search the top 50 videos automatically recommended by default overall ranking in four popular Chinese language online video-sharing platforms, including BiliBili ( http://www.bilibili.com ), Douyin (Chinese version of TikTok, http://www.douyin.com ), Haokan Video ( https://haokan.baidu.com ), and Xigua Video ( https://www.ixigua.com ). As regards the introductions to these four Chinese domestic video websites used for analysis, a more detailed description can be found in Supplementary Table 1. The initial selection of video platforms was based on their operational characteristics, and only those platforms that offer free access to ordinary individual users to create and upload self-produced videos and allow frequent user-to-user interactions were considered, while those that focus on compensable services such as TV series, documentaries, films, or webcasts were excluded. Therefore, some other famous online video platforms in China, including YOUKU ( https://www.youku.com/ ), iQIYI ( https://www.iqiyi.com/ ), and Tencent Video ( https://v.qq.com/ ), were not utilized in this study. In this current study, the definition of migraine followed the guidelines from the International Classification of Headache Disorders, 3rd edition (ICHD-3), that migraine is a disabling primary neurological condition typically characterized by recurrent moderate or severe unilateral pulsatile headaches . The search was performed on a Windows 10-operated personal computer using a newly installed Mozilla Firefox browser (version 121.0.1) in Suzhou, Jiangsu, China, within one day (December 26, 2023). In order to minimize the potential bias introduced by personal recommendation algorithms, all cookies, previous search history, and temporary internet files were deleted and video website accounts were logged out before and between search queries in the private mode. After searching, the top 50 videos automatically recommended by default overall ranking in each video website were prepared for initial screening. This decision was based on a previous literature review that concluded that amateur internet health seekers seldom pay attention to content beyond the first two pages they find . Therefore, in this circumstance, only the video materials on the first two pages were brought into consideration, and most Chinese language video platforms limit their video number on each page between approximately 20 and 30, we eventually included the top 50 (averagely 25 videos per page × 2 page) automatically recommended videos for further screening. The exclusion criteria were set as follows: (1) videos which are not in Chinese (the Chinese here includes Mandarin, Cantonese, and other dialects of Chinese); (2) videos which are irrelevant to migraine treatment; (3) commercial advertisements; (4) duplicates which are repeatedly uploaded to the same video platform. After screening, 14 irrelevant videos, 3 duplicate videos, and 1 video in other languages were excluded, while a total of 182 eligible online videos directly concerning migraine treatment were eventually included for further data extraction and content evaluation. A more detailed flow chart of search strategy and study design has been shown in Fig. . For those included videos, their general information, including uniform resource locators (URLs) authorship, the numbers of views, likes, shares and comments, date of upload, and video length were collected and recorded in an Excel sheet (Microsoft Corp). Classification of videos Our researchers categorized the included videos in accordance with their producer identity as follows: (1) general users; (2) health professionals; (3) news agencies; (4) for-profit organizations; and (5) non-profit organizations. For those online videos created by authors classified as health professionals, a further grouping was conducted as follows: (1) doctors specializing in neurology of modern evidence-based medicine; (2) doctors specializing in other areas of modern evidence-based medicine; (3) doctors of traditional Chinese medicine (TCM); (4) other health-related professionals. Furthermore, for videos produced by doctors of TCM, we additionally performed a more detailed classification based on their speciality as follows: (1) doctors specializing in traditional Chinese herbs; (2) doctors specializing in traditional Chinese physiotherapy; (3) doctors specializing in both traditional Chinese herbs and physiotherapy. A more detailed description of authorship classification can be found in Supplementary Table 2. Quality and Reliability Assessment In this study, two different questionnaires were employed respectively to quantify the overall quality and reliability of our included online videos concerning migraine treatment. The DISCERN instrument, which was first introduced to judge the quality of online information on treatment choices in 1999 , has now been widely validated and applied for evaluating health-related content on video-sharing websites . Therefore, we adopted a modified DISCERN tool to rate the video content’s reliability based on 5 items (Table ). The modified DISCERN score ranged from 0 to 5, and a greater score indicated better reliability (unreliable to reliable). Moreover, the Global Quality Score (GQS), as a commonly utilized 5-point scale ranging from 1 (poor quality) to 5 (excellent quality) for the evaluation of health-related content on the internet , was also employed to assess the overall quality of our included videos in this study (Table ). Currently, the combination of modified DISCERN questionnaire and GQS scale has been commonly utilized in the quality and credibility assessment of online health-related videos by previous researchers , thus our current study similarly employed this evaluation strategy. Two qualified researchers (Ge RG and Chen YH) with sufficient medical education and training background were assigned to independently rate the online videos with modified DISCERN and GQS tools. Before the formal scoring, two raters have fully reviewed and understood the questionnaires in detail to minimize potential biases caused by misunderstanding about the scoring instruments. Additionally, we used the Cohen’s Kappa test to quantify the agreement between the results from the two raters. A value of > 0.8 was considered excellent consistency, a value between 0.8 and 0.6 represents substantial consistency, a value between 0.6 and 0.4 represents moderate consistency, and a value of < 0.4 was considered poor consistency . For those scores that cannot be agreed upon by two raters, a senior researcher (Chang J) was appointed to make a final decision. Video content evaluation In terms of the video content evaluation, we have referred to a previous study  and collected and described information on four main aspects as follows: (1) did the video mention the caution against medication overuse headache? (2) did the video encourage patients to keep a headache diary? (3) did the video emphasize the preventive migraine treatment? (4) what available treatments were recommended to patients in the video? Statistical analysis In this study, we adopted the Shapiro-Wilk test to assess the normality of the data extracted from the included videos. For those data which followed nonparametric distribution, the median and interquartile range (IQR) were used for descriptive analysis. While for those followed parametric distribution, the mean and standard deviation (SD) were used for descriptive analysis. The nonparametric comparisons between two unpaired groups of data were performed with the Mann-Whitney test, while those between three or more groups of data were conducted with the Kruskal-Wallis H test. Moreover, we also employed the Spearman correlation coefficient to explore the potential association of video quality and reliability with video general information. The P -value of < 0.05 was considered statistically significant.   In this cross-sectional study based on electronic media, the search terms “偏头痛” (“Migraine” in Chinese) and “治疗” (“Treatment” in Chinese) were adopted to search the top 50 videos automatically recommended by default overall ranking in four popular Chinese language online video-sharing platforms, including BiliBili ( http://www.bilibili.com ), Douyin (Chinese version of TikTok, http://www.douyin.com ), Haokan Video ( https://haokan.baidu.com ), and Xigua Video ( https://www.ixigua.com ). As regards the introductions to these four Chinese domestic video websites used for analysis, a more detailed description can be found in Supplementary Table 1. The initial selection of video platforms was based on their operational characteristics, and only those platforms that offer free access to ordinary individual users to create and upload self-produced videos and allow frequent user-to-user interactions were considered, while those that focus on compensable services such as TV series, documentaries, films, or webcasts were excluded. Therefore, some other famous online video platforms in China, including YOUKU ( https://www.youku.com/ ), iQIYI ( https://www.iqiyi.com/ ), and Tencent Video ( https://v.qq.com/ ), were not utilized in this study. In this current study, the definition of migraine followed the guidelines from the International Classification of Headache Disorders, 3rd edition (ICHD-3), that migraine is a disabling primary neurological condition typically characterized by recurrent moderate or severe unilateral pulsatile headaches . The search was performed on a Windows 10-operated personal computer using a newly installed Mozilla Firefox browser (version 121.0.1) in Suzhou, Jiangsu, China, within one day (December 26, 2023). In order to minimize the potential bias introduced by personal recommendation algorithms, all cookies, previous search history, and temporary internet files were deleted and video website accounts were logged out before and between search queries in the private mode. After searching, the top 50 videos automatically recommended by default overall ranking in each video website were prepared for initial screening. This decision was based on a previous literature review that concluded that amateur internet health seekers seldom pay attention to content beyond the first two pages they find . Therefore, in this circumstance, only the video materials on the first two pages were brought into consideration, and most Chinese language video platforms limit their video number on each page between approximately 20 and 30, we eventually included the top 50 (averagely 25 videos per page × 2 page) automatically recommended videos for further screening. The exclusion criteria were set as follows: (1) videos which are not in Chinese (the Chinese here includes Mandarin, Cantonese, and other dialects of Chinese); (2) videos which are irrelevant to migraine treatment; (3) commercial advertisements; (4) duplicates which are repeatedly uploaded to the same video platform. After screening, 14 irrelevant videos, 3 duplicate videos, and 1 video in other languages were excluded, while a total of 182 eligible online videos directly concerning migraine treatment were eventually included for further data extraction and content evaluation. A more detailed flow chart of search strategy and study design has been shown in Fig. . For those included videos, their general information, including uniform resource locators (URLs) authorship, the numbers of views, likes, shares and comments, date of upload, and video length were collected and recorded in an Excel sheet (Microsoft Corp).   Our researchers categorized the included videos in accordance with their producer identity as follows: (1) general users; (2) health professionals; (3) news agencies; (4) for-profit organizations; and (5) non-profit organizations. For those online videos created by authors classified as health professionals, a further grouping was conducted as follows: (1) doctors specializing in neurology of modern evidence-based medicine; (2) doctors specializing in other areas of modern evidence-based medicine; (3) doctors of traditional Chinese medicine (TCM); (4) other health-related professionals. Furthermore, for videos produced by doctors of TCM, we additionally performed a more detailed classification based on their speciality as follows: (1) doctors specializing in traditional Chinese herbs; (2) doctors specializing in traditional Chinese physiotherapy; (3) doctors specializing in both traditional Chinese herbs and physiotherapy. A more detailed description of authorship classification can be found in Supplementary Table 2.   In this study, two different questionnaires were employed respectively to quantify the overall quality and reliability of our included online videos concerning migraine treatment. The DISCERN instrument, which was first introduced to judge the quality of online information on treatment choices in 1999 , has now been widely validated and applied for evaluating health-related content on video-sharing websites . Therefore, we adopted a modified DISCERN tool to rate the video content’s reliability based on 5 items (Table ). The modified DISCERN score ranged from 0 to 5, and a greater score indicated better reliability (unreliable to reliable). Moreover, the Global Quality Score (GQS), as a commonly utilized 5-point scale ranging from 1 (poor quality) to 5 (excellent quality) for the evaluation of health-related content on the internet , was also employed to assess the overall quality of our included videos in this study (Table ). Currently, the combination of modified DISCERN questionnaire and GQS scale has been commonly utilized in the quality and credibility assessment of online health-related videos by previous researchers , thus our current study similarly employed this evaluation strategy. Two qualified researchers (Ge RG and Chen YH) with sufficient medical education and training background were assigned to independently rate the online videos with modified DISCERN and GQS tools. Before the formal scoring, two raters have fully reviewed and understood the questionnaires in detail to minimize potential biases caused by misunderstanding about the scoring instruments. Additionally, we used the Cohen’s Kappa test to quantify the agreement between the results from the two raters. A value of > 0.8 was considered excellent consistency, a value between 0.8 and 0.6 represents substantial consistency, a value between 0.6 and 0.4 represents moderate consistency, and a value of < 0.4 was considered poor consistency . For those scores that cannot be agreed upon by two raters, a senior researcher (Chang J) was appointed to make a final decision.   In terms of the video content evaluation, we have referred to a previous study  and collected and described information on four main aspects as follows: (1) did the video mention the caution against medication overuse headache? (2) did the video encourage patients to keep a headache diary? (3) did the video emphasize the preventive migraine treatment? (4) what available treatments were recommended to patients in the video?   In this study, we adopted the Shapiro-Wilk test to assess the normality of the data extracted from the included videos. For those data which followed nonparametric distribution, the median and interquartile range (IQR) were used for descriptive analysis. While for those followed parametric distribution, the mean and standard deviation (SD) were used for descriptive analysis. The nonparametric comparisons between two unpaired groups of data were performed with the Mann-Whitney test, while those between three or more groups of data were conducted with the Kruskal-Wallis H test. Moreover, we also employed the Spearman correlation coefficient to explore the potential association of video quality and reliability with video general information. The P -value of < 0.05 was considered statistically significant.   General information of eligible videos After the exclusion criteria were applied, a total of 182 videos were included for further data extraction and analysis (Fig. ). In this study, the median duration of videos was 117 s (IQR 74–217.3), the median number of video views was 4,276 (IQR 1,303 − 15,000), the median number of likes was 84 (IQR 9.75–862.5), the median number of shares was 246.5 (IQR 14.75–1534), and the median number of comments was 9 (IQR 1–87.25). Among the four platforms, the median duration of videos on Douyin was generally shorter than those on the other three platforms, and the median number of likes, shares, and comments received by videos on Douyin was notably higher than the overall level. In terms of the identity of the video producers, as shown in Table and 105 of 182 videos were created by health professionals (57.7%), but only 26 of them were made by doctors specializing in neurology of modern medicine. Among organizational users, for-profit organizations contributed the most videos ( n = 27, 14.8%), followed by news agencies ( n = 21, 11.5%) and non-profit organizations ( n = 5, 2.7%). Interestingly, all 47 videos on Douyin were provided by health professionals, and only two of them were produced by doctors of TCM. Information quality and reliability According to the results of the Cohen’s Kappa test, the Kappa coefficients of the DISCERN scores and GQS scores made by our two independent raters were 0.755 and 0.751, respectively, indicating a substantial consistency of our scoring process. Generally, as shown in Table ; Fig. A-B, the median of the DISCERN score of overall videos was 1 (IQR 1–2), and the median of the GQS score of overall videos was 2 (IQR 2–3), which represented that the overall quality and reliability of the content of our included videos were relatively poor. When examining specific video platforms, although Douyin enjoyed a greater median value of its DISCERN score compared to other video websites, only the difference between that from the Xigua Video was found to be statistically significant. However, notably, in terms of the GQS score, the videos from the Douyin platform received a greater quality score than the other three video platforms, with all P -values < 0.05. If we largely split the data according to their producer identity, results suggested that videos created by health professionals exhibited greater quality compared with those by news agencies and especially general individual users (Fig. C). Yet, as regards reliability, no significant difference was observed between videos from each video producer category (Fig. D). After further classifying the data on health professionals by their medical speciality, videos created by doctors specializing in modern medicine, regardless of neurology or other areas, showed notably greater quality as well as reliability over those by doctors of TCM (Fig. E-F). Interestingly, when examined by a more detailed subgroup of TCM doctors, it was observed that videos created by TCM practitioners who combined the utilization of physiotherapy and herb-based medicine were superior in both quality and reliability to those created by TCM practitioners who only solely specialized in physiotherapy or herb-based medicine (Supplementary Fig. 1A-B). Video content As shown in Table , the results suggested that only 10 of 182 videos encouraged patients to keep a headache diary and 12 of 182 videos warned about the risk of medication overuse, while slightly more migraine-related videos emphasized preventive treatment of the recurrence of chronic migraine, reaching 32 (17.6%). In terms of the recommended treatment choices, almost all of the videos gave recommendations for both pharmacological and non-pharmacological treatment. It was also observed that massage was the most frequently recommended non-pharmacological treatment and was mentioned in 40 of 182 videos (22.0%). For pharmacological treatment, Triptans was recommended most frequently ( n = 57, 31.3%), followed by NSAIDs ( n = 55, 30.2%), while pizotifen, mannitol, angiotensin II receptor blockers, barbiturates and melatonin were mentioned only once. To note, TCM, as a complementary medicine in China, was also strongly recommended in our included videos, where acupuncture was mentioned in 31 online videos (17.0%). Association of video general information with video quality and reliability According to Table , significant positive correlations were widely observed among the general information of included online videos, with the highest Spearman correlation coefficient being noticed between numbers of received likes and shares ( r = 0.9654, P -value < 0.05). If we further brought the video quality and reliability into consideration, sadly, only the correlations of GQS score with number of received likes and comments were found to be slightly positive and statistically significant ( r = 0.1585 and 0.1855 respectively, P -value < 0.05).   After the exclusion criteria were applied, a total of 182 videos were included for further data extraction and analysis (Fig. ). In this study, the median duration of videos was 117 s (IQR 74–217.3), the median number of video views was 4,276 (IQR 1,303 − 15,000), the median number of likes was 84 (IQR 9.75–862.5), the median number of shares was 246.5 (IQR 14.75–1534), and the median number of comments was 9 (IQR 1–87.25). Among the four platforms, the median duration of videos on Douyin was generally shorter than those on the other three platforms, and the median number of likes, shares, and comments received by videos on Douyin was notably higher than the overall level. In terms of the identity of the video producers, as shown in Table and 105 of 182 videos were created by health professionals (57.7%), but only 26 of them were made by doctors specializing in neurology of modern medicine. Among organizational users, for-profit organizations contributed the most videos ( n = 27, 14.8%), followed by news agencies ( n = 21, 11.5%) and non-profit organizations ( n = 5, 2.7%). Interestingly, all 47 videos on Douyin were provided by health professionals, and only two of them were produced by doctors of TCM.   According to the results of the Cohen’s Kappa test, the Kappa coefficients of the DISCERN scores and GQS scores made by our two independent raters were 0.755 and 0.751, respectively, indicating a substantial consistency of our scoring process. Generally, as shown in Table ; Fig. A-B, the median of the DISCERN score of overall videos was 1 (IQR 1–2), and the median of the GQS score of overall videos was 2 (IQR 2–3), which represented that the overall quality and reliability of the content of our included videos were relatively poor. When examining specific video platforms, although Douyin enjoyed a greater median value of its DISCERN score compared to other video websites, only the difference between that from the Xigua Video was found to be statistically significant. However, notably, in terms of the GQS score, the videos from the Douyin platform received a greater quality score than the other three video platforms, with all P -values < 0.05. If we largely split the data according to their producer identity, results suggested that videos created by health professionals exhibited greater quality compared with those by news agencies and especially general individual users (Fig. C). Yet, as regards reliability, no significant difference was observed between videos from each video producer category (Fig. D). After further classifying the data on health professionals by their medical speciality, videos created by doctors specializing in modern medicine, regardless of neurology or other areas, showed notably greater quality as well as reliability over those by doctors of TCM (Fig. E-F). Interestingly, when examined by a more detailed subgroup of TCM doctors, it was observed that videos created by TCM practitioners who combined the utilization of physiotherapy and herb-based medicine were superior in both quality and reliability to those created by TCM practitioners who only solely specialized in physiotherapy or herb-based medicine (Supplementary Fig. 1A-B).   As shown in Table , the results suggested that only 10 of 182 videos encouraged patients to keep a headache diary and 12 of 182 videos warned about the risk of medication overuse, while slightly more migraine-related videos emphasized preventive treatment of the recurrence of chronic migraine, reaching 32 (17.6%). In terms of the recommended treatment choices, almost all of the videos gave recommendations for both pharmacological and non-pharmacological treatment. It was also observed that massage was the most frequently recommended non-pharmacological treatment and was mentioned in 40 of 182 videos (22.0%). For pharmacological treatment, Triptans was recommended most frequently ( n = 57, 31.3%), followed by NSAIDs ( n = 55, 30.2%), while pizotifen, mannitol, angiotensin II receptor blockers, barbiturates and melatonin were mentioned only once. To note, TCM, as a complementary medicine in China, was also strongly recommended in our included videos, where acupuncture was mentioned in 31 online videos (17.0%).   According to Table , significant positive correlations were widely observed among the general information of included online videos, with the highest Spearman correlation coefficient being noticed between numbers of received likes and shares ( r = 0.9654, P -value < 0.05). If we further brought the video quality and reliability into consideration, sadly, only the correlations of GQS score with number of received likes and comments were found to be slightly positive and statistically significant ( r = 0.1585 and 0.1855 respectively, P -value < 0.05).   In this study based on 182 eligible videos, our research team reviewed and assessed the general characteristics, video content, quality, and reliability of migraine treatment-related online videos from the four most popular Chinese language video-sharing platforms. This paper might be one of the first studies to investigate the Chinese language videos concerning migraine treatment, which may contribute to a better understanding of the current status of and the shortcomings of migraine education for patients based on electronic media in China Mainland. Overall, the quality and reliability of our included videos concerning migraine treatment for informal patient education were relatively poor and unsatisfactory, and significant differences were observed between different video platforms and video producers. To be more specific, the videos from Douyin enjoyed significantly better quality compared with those three other platforms, yet only had a modest statistical advantage over Xigua Video on the topic of video reliability. If we brought the identity of video producers into consideration, the overall quality of videos posted by health professionals was greater than those from general users and news agencies. However, for reliability, no significant statistical differences were observed. After classifying the health professionals into three subtypes, it was found that videos produced by doctors of modern medicine, regardless of neurologist and non-neurologist, had an overwhelming advantage over doctors of TCM on both video quality and reliability. However, when further examined by the TCM doctor category, videos from TCM practitioners who jointly master traditional Chinese physiotherapy and herb-based medicine exhibited greater quality and reliability compared with those from TCM practitioners who solely specialize in physiotherapy or herbal medicine. As regards the migraine treatment recommended by video creators, only 6.6% included videos mentioned the risk of medication overuse, 5.5% included videos encouraged patients to keep a headache diary, and 17.6% included videos emphasized the preventive treatment for the recurrence of chronic migraine. For specific treatment measures; massage, avoiding headache triggers, and relaxation were the top three most frequently recommended non-pharmacological choices, Triptans, NSAIDs, and anticonvulsants were the top three most frequently recommended pharmacological choices, while acupuncture, herbs, and moxibustion were the top three most frequently recommended TCM choices. Additionally, several common problems and shortcomings observed in the video content were also outlined during our evaluation as follows, which may potentially bring adverse effects to their audiences and migraine patients. First and also most importantly, some video producers, particularly general users and doctors of TCM, tended to exaggerate or overestimate the effectiveness and benefits of treatment measures they recommended, or even worse, propose completely baseless and irresponsible statements. For example, a producer of our included online video recklessly claimed that certain traditional Chinese herbs can “eliminate” migraine forever, yet without any sound evidence from relevant scientific research. Therefore, these very behaviours might cause unfounded, unscientific, and highly misleading information about migraine treatment for the patient population. Second, the treatment recommendations, especially pharmacological, provided by the majority of our included videos were outdated and insufficient. Some recently emerging approaches to combating migraine, such as calcitonin gene-related peptide (CGRP)-targeted therapies, were less frequently mentioned by video producers compared with other conventional medications for migraine. At the same time, despite the Triptans being the most commonly recommended for migraine treatment in our included online videos, the real-world utilization of Triptans in China was severely constrained. In fact, there are currently only two types of Triptans (Rizatriptan and Zolmitriptan) that are theoretically available with a prescription at pharmacies and hospitals in China. Compared with other cheap and easily purchased over-the-counter painkillers, Triptans are notably less accessible for most migraine or other headache patients residing in China. Finally, we also noticed that a large number of medical jargons were employed by health professionals, which might be difficult for patients with little medical education background to fully understand. For example, some video producers might simply put forward the term “NSAIDs” but did not provide any further explanation or clarification. However, given that the vast majority of the Chinese audiences lack medical or pharmacological knowledge, this technical term may end up causing confusion and misunderstanding, and even leading to medication errors. In order to explain the overall finding of our current study and the common issues of the included videos concluded above, we have proposed several speculations. First, in fact, our four included online video websites were all commercial and profit-oriented and were not specifically intended for healthcare professionals. In other words, due to the lack of professionalism, it might be difficult for them to conduct any form of peer review or the most basic check on the integrity and accuracy of the medical and scientific content provided by the video creators. Besides, considering that the majority of the general users of these video platforms were completely for entertainment and curious purposes, this might in turn force the video uploaders to create their videos and titles with sensational and unilateral words to catch the viewers’ eyes, which may potentially distort the expression of their video contents. Moreover, it cannot be ignored that TCM is extremely popular among the Chinese patients. Despite the TCM has been reported to be likely to help the management of migraine , the exact effectiveness of some treatment recommendations from TCM remained controversial and the overall quality of their clinical evidence were still generally poor or occasionally moderate . At last, given the setting that migraine is a complicated primary neurological disorder, doctors specializing in other areas of modern medicine, such as cardiologist, gynaecologist, endocrinologist, et al. observed in this study, may not necessarily have sufficient neurological or headache-targeted knowledge to properly and thoroughly explain this disease to the audiences. These joint factors might be the main cause of the unstable and generally low quality and reliability of video content in the Chinese language concerning informal migraine patient education. Fortunately, although the performance of online videos collected and evaluated in our current study was relatively unsatisfactory and disappointing, it cannot be denied that video-based patient education is still a highly promising game-changer to disease prevention and management worldwide . Appropriate measures to better regulate and monitor the quality and reliability of disease-related video resources, such as the construction of an online video platform that fully targets the patient population and can be sufficiently reviewed by healthcare professionals, might be helpful to further increase the effectiveness and efficiency of patient learning and eventually lead to a deeper disease understanding. At the same time, government departments and dedicated corporate communication agencies should also shoulder their responsibilities and persevere in combating unsubstantiated rumours and misinformation disseminated through the internet. However, there were several limitations in our current article. First, despite we have included a total of 182 online videos from four video-sharing platforms for our study, a larger sample size is still needed in the future for more precise evaluation to better understand and combat the downside of health-related misinformation spread by online videos. Additionally, the potential influence caused by the automatic recommendation algorithms of video platforms cannot be completely excluded, even though measures have been taken to minimize it. In addition, the overall quality and credibility of online healthcare-related videos may also be affected by the partial or total plagiarism and re-uploading of certain video materials by other producers, although some online video-sharing platforms have built their user-reporting system targeting the theft of others’ creations. Besides, videos from some less popular, smaller video-sharing sites in China were inevitably omitted, thus to some extent leading to selection bias. It also should be highlighted that, although the GQS scale and modified DISCERN questionnaire have been commonly used for video assessment by previous researchers, they are still not fully customized evaluation tools for online videos. Finally, our current study highly targeted China and only specifically revealed the quality and reliability of Chinese language online videos, yet those in other languages, such as Japanese, Korean, and English, were not further explored, which calls for future research. Through this investigation based on Chinese language electronic media, our researchers have successfully revealed the generally poor quality and reliability of online videos for informal patient education concerning migraine treatment in China Mainland, pointing out the necessity for the Chinese migraine population to evaluate the headache-related video content with full caution, and the practical demand for more video resources with professional knowledge of evidence-based medicine, which may contribute to better controlling primary headache disorders in China Mainland in the future. Additionally, it also highlighted the growing importance of a more active participation of Chinese medical societies as well as local government healthcare-related agencies in the public education about migraine management, reinforcing the combat against online disinformation, and leading the patients towards correct and in-depth information source.   Overall, the quality and reliability of Chinese language online videos concerning informal patient education for migraine treatment uploaded to four popular domestic video platforms in China Mainland were poor and the health-related information provided by which should be treated with caution by its audiences. Nevertheless, video-based disease management is still promising and hopeful to be a game-changer in the future. Therefore, sound actions and strategies are urgently needed to further improve the general performance of online content associated with medical professional knowledge and constrain the potential spread of misleading information.   Supplementary Material 1.   