{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:25:14Z","timestamp":1789140314960,"version":"build-2803163510"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this secondary analysis was to examine engagement with a mobile app for migraine self\u2010management and to identify predictors of migraine app usage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Migraine self\u2010monitoring and behavioral strategies are central components in migraine self\u2010management, but patient adherence often remains a challenge. Recently, migraine apps have shown promise in enabling more frequent and continuous headache tracking and supporting self\u2010management by integrating behavioral strategies; however, data on patient engagement with these digital interventions are still scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This secondary analysis of the EMMA trial used the full dataset of the intervention group, which received a migraine app for 24\u2009weeks, 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\u2010efficacy, and first\u2010week app use. Descriptive analyses summarized engagement patterns for the overall app, the diary, and self\u2010management modules. Kaplan\u2013Meier survival curves illustrated usage over time. Univariable linear regression models explored associations between patient characteristics and first\u2010week app usage as predictors of total app usage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 238 patients, 161 (67.7%) were still actively using the app after 24\u2009weeks. 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.<\/jats:p>\n                    <jats:p>Engagement with the behavioral self\u2010management modules was lower overall, with faster drop\u2010off rates. Among the behavioral self\u2010management 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2010monitoring. However, engagement with the behavioral self\u2010management modules was lower than intended, highlighting the persistent challenge of promoting adherence to behavioral migraine interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>German Clinical Trials Register: DRKS00024174<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.70009","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T12:38:08Z","timestamp":1764074288000},"page":"118-131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Engagement and predictors of use of a smartphone app for migraine self\u2010management: A secondary analysis of the\n                    <scp>EMMA<\/scp>\n                    trial"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4232-9608","authenticated-orcid":false,"given":"Stefanie","family":"Lysk","sequence":"first","affiliation":[{"name":"Institute of Social Medicine, Epidemiology and Health Economics Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Pach","sequence":"additional","affiliation":[{"name":"Institute of Social Medicine, Epidemiology and Health Economics Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Tissen\u2010Diabat\u00e9","sequence":"additional","affiliation":[{"name":"Institute of Social Medicine, Epidemiology and Health Economics Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Scholler","sequence":"additional","affiliation":[{"name":"Robert Koch Institute  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia M.","family":"Witt","sequence":"additional","affiliation":[{"name":"Institute for Complementary and Integrative Medicine University Hospital Zurich and University Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2022.107225"},{"key":"e_1_2_12_3_1","unstructured":"DienerHC.Therapie der Migr\u00e4neattacke and Prophylaxe der Migr\u00e4ne S1\u2010Leitlinie. Accessed September 23 2025.https:\/\/register.awmf.org\/assets\/guidelines\/030\u2010057l_S1_Therapie\u2010der\u2010Migraeneattacke\u2010Prophylaxe\u2010der\u2010Migraene_2024\u201006.pdf"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-023-01571-8"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-823357-3.00031-8"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00482-017-0214-1"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14914"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-019-0961-8"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/app11156856"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11940-010-0102-9"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14153"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14451"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016670"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-021-00509-5"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2023.02.002"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10194-011-0348-y"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06539-x"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13429"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14392"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-019-0739-3"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13422"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102415591506"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.2196\/36761"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14519"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00482-020-00508-3"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S309542"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-09981-3"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024211053572"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurpra.2021.01.014"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102416660549"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12836"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00103-021-03415-9"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2023.104421"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000459"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000001289"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.9397"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8578"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2020.100344"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.2196\/20283"},{"key":"e_1_2_12_40_1","unstructured":"BfArM.Digital Health Applications. Federal Institute for Drugs and Medical Devices. Accessed June 5 2025.https:\/\/www.bfarm.de\/EN\/Medical\u2010devices\/Tasks\/DiGA\u2010and\u2010DiPA\/Digital\u2010Health\u2010Applications\/_node.html"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.17708"},{"key":"e_1_2_12_42_1","unstructured":"GKV\u2010Spitzenverband.Bericht des GKV\u2010Spitzenverbandes \u00fcber die Inanspruchnahme und Entwicklung der Versorgung mit Digitalen Gesundheitsanwendungen. Accessed June 6 2025.https:\/\/www.gkv\u2010spitzenverband.de\/media\/dokumente\/krankenversicherung_1\/telematik\/digitales\/2021_DiGA_Bericht_final_barrierefrei.pdf"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-020-01139-w"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.12688\/wellcomeopenres.19363.1"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1023\/a:1026119331193"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-018-0837-3"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12564"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.2196\/35371"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000001247"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17217920"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.2196\/22212"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2016.06.015"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.2196\/49998"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.70009","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/head.70009","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.70009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T05:32:48Z","timestamp":1773466368000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.70009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":52,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/head.70009"],"URL":"https:\/\/doi.org\/10.1111\/head.70009","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]},"assertion":[{"value":"2025-09-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}