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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
Min; Rendas-Baum, Regina; Varon, Sepideh; Kosinski, Mark. Validation of the Headache Impact Test (HIT-6) across episodic and chronic migraine. Cephalalgia 2011; 31: 357-367.


View Comments (13)
  • Garangwyn
    5 years ago

    I just read Janet’s story about “It’s Not Just a Pain Disorder” and she referred to the “Headache Impact Test” which I was hoping to be able to take. But the link to that test is broken! Has it been moved, or RE-moved??

  • Diana-Lee author
    5 years ago

    Hi, Jennifer. For some reason the page that used to house access to the test was taken down. You can access a version here: http://www.qualitymetric.com/demos/TP_Launch.aspx?SID=1

  • Laura E. Phillips
    7 years ago

    Other diaries and questionnaires ask me how long my headaches last, and when they started. My headaches never go away – it is just a mater of severity. So I like the way it addresses head pain. However, I wish it asked about symptoms other than headaches. If I answered the questions considering only headache – my score will not reflect my level of disability. For example, I left work last week because of the weakness, dizziness and disassociation were so severe. If the only symptom I was experiencing was headache – I probably would have been able to remain at the office. And I often want to lay down because of weakness and disassociation – not because the head pain is so bad.

    Descriptions or definitions of migraine written by medical professionals include other symptoms. I find it strange that the makers of a migraine “test” would only ask about the headaches.

  • Diana-Lee author
    5 years ago

    The HIT addresses all symptoms associated with a patient’s Migraine attacks, not just head pain.

  • Bre Miller
    7 years ago

    I just took this test, and scored 74 out of 78… not that I didn’t already know that my migraines were severe, but hopefully this test will help others understand how disabling a migraine can be, it’s not “just a headache”.

  • Kathy Jo Horton Bishop
    7 years ago

    67 here and I was trying to be a little soft on how bad they were but I knew better…..maybe people will understand…..been trying to unpack it’s taking me forever.. no one seems to understand that…..everything takes twice as long as a person who doesn’t have chronic migraines….finally the world is starting to understand what we go through

  • Linda Castellano
    7 years ago

    Wow interesting Janene I have never paid any attention to my breath in the” pro dome” stage but I will admit during a full blown attack everything that has an odor is so srtong for me I have to cover my nose with a wash cloth-I am talking I smell laundry detergent at the other end of the house, someone opens the fridgee I can smell kethcup and even the freezer smells to me.I know this all sounds crazy but I don’t know how else to describe this-so I have to wonder how bad my breath would smell to others-I cannot stand it but I blame it on being sick and being so sensitive to ALL odors-Weird but migraines really have an effect on the WHOLE body not just the head—Uggh!

  • Christi Costlow Baker
    7 years ago

    I’m the same way when I’m in a full blown attack. I’m super-sensitive to smells and have to cover my nose. So..very..strange!

  • Christi Costlow Baker
    7 years ago

    I would love to take this test, but it requires a site name and I can’t get past this. :/

  • Migraine.com
    7 years ago

    Try the PDF version provided on the site (no registration required). Here is the direct link: http://www.headachetest.com/HIT6/PDFS/English.pdf

  • Marietta Johnson
    7 years ago

    YES!! I had the SAME issue!!

  • Janene Zielinski
    7 years ago

    This is going to sound ridiculous, but this morning I told my husband I have a “whopper” coming on and he said, “I know, you’ve had bad breath for two days”. Here I am struggling with all the common “pro dome” stuff like neck pain, excessive yawning, visual disturbances, etc. and I’m thinking I’m hiding my pain and dread pretty well and he has to add a new one to my list! I don’t mean to make light of anything – I guess I’m just experiencing that psychological distress you mention that this test covers. I work with people all day long and can’t have bad breath! I practice good hygiene – anybody ever dealt with this in relation to migraines and have an idea? Sorry if I’m a bit “off-topic”.

  • Christine E.
    5 years ago

    I took the online test, but when I tried to get the score, it said that I “hadn’t taken any surveys”. I was also disappointed that it only asked about pain, and not about tinnitus, light sensitivity, vertigo, nausea, etc. I also tried the link to the PDF above and it didn’t work 🙁

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