Headache Impact Test (HIT-6)

What is the Headache Impact Test (HIT-6) scale for headaches?

The Headache Impact Test (HIT-6) is a valuable tool for assessing the impact of headaches on a person's daily life. The HIT-6 provides a quick and effective way to measure headache-related disability and determine the severity of headache impact on patients.

The HIT-6 consists of six questions that cover key areas affected by headaches:

1. Pain intensity
2. Social functioning
3. Role functioning (work, school, household activities)
4. Cognitive functioning
5. Psychological distress
6. Vitality

Is the HIT-6 reliable and valid for chronic migraine?

The Headache Impact Test has been extensively studied and validated for use in chronic migraine patients, demonstrating both reliability and validity in this population.

Reliability refers to the consistency of a measure, and the HIT-6 has shown strong internal consistency and test-retest reliability in chronic migraine sufferers. A study by Yang and colleagues (2011) found that the test was reliable with high internal consistency and very good test-retest reliability for chronic migraine patients, suggesting that HIT-6 scores remain stable over time when no change in headache status occurs. Houts and colleagues (2021) also found that HIT-6 can classify distinct subgroups among chronic migraine patients.

The HIT-6 correlates well with other established measures of headache impact and disability. For instance, it strongly correlates with the Migraine Disability Assessment (MIDAS) questionnaire, another widely used tool in headache research and clinical practice (Yang et al., 2011).

Common headache disorders this test can measure

The Headache Impact Test is helpful in measuring headache impact  on a person's daily life. While initially developed with migraine in mind, it has shown its effectiveness across multiple headache types. Here are some common headache disorders that the HIT-6 can effectively measure:

• Migraine (episodic and chronic): The HIT-6 is particularly well-validated for both episodic and chronic migraine. It can differentiate between these two forms, with chronic migraine patients typically scoring higher, reflecting the greater impact on their quality of life.
• Tension-type headache: As one of the most common primary headache disorders, the substantial impact of tension-type headache can be reliably measured using the HIT-6. The test captures the effects of this condition on work productivity, social functioning, and overall well-being.
• Cluster headache: Although less common, cluster headaches significantly affect a person's life. The HIT-6 has been used to assess the burden of this condition, providing valuable insights into its effects on daily activities and emotional well-being.

How to use our HIT-6 questionnaire

Using the HIT-6 in clinical practice can be straightforward and efficient. Here's a short guide for incorporating this valuable tool in patient care to measure headache pain:

Step 1: Administer the questionnaire

Provide the patient with the HIT-6 form in paper or digital format. The questionnaire consists of six questions about how headaches affect daily life, such as "How often is the pain severe?". Ensure the patient understands that responses should reflect their experience over the past four weeks. The HIT-6 is designed to be self-administered and typically takes about 2-3 minutes to complete.

Step 2: Calculate the score

Sum the patient's responses to obtain the total HIT-6 score. Each question is scored on a scale of 6 to 13 points, resulting in a total score range of 36 to 78. Higher scores indicate greater headache impact.

Step 3: Interpret the results

Interpret the indicated score ranges within the test to determine the level of headache impact. Consider these results alongside other clinical information to assess the patient's condition comprehensively.

Step 4: Discuss and plan

Review the HIT-6 results with the patient, discussing headache impact severity. Use this information to guide treatment decisions, set management goals, and monitor progress.

How do you interpret the Headache Impact Test?

Interpreting the Headache Impact Test involves understanding the scoring system and what the scores mean regarding the impact of pain among headache sufferers. The HIT-6 consists of six questions, each with five response options:

• Never: 6 points
• Rarely: 8 points
• Sometimes: 10 points
• Very often: 11 points
• Always: 13 points

To calculate the total score, sum the points for all six questions. The total score will range from 36 to 78 points. The total score falls into one of four impact categories:

• Little or no impact (≤49 points): Headaches have minimal effect on daily life. Patients in this category may not require intensive management.
• Some impact (50-55 points): Headaches are having a noticeable effect on daily activities. These patients may benefit from discussing preventive strategies and lifestyle modifications.
• Substantial impact (56-59 points): Headaches significantly affect various aspects of the patient's life, and more aggressive management strategies may be warranted.
• Severe impact (≥60 points): Headaches are having a major impact on the patient's quality of life. Patients who experience severe pain often require comprehensive headache management plans, potentially including preventive medications and lifestyle interventions.

What causes chronic and episodic migraine?

Chronic and episodic migraines are complex neurological conditions with multifaceted causes. Understanding the underlying factors can help develop more effective treatment strategies and improve patient outcomes.

Episodic migraine is characterized by headache attacks occurring less than 15 days per month. The causes of episodic migraine include:

1. Genetic predisposition: Studies have shown that migraines tend to run in families, suggesting a genetic component.
2. Environmental triggers: Factors such as stress, certain foods, changes in sleep patterns, and hormonal fluctuations can trigger migraine attacks in susceptible individuals.
3. Neurotransmitter imbalances: Changes in levels of serotonin and other neurotransmitters have been implicated in migraine pathophysiology.

Chronic migraine is defined as headaches occurring on 15 or more days per month, with at least 8 of those days meeting the criteria for migraine diagnosis. Several factors influence the transition from episodic to chronic migraine:

1. Medication overuse: Frequent use of acute headache medications can lead to medication overuse headaches, contributing to chronic migraines.
2. Comorbid conditions: Disorders such as depression, anxiety, and sleep disturbances are more common in chronic migraine and may contribute to their development.
3. Lifestyle factors: Obesity, caffeine overuse, and high stress levels have been associated with an increased risk of developing chronic migraine.

References

Houts, C. R., McGinley, J. S., Wirth, R. J., Cady, R., & Lipton, R. B. (2021). Reliability and validity of the 6-item Headache Impact Test in chronic migraine from the PROMISE-2 study. Quality of Life Research, 30(3), 931–943. https://doi.org/10.1007/s11136-020-02668-2

Yang, M., Rendas-Baum, R., Varon, S. F., & Kosinski, M. (2011). Validation of the Headache Impact Test (HIT-6™) across episodic and chronic migraine. Cephalalgia: An International Journal of Headache, 31(3), 357–367. https://doi.org/10.1177/0333102410379890