TOPLINE:

A smartphone-based progressive muscle relaxation (PMR) program offered to patients with migraine visiting the emergency department yielded significant improvements in migraine-related disability scores compared with usual care.

METHODOLOGY:

• Researchers conducted a parallel, randomized clinical trial of 94 adults (age, 18-65 years) who presented to the New York University Langone Health emergency department between June 2019 and October 2021 with four or more migraine days per month and a Migraine Disability Assessment Scale (MIDAS) score > 5.
• Participants were randomly assigned (1:1) to either the PMR group or the control group. The control group used the app only as a daily symptom diary, whereas the PMR group used the RELAXaHEAD app, which included a symptom diary and guided relaxation practiced 10-15 minutes daily for at least 60 days.
• The modified intention-to-treat analysis included 69 participants (median age, 33 years; 82.6% women) who had at least one follow-up evaluation.
• The primary outcome was the change in MIDAS scores from baseline to 3 months. Secondary outcomes included migraine-specific quality of life and the number of monthly headache days.

TAKEAWAY:

• PMR users showed greater improvement in MIDAS scores than patients who did not use PMR (mean change, −25.1 vs 6.9 points; P = .01).
• A significantly higher proportion of patients who used PMR achieved at least a five-point improvement in MIDAS scores than those who used a control symptom diary (82.4% vs 45.7%; P = .002). The odds of achieving this improvement were over 10 times higher among PMR users (odds ratio, 10.63; P < .001).
• Higher PMR usage was associated with greater improvement, with 90% of participants with high PMR use achieving at least a five-point improvement in MIDAS scores compared with 71.4% of those with low PMR use and 45.7% of those who used a control symptom diary (P = .001).
• No significant differences were found in migraine-specific quality of life or monthly headache days.

IN PRACTICE:

"In this randomized clinical trial, smartphone-based relaxation offered to patients who visit the ED with migraine was associated with reduced migraine-related disability," the authors wrote. "Our results support the ED visit as a feasible method for recruiting patients with migraine for trials and instituting methods to reduce headache-related disability." 

SOURCE:

The study was led by Mia T. Minen, MD, MPH, NYU Langone Health, New York City. It was published online on October 16, 2025, in JAMA Network Open.

LIMITATIONS:

The study was constrained by its modest sample size and significant participant attrition. PMR sessions were only counted when recorded through the app's analytics, potentially underestimating actual usage. Additionally, changes in preventive medications during the study period were not tracked.

DISCLOSURES:

The study was supported by grants from the National Center for Complementary and Integrative Health and the National Center for Advancing Translational Sciences. Minen reported receiving support from Irody, which was paid to institutions outside the submitted work, and owning an app licensed to Irody. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.