The overall goals of this proposed project are 1) to develop Dr. Mia Minen into a pain researcher in integrative and complementary health with skills to conduct independent multidisciplinary research; and 2) to conduct a clinical research study to assess the feasibility and acceptability of a relaxation intervention for migraine patients who present to the emergency department (ED). Dr. Minen will develop and advance her knowledge base, experience, and skills in 5 key areas through mentored training: 1) Mind-body intervention (MBI) techniques; 2) Advanced research methods (in health services, clinical trials, and mobile health strategies); 3) Emergency medicine pain research methodology and responsible conduct; 4) New research design frameworks; and 5) Prevention science, program intervention development, and comparative effectiveness research. The long-term goal of the research training is to be able to independently develop, assess, refine, and compare novel and existing evidence-based MBIs for migraine patients across medical specialties, with a special focus on the emergency medicine and primary care settings. In addition, the purpose of the training is to gain advanced skills to study the MBIs alone and in combination with nutraceuticals and medications. The research proposed in this K23 application is important to understanding how evidence-based MBIs can be made more accessible for chronic pain patients in the acute care setting. It helps to set the framework for translating evidence-based MBIs into use in other medical settings. Migraine, the chronic pain condition being used as an example for study, is a significant public health issue. Migraine affects over 30 million Americans, and it is considered to be one of the most disabling conditions. It is responsible for a substantial number of the five million headache visits/year to US EDs. The purpose of this research is to study use of progressive muscle relaxation, a MBI, in patients with migraine who present to the emergency department. During the study, we will use patient feedback to optimize the smartphone application (app) RELAXaHEAD, an app with PMR and a daily headache diary. We will then conduct a feasibility and acceptability study of the RELAX approach (use of RELAXaHEAD and abortive migraine pain medication). The results of this research will inform a future R01 application to conduct a large-scale trial of MBI for migraine patients who present to the ED. The proposed research and training will be conducted at New York University Langone Medical Center's ED. Dr. Minen's mentorship and advisory team includes an interdisciplinary team with experts in MBI and behavioral research, mobile health, headache medicine, emergency medicine, qualitative and mixed methods research, population health, and statistics. The proposed research and training plans will provide a strong foundation for Dr. Minen as an independently funded clinical investigator dedicated to using MBIs alone and in combination with nutraceuticals and medications to improve the care of chronic pain patients in the acute care setting.

Public Health Relevance

Mind-body interventions (MBIs) are not widely accessible for large numbers of chronic pain patients. One of the most common and disabling chronic pain conditions is migraine, which affects over 30 million Americans and is responsible for a substantial number of the 5 million emergency department (ED) visits for headache in the United States each year. Given that few migraine patients utilize the evidence-based MBIs that are effective for preventing migraines and that few migraine patients leave the ED pain free, their headaches frequently return, and discharge plans for follow-up treatment are often inadequate, the aim of this study is to assess the feasibility and acceptability of introducing progressive muscle relaxation (PMR), an established effective MBI, to migraine patients visiting the ED using a smartphone-based platform.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZAT1)
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Mudd, Lanay Marie
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New York University
Schools of Medicine
New York
United States
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Minen, Mia T; Ortega, Emma; Lipton, Richard B et al. (2018) American Headache Society Survey About Urgent and Emergency Management of Headache Patients. Headache 58:1389-1396
Minen, Mia T; Azarchi, Sarah; Sobolev, Rachel et al. (2018) Factors Related to Migraine Patients' Decisions to Initiate Behavioral Migraine Treatment Following a Headache Specialist's Recommendation: A Prospective Observational Study. Pain Med 19:2274-2282
Minen, Mia T; Stieglitz, Eric J; Sciortino, Rose et al. (2018) Privacy Issues in Smartphone Applications: An Analysis of Headache/Migraine Applications. Headache 58:1014-1027
Minen, Mia T; Jalloh, Adama; Ortega, Emma et al. (2018) User Design and Experience Preferences in a Novel Smartphone Application for Migraine Management: A Think Aloud Study of the RELAXaHEAD Application. Pain Med :
Begasse de Dhaem, Olivia; Minen, Mia T (2017) Emerging Subspecialties in Neurology: Headache medicine. Neurology 88:e122-e125