A Better Picture of Migraine-Related Disability: The Headache Impact Test (HIT)
The migraine disability assessment (MIDAS) questionnaire has always been a good way of determining the number of days migraine patients experiencing episodic migraine are unable to work or perform their regular activities at home, but until recently there hasn't been a very good questionnaire for providing doctors with a fuller picture of the ways in which patients are disabled by their migraine attacks.
The Headache Impact Test (HIT-6) has been developed to do this, especially among chronic migraineurs. This is extremely important because migraine is both underdiagnosed and undertreated. A reliable diagnostic tool available to both patients and doctors like the HIT is has the power to change that.
In an effort to determine how accurate the HIT is in assessing the burden and level of disability of chronic migraine sufferers, a group of researchers used the test to assess more than 2,000 patients. They determined the HIT does an accurate, reliable job of determining the impact of episodic and chronic migraine and the difference in level of disability associated with chronic migraine when compared to episodic migraine.
The HIT measures the patient's level of head pain, social, work and cognitive functioning, vitality and psychological distress. Each item is assessed a numeric value and tallied to provide an overall headache severity level. The lowest possible number is 36 and the highest is 78. Within that range there are four categories of headache severity:
- Little or no impact (46 or less)
- Some impact (50 -55)
- Substantial impact (56-59)
- Severe impact (60-78)
While the MIDAS asks patients to share how many days a month they are kept from work, household tasks and family and social obligations, the HIT provides a more well rounded picture of an individual's disability by asking the patient to rank the extent to which migraine interrupts a host of activities of daily life on a scale from one to five. This is especially important for chronic migraine sufferers, many of whom are completely unable to work or perform household chores and cannot actually answer the question of how many days a month they are taken away from these tasks.
More than half of episodic migraineurs and almost three-quarters of chronic migraineurs in the study said their migraine disease had a severe impact on their daily lives. More than half of non-migraine study participants said their headaches had little to no impact on their daily lives. The researchers observed a high level of consistency between patients with chronic migraine and their level of disability on the HIT scale.
The HIT is available online, which allows patients who wonder if their migraines are something to be concerned about to objectively assess for themselves the extent to which their lives are being interrupted. They can then take the results to a doctor and seek out treatment of their own initiative even if a doctor never asks about how their lives are impacted by migraine disease. The HIT can be found at: Headache Impact Test.
Can you tell when a migraine attack is coming?