Health enSuite is a suite of applications designed by our research team at the Centre of Research in Family Health at IWK Health. These applications evaluate virtual solutions for clinical problems and assist family doctors with their adult patients. Health enSuite will be utilized by Canadian family physicians targeting insomnia, anxiety, migraine headache, and caregiver distress. Health enSuite Migraine has been designed to make cognitive and behavioral techniques for managing migraine headache readily available to primary care patients. The online program combines treatment elements that are effective in preventing and managing migraine headache pain, including trigger management, stress management, relaxation techniques, cognitive reappraisal, and psychoeducation.
Headaches are highly prevalent among Canadians and many people visit their primary care provider due to headache symptoms. Headaches can be classified based on frequency (acute, episodic, chronic) and symptom presentation (migraine headache, tension-type, cluster, etc.). Headaches are of concern to many people as the World Health Organization (WHO) has reported that in 2016, more than half of people around the world between 16-65 years old reported having headaches. Up to 70% of individuals experience tension headaches, and 8.3% of Canadians are affected by migraine headache. Headache symptoms can last a few hours to several days and are debilitating as they cause significant pain and distress. Headaches can also negatively impact one's life as they cause problems related to work performance and/or school activities (i.e., not being able to complete an assignment or project on time). People who seek medical attention from their primary care provider for their headache pain often have difficulty receiving adequate treatment. One of the barriers to the optimal treatment of headaches is that the availability of non-pharmacological, psychosocial treatments is very limited. Although medications can be an important part of effective headache management, the use of non-pharmacological treatments is widely recommended . Among headache disorders, migraine headaches are particularly debilitating due to their neurological basis, severity, and high burden on daily functioning. Unlike tension-type headaches, migraine headaches involve additional symptoms such as nausea, photophobia, and phonophobia, leading to greater disability. Given this significant impact, our study focuses specifically on developing a digital Cognitive Behavioral Therapy (CBT) intervention for migraine headache sufferers. The National Canadian Migraine Strategy has recommended self-management patient interventions and patient education to learn skills to manage their symptoms in partnership with their healthcare providers. They have also advocated for the use of non-pharmacological therapies like stress management, skills to avoid triggers causing migraine headache, relaxation therapies, and self-monitoring for the management of migraine headache as part of their chronic disease management program for migraine headache. Although many medications can reduce pain due to migraine headache, their frequent use has associated side effects, and the prolonged use or overuse of medications can also cause migraine headache. Thus, an overreliance on pharmacological treatments and a lack of attention to lifestyle and psychosocial factors contributing to migraine headache symptoms can create sub-optimal outcomes for patients. Therefore, our goal is to develop a CBT program for migraine headache that can be delivered through an internet-connected phone, tablet, or computer and provide effective treatment to a wide range of patients with migraine headache. Health enSuite is a suite of applications designed by our research team at the Centre of Research in Family Health at IWK Health. Health enSuite will be utilized by patients suffering from insomnia, anxiety, migraine headache, and caregiver distress. Health enSuite Migraine has been designed to make cognitive and behavioral techniques for managing migraine headache readily available to people suffering from migraine headache. The online program combines treatment elements that are effective in preventing and managing migraine headache pain, including trigger management, stress management, relaxation techniques, cognitive reappraisal, and psychoeducation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
415
The program consists of treatment modules delivered over 8 weeks. Modules include topics such as Headaches and Triggers, Relaxation, Breathing, Changing Thoughts, Imagery, Problem Solving, Nutrition, Sleep, Exercise, Medication, and more. Each module features sections like Goals, Getting Started, Let's Talk, and a Quiz, with Let's Practice in four modules. Intervention participants track headaches using a structured tracker to log impacts, daily events (e.g., exposure, strategies, medication), and notes. Control group participants track headaches only at baseline, two months, and five months post-randomization. Weekly reminders ("nudges") encourage app usage, with the same frequency for all users. Reports summarizing daily headache data are available to participants.
Change in Migraine Headache Frequency
Migraine headache frequency will be tracked using the electronic migraine headache tracker within the Health enSuite Migraine app. The outcome is the change from baseline in the number of migraine headache days. Unit of Measure: Number of migraine headache days per month
Time frame: Baseline assessment, 2 months post randomization, 5 months post randomization
Responder Rate for Migraine Headache
Percentage of participants achieving ≥30% reduction in migraine headache days from baseline, measured via the migraine headache tracker. Unit of Measure: % of participants with ≥30% reduction in headache days.
Time frame: Baseline assessment, 2 months post randomization, 5 months post randomization
Change in Maximum Migraine Headache Intensity
Maximum headache intensity will be self-reported using the migraine headache tracker. Unit of Measure: Intensity score (0-10 scale)
Time frame: Baseline assessment, 2 months post randomization, 5 months post randomization
Change in Migraine-Related Functional Impairment (MIDAS)
The Migraine Disability Assessment (MIDAS) questionnaire will be used to measure functional impairment due to migraine. The outcome is the change in MIDAS total score. Unit of Measure: MIDAS total score (0-21+)
Time frame: Baseline assessment, 2 months post randomization, 5 months post randomization
Change in Depression Symptoms (PHQ-9)
Depression symptoms will be measured using the 9-item Patient Health Questionnaire (PHQ-9). The outcome is the change in PHQ-9 total score. Unit of Measure: PHQ-9 total score (0-27)
Time frame: Baseline assessment, 2 months post randomization, 5 months post randomization
Changes in Daily Factors Related to Migraine Episodes
Exploratory assessment of daily self-reported factors (sleep, mood, emotional state, environmental exposures, dietary intake, coping strategies, and medication use) and their association with migraine episodes, as reported in the optional components of the migraine headache tracker. Unit of Measure: Self-reported diary entries (descriptive/exploratory; no single standardized unit)
Time frame: Baseline assessment, 2 months post randomization, 5 months post randomization
Changes from baseline in daily factors
such as sleep, mood, emotional state, environmental exposures, dietary intake, coping strategies, and medication use, and their potential associations with migraine episodes, as self-reported in the optional components of the migraine headache tracker.
Time frame: Baseline assessment, 2 months post randomization, 5 months post randomization
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