Department of Neurology, NYU Langone Medical Center, New York, New York, USA.
J Neurotrauma. 2021 Jan 1;38(1):94-101. doi: 10.1089/neu.2019.6601. Epub 2020 Aug 26.
Persistent post-traumatic headache (PPTH) is often the most common injury after mild traumatic brain injury (mTBI), reported by 47-95% of patients. Progressive muscle relaxation (PMR) has level A evidence in preventing migraine and tension headaches. However, research on this behavioral therapy for PPTH, let alone smartphone delivered, is limited. We performed a single-arm study of prospective patients calling our Concussion Center between June 2017 and July 2018. Inclusion criteria were that subjects had to meet International Classification of Headache Disorders, 3rd Edition criteria for PPTH secondary to mTBI, have four or more headache days a month, be age 18-85 years and 3-12 months post-injury, own a smartphone, and not tried headache behavioral therapy within the year. We recorded baseline headache and neuropsychiatric data. Using the RELAXaHEAD smartphone application, which has a headache diary and PMR audio files, participants were instructed to record headache symptoms and practice 20 min of PMR daily. There were three monthly follow-up assessments. There were 49 subjects enrolled. Basic demographics were: 33 (67%) female with mean age 40.1 ± 14.6 [20, 75] years. Of the 49 subjects, 15 (31%) had pre-existing headaches. In 11 (22%) subjects, mTBI was sports related. Subjects reported 17.7 ± 9.3 [4, 31] headache days in the month before enrollment, and 49 (100%) experienced over three concussion symptoms. Participants inputted data in the RELAXaHEAD app on average 18.3 ± 12.0 days [0, 31] the first month. Number of participants who did PMR over four times per week was 12 (24.5%) the first month, 9 (22.5%) the second month, and 6 (15%) the third month. After 3 months, 17 (42.5 %) participants continued doing PMR. Participants cited time constraints, forgetfulness, application glitches, and repetitiveness as obstacles to practicing PMR. It is feasible to get PPTH subjects to practice behavioral therapy through low-cost smartphone-based PMR two times weekly. Future work will assess efficacy and examine how to optimize barriers to PMR.
持续性创伤后头痛（PPTH）是轻度创伤性脑损伤（mTBI）后最常见的损伤，有 47-95%的患者报告存在这种损伤。渐进性肌肉放松（PMR）在预防偏头痛和紧张性头痛方面具有 A 级证据。然而，针对 PPTH 的这种行为疗法的研究，更不用说通过智能手机进行的研究，是有限的。我们对 2017 年 6 月至 2018 年 7 月期间拨打我们脑震荡中心电话的前瞻性患者进行了一项单臂研究。纳入标准是受试者必须符合国际头痛疾病分类，3 版标准，继发于 mTBI 的 PPTH，每月头痛天数≥4 天，年龄 18-85 岁，受伤后 3-12 个月，拥有智能手机，并且在一年内未尝试过头痛行为疗法。我们记录了基线头痛和神经精神病学数据。使用 RELAXaHEAD 智能手机应用程序，该程序具有头痛日记和 PMR 音频文件，参与者被指示记录头痛症状并每天练习 20 分钟 PMR。有三次每月随访评估。共纳入 49 名受试者。基本人口统计学特征为：33 名（67%）女性，平均年龄 40.1±14.6[20，75]岁。在 49 名受试者中，15 名（31%）有既往头痛。在 11 名（22%）受试者中，mTBI 与运动有关。受试者在入组前一个月报告了 17.7±9.3[4，31]天的头痛，49 名（100%）经历了超过 3 项脑震荡症状。参与者在 RELAXaHEAD 应用程序中输入数据的平均天数为第一个月 18.3±12.0 天[0，31]。第一个月有 12 名（24.5%）参与者每周进行 4 次以上 PMR，第二个月有 9 名（22.5%），第三个月有 6 名（15%）。3 个月后，17 名（42.5%）参与者继续进行 PMR。参与者提到时间限制、健忘、应用程序故障和重复性是进行 PMR 的障碍。通过基于智能手机的 PMR 每周两次，让 PPTH 患者进行行为治疗是可行的。未来的工作将评估疗效，并研究如何优化 PMR 的障碍。
