Summary: Migraine sufferers reported a decrease in the frequency of attacks, as well as improvement in anxiety and depression symptoms, following participating in progressive muscle relaxation therapy via the RELAXaHEAD smartphone app.
Source: NYU Langone Health
Migraine sufferers who used a smartphone-based relaxation technique at least twice a week experienced on average four fewer headache days per month, a new study shows.
Developed in part by researchers at NYU School of Medicine, the app, called RELAXaHEAD, guides patients through progressive muscle relaxation, or PMR. In this form of behavioral therapy, patients alternately relax and tense different muscle groups to reduce stress.
The study authors say their work, publishing in the journal Nature Digital Medicine online June 4, is the first to evaluate the clinical effectiveness of an app for treating migraine and adding an app to standard therapies (such as oral medications) under the supervision of a doctor.
“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. “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.”
Migraine affects over 36 million people in the United States. Primary symptoms include moderate to severe head pain that is often accompanied by nausea and sensitivity to light and sound. Patients are often prescribed drug treatments and behavioral therapy, but do not pursue the therapy even after a doctor’s recommendation because of the expense and inconvenience, says Minen, an assistant professor of population health and chief of headache research at NYU Langone Health. “Oftentimes they end up only taking medications,” she says.
To see if an app might increase compliance, the research team analyzed app use by 51 confirmed migraine patients at NYU Langone Health, all of whom owned smartphones. Participants were asked to use the app for 90 days and to keep a daily record of the frequency and severity of their headaches, while the app kept track of how long and often patients used PMR.
Study participants, on average, had 13 headache days per month, ranging between four and 31. Thirty-nine percent of patients in the study also reported having anxiety, and 30 percent had depression.
PMR therapy utilizing the RELAXaHEAD app dropped to 51 percent after six weeks, and to 29 percent after three months. The study authors, who anticipated a gradual decrease in the use of the app, next plan to identify potential ways to encourage more frequent sessions. They also plan to study the best ways to introduce the app into their clinical practices.
Minen says that taken as a whole, the study results suggest that accessible smartphone technologies “can effectively teach patients lifelong skills needed to manage their migraines.”
Minen was part of the team that partnered with Boston-based Irody Inc. to design and develop RELAXaHEAD, in which NYU Langone holds a financial interest. However, the app is not yet publically available.
In addition to Minen, other researchers from NYU Langone Health were Samrachana Adhikari, PhD, and Thomas Berk, MD. Other study investigators include Elizabeth Seng, PhD, and Richard Lipton both at Albert Einstein College of Medicine in New York; Sarah Jinich at Barnard College in New York; and Scott Powers, PhD, at Cincinnati Children’s Hospital.
Funding: Funding support for the study was provided by the American Academy of Neurology, the American Brain Foundation, and U.S. Department of Health and Human Services grants K23AT009706-01 and K23NS096107, and National Institutes of Health CTSI grant UL1TR001445.
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Smartphone-based migraine behavioral therapy: a single-arm study with assessment of mental health predictors
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 app-based 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.