Abstract Details

Title Randomized Controlled Trial of a Smartphone-based Preventive Migraine Self-management Program in the Emergency Department Setting: A Promising Teachable Moment

Topic Headache

Presentation(s) S22 - Advances in Migraine and Therapeutics (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Background

The emergency department (ED) is a critical point of contact with the healthcare system for many patients with migraine and an opportunity to initiate accessible nonpharmacologic migraine treatment.

Objective We examined whether a smartphone self-management progressive muscle relaxation (PMR) based therapy improved patient-centered outcomes for migraine compared to enhanced usual care (EUC).

Design/Methods

We conducted a randomized controlled trial of the smartphone application RELAXaHEAD with and without PMR in patients who visited the ED for headache and met migraine criteria. We collected follow-up data on our primary outcomes (migraine-related disability (MIDAS), migraine-related quality of life (MSQv2), and monthly headache days (MHDs)).

Results Of the 94 patients (Control (n=48); PMR (n=46)), 69/94 (73%) had baseline MIDAS and >1 follow-up MIDAS score. MIDAS mean change scores differed for the two groups (Control =6.86 and PMR -25.09, p=0.007). There was a statistically significant difference in the number of respondents improving by >5 MIDAS points for PMR vs. Control (PMR 28/34 (82.4%), Control 16/35 (45.7%), p=0.002) and in the number of respondents improving by ≥10 MIDAS points, with (PMR 21/34 (61.8%), Control 13/35 (37.1%), p=0.041). This effect persisted in Logistic Regression Models, including baseline MIDAS scores. The MSQv2, Role function preventive, and Emotional function change scores were higher among PMR (n=34) than Control (n=35) with PMR 16.9 vs. Control 11.3 and PMR 26.5 vs. Control 19.8, respectively. In the 51% (48/94) of participants with three-month follow-up MHD data, PMR (n=23) had a -2.9±8.0 mean MHD change, and control (n=25), a mean MHD change of -1.6±6.5, p=0.533.

Conclusions A PMR-based self-management program yielded substantial clinically significant results in reducing migraine-related disability and a clinically though not statistically significant decrease in MHDs. Future work should examine how to implement this treatment into the ED workflow and make it more accessible to patients.

Authors/Disclosures
Mia T. Minen, MD, FAAN (NYULMC Neurology) PRESENTER	The institution of Dr. Minen has received research support from NIH. Dr. Minen has received intellectual property interests from a discovery or technology relating to health care. Dr. Minen has received personal compensation in the range of $500-$4,999 for serving as a First Contact-Primary Care Advisory Board Member with American Headache Society . Dr. Minen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PCORI grant on migraine evidence based map for stakeholders with ECRI .
Elizabeth Seng, PhD (Yeshiva University, Albert Einstein College of Medicine)	Dr. Seng has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Seng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Click Therapeutics. The institution of Dr. Seng has received research support from NINDS.
Benjamin Friedman	No disclosure on file
Alexis George (NYU Langone Health)	Ms. George has nothing to disclose.
Kristina M. Fanning, PhD (MIST Reserach)	The institution of Kristina Fanning has received research support from Abbvie. The institution of Kristina Fanning has received research support from NYC Langone Health . The institution of Kristina Fanning has received research support from Allay Lamp. The institution of Kristina Fanning has received research support from Juva Health.
Ryan Bostic (MIST Research INC)	No disclosure on file
Scott Powers, PhD (Cincinnati Children's Hospital)	Scott Powers, PhD has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Theranica. The institution of Scott Powers, PhD has received research support from NIH. The institution of Scott Powers, PhD has received research support from PCORI. Scott Powers, PhD has a non-compensated relationship as a Associate Editor with The Journal HEADACHE that is relevant to AAN interests or activities. Scott Powers, PhD has a non-compensated relationship as a Member Board of Directors with American Headache Society that is relevant to AAN interests or activities.
Richard B. Lipton, MD, FAAN (Albert Einstein College of Medicine)	Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biohaven. Dr. Lipton has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GlaxoSmithKline. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vedanta. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Grifols. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axon. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Satsuma. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cool Tech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BDSI. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Lipton has stock in Biohaven. Dr. Lipton has stock in Manistee. Dr. Lipton has stock in Axon. Dr. Lipton has stock in CoolTech. The institution of Dr. Lipton has received research support from Teva. The institution of Dr. Lipton has received research support from Amgen. The institution of Dr. Lipton has received research support from Allergan/Abbvie. The institution of Dr. Lipton has received research support from Gammacore. The institution of Dr. Lipton has received research support from Axsome. The institution of Dr. Lipton has received research support from Charleston Labs. The institution of Dr. Lipton has received research support from Eli Lilly. The institution of Dr. Lipton has received research support from Satsuma. The institution of Dr. Lipton has received research support from NIH . The institution of Dr. Lipton has received research support from Veterans Administration. Dr. Lipton has received publishing royalties from a publication relating to health care.