Clinical Decision Support for Patient Migraine Management



 DESCRIPTION (provided by applicant): I earned a Ph.D. in clinical psychology in the health track from Ohio University in 2012. My early research examined psychological factors in the treatment of migraine and translating an established behavioral migraine treatment to a mobile health application. My dissertation carved out an independent line of research examining acute migraine medication adherence. The proposed project extends this research by examining adherence to acute and preventive migraine management strategies using a mobile health application, and developing a mobile health intervention to improve adherence to migraine management strategies. In 2013, after an internship and post-doctoral training at the West Haven VA and Yale School of Medicine, I attained a tenure-track faculty position at Yeshiva University's Ferkauf Graduate School of Psychology (Clinical Psychology, Health Emphasis Ph.D. Program) and Albert Einstein College of Medicine (Department of Neurology). My burgeoning program of research examines psychological factors in headache and adherence. These two departments support my career development with excellent mentorship, space, equipment, administrative support; they have a history of supporting successful K-awards with dually appointed faculty. My career goal is to become an independent clinical investigator and leader in the study of behavioral factors in migraine. My short-term objectives (over the K-award period) are to 1) evaluate factors associated with adherence to migraine management strategies and 2) develop a clinical decision support tool to improve adherence to migraine management. My long-term objectives are to improve our understanding of factors associated with patient adherence in migraine, and develop and disseminate interventions to improve patient adherence in migraine. These advances could significantly reduce the impact and burden of migraine. This award will help me achieve that goal through providing increased dedicated research time and training in migraine management, clinical investigation, clinical decision support, and advanced statistics. Migraine is a prevalent, disabling disorder characterized by episodic attacks of head pain. Patient adherence to recommended migraine management strategies can reduce the cost and burden of migraine. Patient adherence to migraine management strategies is consistently poor, in part because people with migraine must engage in both preventive migraine management to reduce migraine frequency and acute migraine management to reduce the impact of a migraine attack. Few studies have investigated who adheres to preventive and acute migraine management strategies (individual differences) and when patients adhere to these strategies (conditions). This knowledge will provide individualized targets to improve adherence. Few interventions have been developed to improve patient adherence to migraine management. Adherence to acute migraine management requires complex in-the- moment decision-making; therefore, a system designed to enhance decision-making (a Clinical Decision Support Tool; CDST) embedded in a commonly used headache diary mobile application may be an effective intervention to improve patient adherence. The proposed research aims to 1) Describe and analyze how individual differences and circumstances influence adherence to preventive and acute migraine management strategies, and 2) Develop a tailored CDST to improve preventive and acute migraine management strategies. Aim 1: One hundred people with frequent, episodic migraine (6-14 days/month) will take a mobile electronic headache diary for three months, adapted to employ fixed interval assessments (same time daily) and ecological momentary assessments (random intervals during the day) to fully capture adherence to preventive and acute migraine management strategies. This study will identify patterns of individual differences and circumstances associated with migraine management adherence. Aim 2: I will pilot a prototype CDST for one week in 24 people with frequent, episodic migraine to obtain feedback about acceptability and satisfaction, and will refine the CDST based on this feedback. Sixty people with frequent, episodic migraine who record suboptimal migraine management adherence for at least one preventive and one acute strategy during three months of monitoring (see Aim 1) will be randomized to receive 1) a CDST (tailored to the most problematic preventive and acute migraine management strategy for each participant) or 2) a Headache Education embedded in the headache diary for an additional three months. This trial will allow us to test feasibility andto obtain initial effect size estimates for the CDST intervention. This trial will provide the preliminary data necessary for a successful federal grant application to support a fully- powered randomized clinical trial examining the efficacy of the CDST to improve preventive and acute migraine management strategies.