LAUSR

Background Progressive muscle relaxation (PMR) has level A evidence in preventing migraine and tension-type headaches. However, there is limited research on behavioral therapy for post-traumatic headache (PTH) let alone delivered via a smartphone application. Aims/objective To gain preliminary evidence as to whether smartphone based PMR is feasible for subjects with PTH. Method(s) We performed a single-arm study of prospective patients calling our Concussion Center between June 2017 and May 2018. Subjects met ICHD-3 criteria for persistent headache secondary to mTBI, were age 18–85 and 3–12 months post injury, with no prior behavioral treatments for headache in the past year. We assessed prior and current headache and neuropsychologic histories. Using the RELAXaHEAD smartphone application, subjects were instructed to record headache symptoms daily and practice 20 minutes of PMR daily. There was a 1-month follow-up assessment. Results In our ongoing study, 21 subjects are currently enrolled, 13 female (62%) with mean age 41.4 (SD 13.1, range 20–65). Nine (43%) subjects had pre-existing headaches. Subjects' injuries were on average 6 months prior to enrollment (SD 2.6, range 4–12). Three (14%) were sports-related. In the month prior to enrollment, subjects reported 19.3 headache days (SD 8.76, median 20, range 5–30). 17 (81%) subjects reported memory problems and 18 (86%) reported impaired concentration. Of 17 subjects enrolled for at least 1 month, 9 (53%) imputed data for 20 or more days within the first month (mean 17 days, SD 12.2, median 20, range 0–31). 4 (24%) practiced PMR 2 + times/wk (mean 8.4 days, SD 8.6, median 6, range 0–31). Conclusion PTH subjects' obstacles regarding adherence to mHealth technology should be further assessed before PMR efficacy can be assessed. Notably, many subjects concurrently reported difficulties with memory and concentration, which may be contributing to poor adherence. Future work will attempt to assess for differences among users vs non-users.