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 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.
Highlights
Migraine affects over 36 million Americans and is the second most disabling condition in life adjusted years according to the World Health Organization.1,2 Nonpharmacologic approaches such as mind–body interventions and cognitive behavioral therapy (CBT) have Grade A evidence for migraine prevention.3 These therapies are effectively free of adverse effects.3 They have enduring benefits4 and may be less costly than pharmacologic interventions.5 these nonpharmacologic treatments are vastly under-utilized for a variety of factors
1234567890():,; 2 The purpose of this study was (1) to examine whether smartphone-based, electronically delivered nonpharmacologic intervention, Progressive muscle relaxation (PMR), using the RELAXaHEAD smartphone application is feasible and acceptable for the selfmanagement of migraine in a neurology outpatient setting using both quantitative methods and qualitative methods, (2) to explore whether smartphone-based PMR might be efficacious in reducing HA days, and (3) to examine potential predictors of app and/or PMR use to aide in future HArelated mobile health studies
Mean HA days reported per month at baseline was 13 ± 8 SD, with a median of 10 HA days (IQR = 1.5) per month
Summary
Migraine affects over 36 million Americans and is the second most disabling condition in life adjusted years according to the World Health Organization. Nonpharmacologic approaches such as mind–body interventions (biofeedback and relaxation) and cognitive behavioral therapy (CBT) have Grade A evidence for migraine prevention. These therapies are effectively free of adverse effects. They have enduring benefits and may be less costly than pharmacologic interventions. these nonpharmacologic treatments are vastly under-utilized for a variety of factors. Migraine affects over 36 million Americans and is the second most disabling condition in life adjusted years according to the World Health Organization.. Migraine affects over 36 million Americans and is the second most disabling condition in life adjusted years according to the World Health Organization.1,2 Nonpharmacologic approaches such as mind–body interventions (biofeedback and relaxation) and cognitive behavioral therapy (CBT) have Grade A evidence for migraine prevention.. A prospective cohort study of outpatients seeing a HA fellowship trained and certified headache (HA) specialist found that only about half (56.6%) of the patients initiated behavioral migraine treatment. Of those who do partake in therapy, there are issues related to adherence to therapy. A recent review found few studies that attempted to assess adherence to nonpharmacologic treatments.
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