41 Practical experience with the use of electronic headache diaries 2 (see Figure 1).1 Patients provided daily information about the presence of headache and its characteristics and accompanying symptoms, aura symptoms and the use of acute (pain) medication. An underlying algorithm verified for each day whether it was a migraine day, a headache day or a non-headache day.10,3 The E-diary was embedded in the Patient Journey App, and patients were encouraged to provide daily information via in-app notifications at 8 am and if they have not responded yet at 6 pm as well. An automated email was sent at 8 pm if the E-headache diary was not filled out yet. Patients could also opt for automated emails. The E-diary was time-locked, becoming inaccessible after 48 hours. The information provided by patients was used to generate a visual overview, providing insight into the migraine course. The company that has developed the app used in our study, is ISO27001 (information security) and ISO9001 (quality management) certified. In addition, they are NEN7510 certified (processing of medical data). The company and the app undergo privacy audits every 3 months, to ensure compliance with the European data protection regulations (GRPR). Access to personal data is role-based and only for healthcare professionals, researchers can only access the data after it is anonymized. Data was transported and stored encrypted in certified data centers, and access to patient data was role-based and for healthcare professionals only. Patients could access the app via a unique, personal code, and could enable an additional code or biometric access. The work flow that is used at the Leiden Headache Center is presented in Figure 1. Predictors of E-diary compliance We assessed the compliance of all patients using the E-diary and conducted a linear regression analysis to identify factors associated with compliance. Compliance, in this context, is quantified as the percentage of E-diary days completed by each individual, calculated as the ratio of completed days to the total days. Our predictors included age, sex, chronic migraine, E-diary grade, and purpose of E-diary use (clinical or research). According to the International Classification of Headache Disorders (ICHD)-3 criteria, chronic migraine requires three consecutive months of recorded migraine and headache days. However, for this linear regression analysis with compliance as the outcome, relying solely on E-diary data for chronic migraine diagnosis is not possible due to potential missing days in the data. To address this, we used a retrospective report from an extended migraine questionnaire to gather self-reported information on migraine and headache days over three months. Self-reported data may be less reliable than daily E-diary recordings, but retrospective reports are commonly used in clinical settings when consecutive monthly data is not available.
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