January 11, 2019
The main objection among clinical researchers is that commercially developed products often lack a scientific basis for their selection of features.
Over the past several years, the development of mobile and wearable health technology for a wide range of conditions rapidly advanced as the use of smartphones spread around the globe to an estimated 5 billion users. With more than a billion people worldwide reported to have headache complaints as of 2015, the burden of this disease marked it as an important target for mobile health technology early on.1,2 Recent reviews, however, have found that available technology has yet to fulfill its early promise.1,3,4
Headache, particularly migraine, is a disorder that lends itself to the application of mobile health apps for a number of reasons:1
1. The common and often chronic nature of headache leads many patients to seek opportunities for self-management;
2. The availability of on-the-spot resources and self-administered behavioral interventions; and
3. Easy access to smart phones by the majority of people in both developed and developing nations.
As of 2016, an estimated 265,000 mobile health applications (apps) were made available on the internet by 45,000 companies worldwide. Despite this enormous array of potentially viable products, in 2014, Hundert, et al5 reported that their review “demonstrated the lack of quality headache diary apps available to consumers.” They assessed the 3 highest scoring apps of that year:
· iHeadache®, developed by Better QOL for iOS, was deemed superior due to a development team that included scientific/clinical headache expertise. They claim that it captures clinically relevant data while eliminating nonessential information.
· ecoHeadache (also called Headache Diary), developed by ecoTouchMedia for iOS, was found to track 13 headache variables, many of which were deemed medically unessential. This app is not currently being offered on the company website.
· Headache Diary Pro, an Android-based app developed by Froggyware. This app was found to be less usable compared with competing apps despite being the best-selling app for Android users.
The main objection among clinical researchers is that commercially developed products often lack a scientific basis for their selection of features. The Hundert study5 reported that only 18% of the 38 apps evaluated were created with scientific or clinical headache expertise and none provided data on psychometric properties of headache. A meta-analysis by Mosadeghi-Nik, et al3 2 years later reported similarly disappointing findings, noting that “despite the availability of numerous mobile apps for headache disorders, the evidence base to support their effectiveness and clinical safety is weak.”
More recent offerings, including the Migraine Buddy and the Curelator apps, appear to be overcoming some of the initial hurdles to providing greater medical utilization.
Migraine Buddy uses a smartphone sensor to collect movement and sleep data in addition to what the user inputs. This app claims to have used the expertise of clinical neurologists and data scientists in the development of its headache diary and tracking program, which has made it the current favorite for patients with migraine.
The Curelator N1-Headache® app was developed through collaborative input from patients, providers, and health organizations such as the National Headache Foundation to more clearly identify potential migraine triggers for an individual user. This product is unique in its power as a clinical research tool. In addition to tracking medication use and migraine activity, the app asks for daily input of environmental and lifestyle information over a 90-day period to create a more comprehensive picture of individual migraine patterns.
According to Peter McAllister, MD, medical director at the New England Institute for Neurology and Headache and chief medical officer at the New England Institute for Clinical Research and Ki Clinical Research in Stamford, Connecticut, apps already have a limited place in clinical practice. “Mobile apps can be very useful to track headache days, as studies have shown that patients tend to underestimate the number of headache days they’re actually having,” he told Neurology Advisor. Dr McAllister frequently recommends Migraine Buddy and iHeadache to his patients with headache.
Future Goals for Headache App Technologies
Many of the apps in development a few years ago are no longer available or may have morphed into new products. As the commercial device field is not regulated by the clinical research universe, validation of these products does not yet exist. To bridge this gap, researchers have put together wish lists of what the medical community would like to see from technology in the near future to make it truly effective in the clinical management of headache and migraine.
The Mosadeghi-Nik review outlined several critical criteria for mobile health apps to meet in order to be clinically useful:3
1. The capability for patients to record clinically important data, including headache characteristics and triggers, which can be stored and uploaded to the cloud to be shared for future research;
2. The provision of important resources and guidelines for headache management and prevention, with the capacity for patient feedback;
3. Interactive features that allow the patient’s clinician to access the data and monitor patient status;
4. A web-based database repository for optional sharing of the data collected; and
5. Medication management capabilities.
Although current usage of mobile health apps for headache is limited in clinical situations, there appears to be a general sense of optimism about the potential for mobile apps to significantly improve the quality and scope of care for people with frequent headache.
1. Stubberud A, Linde Mattias. Digital technology and mobile health in behavioral migraine therapy: a narrative review. Curr Pain Headache Rep. 2018;22:66.
2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545-1602.
3. Mosadeghi-Nik M, Askari MS, Fatehi F. Mobile health (mHealth) for headache disorders: A review of the evidence base. J Telemed Telecare. 2016;22:472-477.
4. Minen MT, Torous J, Raynowska J, et al. Electronic behavioral interventions for headache: a systematic review. J Headache Pain. 2016;17:51.
5. Hundert AE, Huguet A, McGrath PJ, Stinson JN, Wheaton M. Commercially available mobile phone headache diary apps: a systematic review. JMIR Mhealth Uhealth. 2014;2(3): e36.