A Smartphone App And Reminder System Helps Youth With Migraines Take Daily Medication

Almost every teenager has experienced the frustration and discomfort associated with a headache. However, for a subset of teens (8% of males, 23% of females), migraine headaches are a debilitating reality. In addition to a headache, migraines are also associated with nausea, vomiting, dizziness, and sensitivity to touch, light, sound, or odors. They often interfere with teens’ ability to attend school, keep up with schoolwork, and participate in social and extracurricular activities. They can also contribute to mood changes, anxiety, and worries about when the next migraine will occur.

They developed a unique intervention that leverages caregiver support and teens’ interest in technology to help patients remember to take their preventative medications. Despite their motivation to reduce migraines, many teens struggle to take their medications every day like their doctor has prescribed (also known as medication adherence). Studies suggest that teens take approximately 64-90% of their prescribed doses. Forgetfulness and busy schedules are the main things that get in the way of taking medication as prescribed. Unfortunately, failure to take preventative medications consistently may result in continued suffering from migraines.

There have been few evidence-based interventions aimed at improving adherence to preventative medications for migraines. There is evidence that educating adults with migraines about their health condition, treatment, and prevention may help to improve medication adherence, but this approach does not address teens’ main barrier of forgetfulness. In fact, while recent research indicated that behavioral approaches are effective in increasing adherence for teens across a range of chronic health conditions, we are unaware of any evidence-based behavioral treatments to help teens with migraines to take their preventative medications.

Recognizing that teens with migraines were in need of support in taking preventative medications, a research team of psychologists and physicians at Cincinnati Children’s Hospital Medical Center decided to partner up with a Cincinnati company, MedaCheck, to take action. They developed a unique intervention that leverages teens’ desire for technology and caregiver support to help patients remember to take their preventative medications. The intervention is based on the Health Belief Model’s principle of cued actions, which suggests that reminders and prompts may be needed to increase the likelihood that a patient will take medication. The researchers tested the app and reminder system in a pilot study to determine whether it was feasible to use and had any effect on medication adherence.

Participants in the study downloaded a smartphone application (MedaCheck) on their personal phones and entered their medication dose schedules into the app. At the time when the teen was supposed to take medication, they received a push notification as a reminder and had the opportunity to enter whether or not they had taken the medication. If the teen ignored the prompt or indicated that medication was not taken, they received a reminder phone call from a call center customer service representative. In the case that the phone call was unanswered or the teen denied taking medication, a caregiver (often a parent or other person identified by the teen) received a phone call to inform them of the missed dose and request assistance to ensure the dose was taken.

Researchers tested this intervention with 40 teens with migraines over a total of 12 weeks. For the first four weeks, participants established a baseline medication adherence rate by using electronic pill bottles to track how often they took their preventative medication. Across all participants, medications were taken approximately 82% of the time.

For the second eight weeks, participants used the MedaCheck app and progressive phone call reminder system while still recording their medication adherence with the electronic pill bottles. Teens received reminder calls for 33% of their scheduled doses, while caregivers were contacted for 15% of doses. After using the app, nearly half of teens were found to be taking their medication more consistently, with one teen demonstrating a 36% increase in medication adherence during the first four weeks of the intervention. Researchers also found that the app was most helpful for participants who initially struggled to take medications during the baseline period. For these teens, the app was most effective in the first month of use, with the observed improvements decreasing in the last month of use. The majority of teens and parents provided positive feedback about their experience with the intervention. Over 80% of participants gave the app high ratings for ease and convenience of use, app satisfaction, and appearance. Over half of teens and 70-74% of caregivers felt the phone call reminders were helpful.

Results from this study suggest that a medication adherence app and progressive phone call reminder system may help teens to improve in taking their medications in the short term. Providers can quickly and easily recommend a smartphone application to help teens with migraines experience a boost in medication adherence. Further, we recognize that parents and other caregivers have a valuable role in providing reminders and establishing accountability for teens taking preventative migraine medications. However, given that the intervention was not effective for all participants, it is important that medical providers consider that some teens will need more intensive help, such as outpatient therapy with a psychologist or social worker, than an app can offer. Ideally, this intervention may be adapted to help teens with other chronic health conditions in consistently taking medications they need to stay healthy.