Minen MT, et al. Smartphone delivered progressive muscle relaxation (RELAXaHEAD) for the treatment of migraine in primary care: A pilot randomized controlled study. Presented at: American Headache Society Annual Meeting; June 15-30, 2020 (virtual meeting).
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The smartphone app RELAXaHEAD, which consists of progressive muscle relaxation therapy assistance and an electronic headache diary, reduced headache days in patients with migraine, a pilot randomized controlled trial showed.
The study was presented during the virtual American Headache Society Annual Scientific Meeting.
Few patients with migraine use behavioral therapies recommended by the United States Headache Consortium for migraine prevention, Mia T. Minen, MD, MPH, chief of headache research and associate professor of neurology at NYU Langone Health, told Healio Primary Care.
Mia T. Minen
“Few practitioners trained in these modalities are aware that they are evidence-based for migraine prevention,” she said. “In addition, providers do not know how to find other providers trained in them. Few behavioral health providers know they can be billed under health and behavior codes with a migraine diagnosis, and these treatments require time, since traditionally patients go to a behavioral health provider for eight to 12 sessions.”
Progressive muscle relaxation teaches patients to relax through muscle exercises and controlled breathing, according to the American Headache Society. Minen said that this particular behavioral therapy is the “easiest one” to create an app that supports the therapy’s use.
The researchers randomly assigned 139 patients from two primary care practices who had at least 4 migraine days per month and owned a smartphone to use RELAXaHEAD or a headache diary alone for 3 months. The mean age of participants was 41.7 years, 83% were women and 53% had severe Migraine Disability Assessment Questionnaire (MIDAS) scores.
Minen and colleagues reported that there were 3 fewer headache days among the 77 patients who used the app vs. the 62 patients who did not. The app users said the app was “satisfactory” and “easy to use” (mean Likert scale, 4.2 out of 5) and that they would be “happy” to use progressive muscle relaxation therapy again (mean Likert scale, 4.3 out of 5).
Although patients performed progressive muscle relaxation therapy 2 to 4 days weekly for the first 6 weeks of the study, adherence tapered off to levels that approached the 62 patients who only kept a diary (P = 0.45), according to the researchers. The progressive muscle relaxation therapy group showed a greater decline in MIDAS scores, but the difference was not statistically significant (P = 0.1).
Still, Minen encouraged primary care physicians to recommend behavioral therapies for migraine prevention.
“They are safe, effective and with long-lasting benefits,” she said. “They can work alone, and when combined with medications, there is not just an additive benefit, but a synergistic one.”
The study authors recommended that future research evaluate ways to improve adherence to the app and to measure efficacy outcomes in larger sample sizes.