Use of headache apps

There is growing interest in use of mobile health tools to supplement clinical care. Yao and colleagues¹ assessed commercial headache apps on a variety of features and characteristics using the Mobile Health Index and Navigation Database (MIND). 

MIND is a publicly accessible digital app library developed by the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center. Each app is rated using 105 objective questions based on five classes within the American Psychiatric Association's app evaluation model (Accessibility, Privacy & Security, Clinical Foundation, Engagement Style, and Data Sharing Towards Therapeutic Goal).

Trained app raters used predefined search criteria to identify 48 commercially available headache apps that were evaluated using the MIND database. A control group of non-headache apps was matched for available platforms and cost.

The most common features were symptom and medication tracking

For both sets of apps 90% were totally free to use with two-thirds available on each of IOS and android platforms. For the 48 headache apps the most common features were symptom tracking (67%), medication tracking (63%), journaling (33%), and psychoeducation (29%). Just under half (46%) could email or export data, 15% allowed collaboration with a healthcare provider, and 4% facilitated peer support. The authors highlighted certain features that were generally lacking including crisis management tools (0%) Health Insurance Portability and Accountability Act compliance (2%), and evidence-based feasibility/efficacy studies (6%). No results were presented regarding comparison with the non-headache apps.

The authors concluded that headache apps could offer useful insights for clinicians into patients’ symptoms and effectiveness of treatments. This will require further development in areas such as protection of personal health information. Interestingly, many of the commercial apps were not developed in conjunction with healthcare providers or through academic institutions.

Useful insights for clinicians into patients’ symptoms and effectiveness of treatments

Impact of preventive treatment on quality of life

Sulaiman and colleagues² presented real-world evidence of impact on health-related quality of life (HRQoL) for therapy-resistant patients with migraine. Their single-centre observational study compared monoclonal antibody preventive treatment with no/other preventive treatment at baseline (T0) and 1 month follow-up (T1) after treatment initiation. Outcome measures included migraine days and a range of validated patient-reported outcomes (PROs).

The study included 103 patients, with 83 (79.6%) receiving monoclonal antibody treatment, 12 (11.7 %) another preventive treatment, and 9 (8.7%) no treatment.The antibody group was approximately 2.4 times more likely to show improvement in the number of migraine days, but this was not statistically significant, and the control group reported a lower number of migraine days at T0 than the antibody group. Similarly, the antibody group appeared to be overrepresented in the medium/high improvement category (in terms of migraine days) when compared to the control group, but Pearson residuals were non-significant. Overall, there was a positive effect on some domains of the PROMIS-29 score at T1 that was associated with a reduced number of migraine days and an increased EQ5DVAS score.

To validate the benefit on HRQoL a larger control group and longer follow-up period were required

The authors concluded that preventive treatment with monoclonal antibodies resulted in a reduction in migraine days and an improvement in certain PROs, but to validate the benefit on HRQoL a larger control group and longer follow-up period were required.