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.

中文翻译：

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智能手机提供的渐进式肌肉放松在持续性创伤后头痛患者中的可行性。

持续性外伤后头痛 (PPTH​​) 通常是轻度外伤性脑损伤 (mTBI) 后最常见的损伤，47-95% 的患者报告。渐进式肌肉放松 (PMR) 在预防偏头痛和紧张性头痛方面具有 A 级证据。然而，对这种 PPTH 行为疗法的研究是有限的，更不用说智能手机了。我们对 2017 年 6 月至 2018 年 7 月期间致电我们脑震荡中心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，第三版继发于 mTBI 的 PPTH 标准，头痛天数超过 4 天一个月，年龄在 18-85 岁和受伤后 3-12 个月，拥有智能手机，并且在一年内没有尝试过头痛行为疗法。我们记录了基线头痛和神经精神数据。使用带有头痛日记和 PMR 音频文件的 RELAXaHEAD 智能手机应用程序，参与者被要求记录头痛症状并每天练习 20 分钟的 PMR。进行了三个月的后续评估。招收了49名受试者。基本人口统计数据为：33 (67%) 名女性，平均年龄为 40.1 ± 14.6 [20, 75] 岁。在 49 名受试者中，15 名 (31%) 有预先存在的头痛。在 11 (22%) 名受试者中，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] 天的头痛天数，并且 49 (100%) 经历了三种以上的脑震荡症状。参与者在第一个月平均有 18.3 ± 12.0 天 [0, 31] 在 RELAXaHEAD 应用程序中输入数据。每周进行四次以上 PMR 的参与者数量为第一个月 12 (24.5%)、第二个月 9 (22.5%) 和第三个月 6 (15%)。3个月后，17 (42.5 %) 名参与者继续进行 PMR。参与者认为时间限制、健忘、应用故障和重复性是实践 PMR 的障碍。通过低成本的基于智能手机的 PMR 每周两次让 PPTH 受试者进行行为治疗是可行的。未来的工作将评估功效并研究如何优化 PMR 的障碍。