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.

Public Health Relevance

Migraine is a common, painful and disabling disorder; effective migraine management strategies are available, but these require complex, in-the-moment decision making, making it difficult for patients to adhere to these strategies. This project will identify who has the most difficulty adhering to migraine management strategies, and when it is most difficult to adhere to migraine management strategies. This project will also develop a new tool, embedded in commonly used mobile applications for headache tracking, to help people with migraine make better in-the-moment decisions about adherence to migraine management strategies.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NS096107-06
Application #
9890012
Study Section
Neurological Sciences Training Initial Review Group (NST)
Program Officer
Oshinsky, Michael L
Project Start
2016-04-15
Project End
2021-03-31
Budget Start
2020-04-01
Budget End
2021-03-31
Support Year
6
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Albert Einstein College of Medicine
Department
Type
DUNS #
081266487
City
Bronx
State
NY
Country
United States
Zip Code
10461
Seng, Elizabeth K; Kuka, Alexander J; Mayson, Sarah Jo et al. (2018) Acceptance, Psychiatric Symptoms, and Migraine Disability: An Observational Study in a Headache Center. Headache 58:859-872
Weinberger, Andrea H; Seng, Elizabeth K; Esan, Hannah et al. (2018) Perceived risks and benefits of quitting smoking in a sample of adults living with HIV/AIDS. AIDS Care 30:564-568
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
Begasse de Dhaem, Olivia; Seng, Elizabeth; Minen, Mia T (2018) Screening for Insomnia: An Observational Study Examining Sleep Disturbances, Headache Characteristics, and Psychiatric Symptoms in Patients Visiting a Headache Center. Pain Med 19:1067-1076
Patel, Zarine S; Hoffman, Lauren K; Buse, Dawn C et al. (2017) Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Suppurativa [corrected]. Curr Pain Headache Rep 21:49
Seng, Elizabeth K; Klepper, Jaclyn E (2017) Development of the Cogniphobia Scale for Headache Disorders (CS-HD): A pilot study. Psychol Assess 29:1296-1301
Grinberg, Amy S; Seng, Elizabeth K (2017) Headache-Specific Locus of Control and Migraine-Related Quality of Life: Understanding the Role of Anxiety. Int J Behav Med 24:136-143
Seng, Elizabeth K; Robbins, Matthew S; Nicholson, Robert A (2017) Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study. Cephalalgia 37:955-964
Jiang, Julie M; Seng, Elizabeth K; Zimmerman, Molly E et al. (2017) Positively worded subscale score of the Perceived Stress Scale is associated with cognitive domain function. J Behav Brain Sci 7:311-324
Jiang, Julie M; Seng, Elizabeth K; Zimmerman, Molly E et al. (2017) Evaluation of the Reliability, Validity, and Predictive Validity of the Subscales of the Perceived Stress Scale in Older Adults. J Alzheimers Dis 59:987-996

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