Smartphone-based migraine behavioral therapy: a single-arm study with assessment of mental health predictors

Abstract

Progressive muscle relaxation (PMR) is an under-utilized Level A evidence-based treatment for migraine prevention. We studied the feasibility and acceptability of smartphone application (app)-based PMR for migraine in a neurology setting, explored whether appbased PMR might reduce headache (HA) days, and examined potential predictors of app and/or PMR use. In this single-arm pilot study, adults with ICHD3 migraine, 4+ HA days/month, a smartphone, and no prior behavioral migraine therapy in the past year were asked to complete a daily HA diary and do PMR for 20 min/day for 90 days. Outcomes were: adherence to PMR (no. and duration of audio plays) and frequency of diary use. Predictors in the models were baseline demographics, HA-specific variables, baseline PROMIS (patient-reported outcomes measurement information system) depression and anxiety scores, presence of overlapping pain conditions studied and app satisfaction scores at time of enrollment. Fifty-one patients enrolled (94% female). Mean age was 39 ± 13 years. The majority (63%) had severe migraine disability at baseline (MIDAS). PMR was played 22 ± 21 days on average. Mean/session duration was 11 ± 7 min. About half (47%) of uses were 1+ time/week and 35% of uses were 2+ times/week. There was a decline in use/week. On average, high users (PMR 2+ days/week in the first month) had 4 fewer days of reported HAs in month 2 vs. month 1, whereas low PMR users (PMR < 2 days/week in the first month) had only 2 fewer HA days in month 2. PROMIS depression score was negatively associated with the log odds of using the diary at least once (vs. no activity) in a week (OR = 0.70, 95% CI = [0.55, 0.85]) and of doing the PMR at least once in a week (OR = 0.77, 95% CI = [0.68, 0.91]). PROMIS anxiety was positively associated with using the diary at least once every week (OR = 1.33, 95% CI = [1.09, 1.73]) and with doing the PMR at least once every week (OR = 1.14 [95% CI = [1.02, 1.31]). In conclusion, about half of participants used smartphone-based PMR intervention based upon a brief, initial introduction to the app. App use was associated with reduction in HA days. Higher depression scores were negatively associated with diary and PMR use, whereas higher anxiety scores were positively associated.

Smartphone‐Delivered Progressive Muscle Relaxation for the Treatment of Migraine in Primary Care: A Randomized Controlled Trial

“…A single-arm study of the feasibility of RELAXaHEAD showed that people with migraine in a tertiary care neurology practice were willing to practice PMR for up to 6 weeks and that there may be a dose-dependent relationship in the effect of the PMR. 20 In this study, we asked participants to use the app daily to assess adherence and declining rates of use, accepting that adherence might be modest based on prior literature. 20,21 Thus, we sought to conduct a 1:1 pilot randomized controlled feasibility and acceptability trial in patients with migraine in the primary care setting comparing smartphone-based PMR to monitored usual care (MUC).…”

“…20 In this study, we asked participants to use the app daily to assess adherence and declining rates of use, accepting that adherence might be modest based on prior literature. 20,21 Thus, we sought to conduct a 1:1 pilot randomized controlled feasibility and acceptability trial in patients with migraine in the primary care setting comparing smartphone-based PMR to monitored usual care (MUC). This was performed using the same RELAXaHEAD app.…”

Behavioral Therapy Preferences in People With Migraine

“…Studies comparing adherence to alternative delivery modes of behavioral therapy suggest web‐ and telephone‐based intervention modalities are feasible. In the case of migraine, there was 1 smartphone‐based behavioral therapy for migraine prevention which showed feasibility, acceptability, and that people with migraine in a tertiary care neurology practice were willing to practice the behavioral intervention for up to 6 weeks 11 . Adherence to alternative delivery modes of behavioral therapy has also been evaluated for other conditions.…”

“…New mechanisms for delivering the behavioral therapy for migraine have been evaluated recently 7-10 . Most recently, there has been the development of smartphone‐based behavioral therapy for migraine 11 . However, to our knowledge, there have not been studies on the preferences of people with migraine for the type of delivery of behavioral therapy they would pursue (in‐person, telephone based, smartphone based) or whether they would pursue it if covered by insurance or whether they had to pay for it out of pocket.…”

Psychologische Behandlungsverfahren bei Kopfschmerz

“…Die Vermittlung von PMR mittels Audiodateien über ein Smartphone (App "RE-LAXaHEAD") wurde kürzlich durch eine New Yorker Forschergruppe untersucht. Für Migränepatienten, die mindestens 2-mal pro Woche PMR-Übungen durchführten, zeigte sich eine durchschnittliche Verminderung der Migränetage um 4 Tage; bei denen, die weniger übten, waren es nur 2 Tage [88]. Neben Entspannungsübungen haben Apps das Potenzial, KVT-Komponenten anzubieten; durch anschließbare Messfühler ist auch die Umsetzung von Biofeedback möglich [70].…”