App-based relaxation technique cuts migraine-related disability

Teaching patients the progressive muscle relaxation (PMR) technique after discharge from the emergency department (ED) for a migraine attack appears to help reduce related disability.

The progressive muscle relaxation intervention is delivered via a smartphone application. It contains audio files that guides patients through a 5-min deep-breathing session, a 6-min PMR session (brief), a 12.5-min PMR session (full), and an 8.5-min muscle scan session. The app also requires the patients to complete a daily symptom-based reporting diary.

In a randomized clinical trial, 94 adult patients (median age 33 years, 82.6 percent female) with self-reported migraine days of ≥4 per month who were visiting an ED for a migraine attack were allocated to either the intervention (n=46) or the control (n=48) group. Those in the intervention group were instructed to listen to the app-based audio files for 60 days, while those in the control group were asked to use the app as a symptom diary. All patients were followed for up to 3 months.

After the intervention, the primary outcome of migraine-related disability at 3 months was significantly lower in the intervention group, with the MIDAS scores decreasing by a mean of −25.1 points and increasing by 6.9 points in the control group (p=0.01). [JAMA Netw Open 2025;8:e2534221]

Significantly more patients in the intervention group achieved a clinically meaningful change in MIDAS score (reduction of ≥5 points) compared with those in the control group (82.4 percent vs 45.7 percent; p=0.002).

Results for the secondary outcomes, such as migraine-specific quality of life (MSQ) and monthly headache days, at 30 days did not significantly differ between the two groups. Scores across all domains of the MSQv2 (role function preventive, emotional function, role function restrictive) were only nominally improved for patients in the intervention group vs those in the control group. Monthly headache days decreased by 2.9 vs 1.6 days, respectively.

“The improvements in MIDAS [score] in the intervention group compared with the control group persisted after adjusting for anxiety and depression,” the investigators said.

They emphasized that the findings are impressive, especially compared with pharmacologic studies with MIDAS as a primary outcome and considering the limited app engagement by patients. [J Headache Pain 2022;23:46; J Headache Pain 2023;24:30; Adv Ther 2021;38:5465-5483; Eur J Neurol 2021;28:1716-1725; Lancet 2019;394:1030-1040]

Analysis of app engagement revealed that patients spent approximately 6 fewer minutes per session. Furthermore, the number of days of diary use was higher for the control group compared with the intervention group over the 12-week study period, which the investigators said was likely due to the greater time and effort required to interact with the app in the intervention group.  

“Progressive muscle relaxation is a grade A, evidence-based treatment for migraine prevention… Our results support the ED visit as a feasible method for … instituting methods to reduce headache-related disability,” they said.