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 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.

Keywords: Medical research; Neurology.

Fig. 1

NYU-migraine participants enrolled from 7 July 2017 to 12 April 2018

Fig. 2

Weekly diary and PMR use. Boxplots of distribution of number of days the diary was used (top figure) and the PMR was used (bottom figure), every week for participants enrolled in the study. For each boxplot, the solid dark center line represents the median, the bounds of the box are given by the first quartile (Q1) and the third quartile (Q3), and the whiskers are bounded by (Q1 − 1.5 × IQR, Q3 + 1.5 × IQR). The points outside the whiskers are the outliers. The median number of days used per week has a decreasing trend over weeks since enrollment, for both diary use and PMR use

Fig. 3

Headache days reported per week. Boxplots of distribution of headache days reported each week since enrollment for participants who used the diary in the corresponding week. Week 0 is the week of enrollment. For each boxplot, the solid dark center line represents the median, the bounds of the box are given by the first quartile (Q1) and the third quartile (Q3), and the whiskers are bounded by (Q1 − 1.5 × IQR, Q3 + 1.5 × IQR). The points outside the whiskers are the outliers

Fig. 4

Difference in headache days between months one and two in high and low users. The first display in the left shows the observed difference in headache days reported by each user, whereas that in the right shows the imputed difference. Users are categorized as high users if their weekly PMR use is two or more days, and as low users otherwise. Along the x axis is the difference in headache days, and along the y axis is whether the weekly PMR use is greater than or equal to 2 days