Can a Smartphone App Help Manage Migraines?

A new Smartphone application (app) can reduce headache (HA) days in patients with migraines, according to study authors who published their findings in Nature Digital Medicine. The app was developed by researchers at NYU School of Medicine and is called RELAXaHEAD. Progressive muscle relaxation (PMR) is an effective yet under-utilized treatment for migraines. The researchers sought to examine if RELAXaHEAD might mitigate HA occurrences while evaluating potential predictors of app/and or PMR use. To conduct this study, they recruited 51 patients (94% female, mean age, 32) between July 7, 2017 and April 12, 2018 to participate in a single-arm pilot study. More than half of participants (63%) had severe migraine disability at study baseline. The population of interest was required to have ICHD3 migraines with at least four HA days per month. They were also required to possess a smartphone and have no prior behavioral migraine therapy in the past year. The study predictors included baseline demographics, HA-specific variables, baseline patient-reported outcomes measurement information system (PROMIS), depression and anxiety scores, overlapping pain conditions, and app satisfaction scores at the beginning of enrollment. The researchers asked participants to maintain a daily HA diary while performing PMR for 20 minutes a day over the duration of 90 days.  Subsequent to being taught how to use the app and following one PMR session, the participants were prompted to complete a satisfaction survey to discern the app’s usability. Those scores indicated that participants found the app kept their attention, was easy to use, and relevant to their condition.

A Reduction in Headaches

Results of the study suggest positive efficacy as participants who were high app/PMR users (PMR 2+ days/week in the first month) reported four fewer HA days in month two versus month one, whereas low app/PMR users (PMR for less than two weeks/week in the first month) had only two fewer HA days by the second month. Moreover, PROMIS depression scores were negatively correlated with the log odds of using the diary at least once (compared to no activity) in a week (OR=0.70; 95% CI, 0.55 to 0.85) and of participating in PMR at least once in a week (OR=0.77; 95% CI, 0.68 to 0.91). Furthermore, PROMIS anxiety was positively linked to using the diary at least once per week (OR=1.33; 95% CI, 1.09 to 1.73) and with doing the PMR at least once every week (OR=1.14; 95% CI, 1.02 to 1.31) “In conclusion, about half of participants used smartphone-based PMR intervention based upon a brief, initial introduction to the app,” the authors wrote. “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.” “Our study offers evidence that patients may pursue behavioral therapy if it is easily accessible, they can do it on their own time, and it is affordable,” says study senior investigator and neurologist Mia Minen, MD, MPH, in a press release. “Clinicians need to rethink their treatment approach to migraine because many of the accepted therapies, although proven to be the current, best course of treatment, aren’t working for all lifestyles.” Minen added that accessible smartphone technologies “can effectively teach patients lifelong skills needed to manage their migraines.”