Smartphone app for muscle relaxation reduces migraine disability in ED patients

A smartphone app for muscle relaxation significantly reduced migraine-related disability in patients visiting the emergency department, a new study shows.

Led by researchers from NYU Langone Health, the study featured a smartphone-based app that guides patients with migraine through progressive muscle relaxation (PMR), an evidence-based treatment for migraine in which patients tense and then relax one muscle group at a time.

Published online October 16 in JAMA Network Open, the work shows that the percentage of patients who had at least a five-point improvement in a standard score of migraine-driven disability nearly doubled for those who used the app versus those who did not. The study used the Migraine Disability Assessment Score (MIDAS), a questionnaire that asks about the number of days over three months that migraine caused a person to miss work, school, or social events.

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."

Mia T. Minen, MD, MPH, lead study author, associate professor in the Departments of Neurology and Population Health, NYU Grossman School of Medicine

Migraine consists of painful, recurrent attacks that can last for hours or days, often with nausea, vomiting, or sensitivity to light or sound. It affects more than 14 percent of people globally and is a frequent cause of repeated emergency department (ED) visits, say the study authors. Nearly half (46 percent) of patients discharged from the ED with a migraine diagnosis revisit the ED within three months.

"The RELAXaHEAD app is meant to reduce migraine disability and hopefully reduce the rate at which patients return to the emergency department for migraine," added Dr. Minen, director of headache research at NYU Langone.

Better the more it is used

This clinical trial involved 69 participants aged 18 to 65 who visited NYU Langone Health's EDs for migraine between 2019 and 2021. Participants were randomly assigned to use either the RELAXaHEAD app with progressive muscle relaxation (PMR) or to be in a control group that used only a headache diary.

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

"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," said Dr. Minen. Moving forward, her team is conducting a large-scale clinical study funded by the National Institutes of Health to evaluate the study app for people with migraine, not in EDs but instead in primary care settings, where such patients most often present for care.

Along with Dr. Minen, study authors were Elizabeth Seng of Ferkauf of the Graduate School of Psychology at Yeshiva University; Benjamin Friedman in the Department of Emergency Medicine at Albert Einstein College of Medicine; Richard Lipton in the Department of Neurology at Albert Einstein College of Medicine; Alexis George in the doctoral program in psychology at City University of New York, Kristina Fanning and Ryan Bostic of MIST Research and Statistical Consulting, and Scott Powers in the Department of Pediatrics at Cincinnati Children's Hospital. This research was supported by National Institutes of Health grants NCCIH K23 AT009706 and NIH NCATS UL1 TR001445.

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.