Digitally based behavioral therapies might be favored by patients because they are low cost and convenient. As part of a study assessing whether smartphone-based biofeedback would be feasible in patients with migraine, we examined recruitment data to understand reasons for participation/non-participation in this novel migraine preventive strategy.

Evidence-based migraine preventive behavioral therapies are safe and well-tolerated with long lasting benefits.  However, adherence to these in-person treatments is poor.

From 6/2019-10/2019 we recruited for a 2-arm randomized waitlist-controlled trial of patients with ICHD3 migraine and 4-20 headache days/ month presenting to a headache center. Patients had to have a smartphone, be likely to try a smartphone-based intervention, not have done behavioral therapy for migraine in the past year and not change preventive medications during the 60-day study period. One arm received HeartMath app+Inner Balance Sensor at enrollment. The other arm received no intervention. Data on recruitment and baseline characteristics of those enrolled are reported.

There were 359/671 (54%) patients approached deemed ineligible at their headache visit. Beyond not having migraine, top reasons for ineligibility were # headache days: 128 (19%); currently doing/recently done behavioral therapy for migraine: 33 (5%); changing preventive medication: 33 (5%). Few cited technology limitations/being unlikely to try a smartphone-based intervention: 18 (3%). There were 160 patients (24%) uninterested (main reasons: time and distance from home). We met our recruitment goal N=52 of whom 88% (48) were female. Mean age was 42+13. Eight (16%) tried behavioral therapy (>1 year ago) and 17 (33%) had previously been recommended behavioral therapy but had never attended.

Reasons for non-participation in a technology-based migraine behavioral study were mainly unrelated to the technology component and were due to traditional trial related inclusion/exclusion criteria. Digital interventions may engage patients with migraine in behavioral interventions when they might not otherwise engage in them.