To improve access and outcomes, we assessed the feasibility and acceptability of a smartphone application (app) based Progressive Muscle Relaxation (PMR) intervention for the self-management of migraine in  primary care.  

PMR is an under-utilized Level A evidence-based treatment for migraine prevention, rarely available in primary care.

We randomized adults with migraine with 4+ headache days/month who owned a smartphone into one of two groups: Group 1 received the app with only a headache diary and Group 2 received the app with a headache diary + PMR. The latter group was asked to do PMR up to 20 minutes/day. Outcomes included satisfaction levels and adherence to the PMR intervention (frequency and duration), frequency of diary entries. Exploratory outcomes included change in headache days and change in the Migraine Disabling Assessment (MIDAS) scale scores.

Of the 139 patients (77 PMR, 62 placebo), 83% were female, mean age was 41.7 ± 12.8 years.  Most were disabled by their migraine (MIDAS 53% severe, 25% moderate disability).  PMR was played for 19+1 days out of 90-days. Mean per session duration was 11+8 minutes.  For the first 6 weeks, participants did PMR 2-4 days/week but adherence declined thereafter. When comparing weekly headache days reported in PMR versus control arms, we observed 3 fewer headache days in the PMR arm (p = 0.45).  Relative to the diary only group, the PMR group showed a greater decline in MIDAS scores that was not statistically significant  (-22.8 vs. -8.7, P=0.1). However, mean effect size showed a moderate change (cohen’s d=0.38, p=0.98).

Preliminary data suggests that smartphone delivered PMR may be an acceptable, accessible form of evidence-based therapy for migraine that can be offered in primary care. Future work should revise the app to improve adherence and assess larger sample sizes measuring efficacy outcomes.