Engagement and predictors of use of a smartphone app for migraine self-management: A secondary analysis of the EMMA trial

Objective: The objective of this secondary analysis was to examine engagement with a mobile app for migraine self-management and to identify predictors of migraine app usage. Background: Migraine self-monitoring and behavioral strategies are central components in migraine self-management, but patient adherence often remains a challenge. Recently, migraine apps have shown promise in enabling more frequent and continuous headache tracking and supporting self-management by integrating behavioral strategies; however, data on patient engagement with these digital interventions are still scarce. Methods: This secondary analysis of the EMMA trial used the full dataset of the intervention group, which received a migraine app for 24 weeks, and examined app engagement and factors associated with frequent app usage. Outcomes were frequency of app engagement, intensity of app engagement, and time of usage. Potential associated factors included demographics, migraine history, burden of disease, headache management self-efficacy, and first-week app use. Descriptive analyses summarized engagement patterns for the overall app, the diary, and self-management modules. Kaplan-Meier survival curves illustrated usage over time. Univariable linear regression models explored associations between patient characteristics and first-week app usage as predictors of total app usage. Results: Of the 238 patients, 161 (67.7%) were still actively using the app after 24 weeks. Total active usage days ranged from 1 to 168, with a mean (SD) of 129.7 (52.5) days, corresponding to usage on approximately 77% of days. Among all app modules, the headache and trigger diaries had the highest usage frequencies, with means (SDs) of 110.6 (49.7) and 118.1 (60.9) days, respectively. Engagement with the behavioral self-management modules was lower overall, with faster drop-off rates. Among the behavioral self-management modules, the training module showed the highest usage, with a mean (SD) of 26.2 (33.9) documented training days. Linear regression analyses showed that older age and higher app usage during the first week were associated with more frequent app usage. Conclusions: This secondary analysis demonstrated high engagement with the headache and trigger diary modules of a migraine app over 6 months. These findings support the potential of smartphone apps to improve adherence to headache self-monitoring. However, engagement with the behavioral self-management modules was lower than intended, highlighting the persistent challenge of promoting adherence to behavioral migraine interventions. Trial registration: German Clinical Trials Register: DRKS00024174. Many people with migraine rely on mobile apps to help track their headaches, triggers, and symptoms. This study examined how people with migraine used a self‐management app over 6 months and found that most users frequently tracked their headaches and triggers in the app's diary, but they used the behavioral self‐management tools less often and engagement with these features decreased over time. People who were older or who used the app more during the first week tended to continue using it longer overall.