Referral Notes:

  • RELAXaHEAD, a smartphone-based muscle relaxation program, aims to reduce migraine-related disability.
  • In a randomized controlled trial involving 69 participants presenting to the ED with migraine, 82.4 percent who used the app over three months had at least a five-point improvement in MIDAS score, compared with 45.7 percent in the control group.
  • The app has also been studied in neurology and primary care settings and, with further validation, has the potential for broad implementation across clinical settings.

A smartphone-based relaxation program reduced migraine-related disability in patients visiting the emergency department (ED) for headache, according to new research published in JAMA Network Open.

Led by researchers at NYU Langone Health, the study tested whether an electronically delivered progressive muscle relaxation (PMR) self-management program, offered to patients with migraine after ED discharge, yielded clinically meaningful reductions in migraine-related disability.

This was the first randomized controlled trial that evaluated a migraine preventive treatment in patients who presented to the ED, and one of the few trials assessing a migraine behavioral therapy in patients visiting the ED.

“Our findings highlight the potential of smartphone-based interventions to empower patients in managing their own migraine.”

Mia T. Minen, MD, MPH

“Our findings highlight the potential of smartphone-based interventions to empower patients in managing their own migraine, and in reducing migraine-related disability without medication,” says lead study author Mia T. Minen, MD, MPH, an associate professor in the Departments of Neurology and Population Health and director of headache research at NYU Langone.

Smartphone-Based PMR Intervention

RELAXaHEAD is a migraine-specific smartphone app that includes an electronic headache diary and guides patients through PMR, an evidence-based treatment in which patients tense and then relax one muscle group at a time.

PMR is a standardized mind-body intervention that has been used for migraine since the 1980s. To enable electronic delivery of PMR, the app was iteratively developed by Dr. Minen and her colleagues, and its performance evaluated in multiple clinical settings.

“The RELAXaHEAD app is meant to reduce migraine disability and hopefully reduce the rate at which patients return to the ED for migraine,” explains Dr. Minen. Research shows that nearly half of patients discharged from the ED with a migraine diagnosis revisit the ED within three months.

Better the More It’s Used

The clinical trial involved 69 participants aged 18 to 65 who visited NYU Langone’s EDs for migraine between 2019 and 2021. Study participants were randomly assigned to either use the RELAXaHEAD app’s PMR features or to a control group that used the app only as a headache diary. Over the course of three months, participants were asked to use the app for 10 to 15 minutes daily.

The number of study patients who had at least a five-point improvement in Migraine Disability Assessment (MIDAS) score was 45.7 percent among those without the PMR and 82.4 percent with PMR. The researchers also found that those who used PMR more frequently experienced better outcomes, suggesting a dose-response relationship.

However, there was no significant difference in secondary outcomes—migraine-specific quality of life or monthly headache days.

“The findings are impressive, especially compared with pharmacologic studies with MIDAS as a primary outcome.”

“While the study did not find significant differences in the number of monthly headache days, the PMR group’s improvement in disability is really meaningful,” says Dr. Minen. “The findings are impressive, especially compared with pharmacologic studies with MIDAS as a primary outcome.”

Expanding Beyond the ED

Moving forward, Dr. Minen and her team are conducting a large-scale clinical study funded by the NIH to evaluate the smartphone app for people with migraine in primary care settings, where these patients most often present for care.

“Extension of the current study can potentially bridge gaps in other care settings,” Dr. Minen says, “and may lead to improvements in healthcare delivery for patients with migraine.”

Disclosures

Dr. Minen has financial interests in the app and its RELAXaHEAD underlying intellectual property, which has been licensed to CareTurner. These interests could benefit from the outcome of this study and are managed according to the policies of NYU Langone Health.