Skip to main content

A six-item short-form survey for measuring headache impact: The HIT-6™

Quality of Life Research volume 12, pages 963–974 (2003)Cite this article

Abstract

Background: Migraine and other severe headaches can cause suffering and reduce functioning and productivity. Patients are the best source of information about such impact. Objective: To develop a new short form (HIT-6) for assessing the impact of headaches that has broad content coverage but is brief as well as reliable and valid enough to use in screening and monitoring patients in clinical research and practice. Methods: HIT-6 items were selected from an existing item pool of 54 items and from 35 items suggested by clinicians. Items were selected and modified based on content validity, item response theory (IRT) information functions, item internal consistency, distributions of scores, clinical validity, and linguistic analyses. The HIT-6 was evaluated in an Internet-based survey of headache sufferers (n = 1103) who were members of America Online (AOL). After 14 days, 540 participated in a follow-up survey. Results: HIT-6 covers six content categories represented in widely used surveys of headache impact. Internal consistency, alternate forms, and test–retest reliability estimates of HIT-6 were 0.89, 0.90, and 0.80, respectively. Individual patient score confidence intervals (95%) of app. ±5 were observed for 88% of all respondents. In tests of validity in discriminating across diagnostic and headache severity groups, relative validity (RV) coefficients of 0.82 and 1.00 were observed for HIT-6, in comparison with the Total Score. Patient-level classifications based in HIT-6 were accurate 88.7% of the time at the recommended cut-off score for a probability of migraine diagnosis. HIT-6 was responsive to self-reported changes in headache impact. Conclusions: The IRT model estimated for a 'pool' of items from widely used measures of headache impact was useful in constructing an efficient, reliable, and valid 'static' short form (HIT-6) for use in screening and monitoring patient outcomes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1992; 12: 229–237.

    Google Scholar 

  2. Solomon GD, Price KL. Burden of migraine: A review of its socioeconomic impact. Pharmacoeconomics 1997; 11(Suppl 2): 1–10.

    Google Scholar 

  3. Ware JE, Bjorner JB, Kosinski M. Practical implications of item response theory and computerized adaptive testing: A brief summary of ongoing studies of widely used headache impact scales. Med Care 2000; 38(Suppl II, 9): 1173–1182.

    Google Scholar 

  4. Bjorner JB, Kosinski M, Ware JE Jr. Calibration of an item pool for assessing the burden of headaches: An application of item response theory to the Headache Impact Test (HIT™). Qual Life Res 2003; 12: 913–933.

    Google Scholar 

  5. Bullinger M, Alonso J, Apolone G, et al. Translating health status questionnaires and evaluating their quality: The International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 1998; 51(11): 913–923.

    Google Scholar 

  6. Gandek B, Alacoque J, Uzun V, Andrew-Hobbs M. Translating the Short-Form Headache Impact Test (HIT-6) in 27 countries: Methodological and conceptual issues. Qual Life Res 2003; 12: 975–979.

    Google Scholar 

  7. Ware JE, Kosinski M, Dewey JE, Gandek B. SF-8 Health Survey Manual-How to Score and Interpret Single-Item Health Measures: A Manual for Users of the SF-8 Health Survey. Lincoln, RI: QualityMetric Incorporated, 2001.

    Google Scholar 

  8. Stewart WF, Lipton R, Liberman J. Variation in migraine prevalence by race. Neurology 1996; 47: 52–59.

    Google Scholar 

  9. Stewart WF, Lipton R, Kolonder K, Liberman J, Sawer J. Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalgia 1999; 19: 107–114.

    Google Scholar 

  10. Bock RD, Mislevy RJ. Adaptive EAP estimation of ability in a microcomputer environment. Appl Psychol Meas 1982; 6: 431–444.

    Google Scholar 

  11. Kerlinger FN. Foundations of Behavioral Research. New York: Holt, Rinehart and Winston, 1973.

    Google Scholar 

  12. Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States: Relation to age, income, race and other sociodemographic factors. J Am Med Assoc 1992; 267(1): 64–69.

    Google Scholar 

  13. McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36). II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993; 31: 247–263.

    Google Scholar 

  14. Ware JE, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek AE. Comparison of methods for scoring and statistical analysis of SF-36 health profiles and summary measures: Summary of results from the Medical Outcomes Study (MOS). Med Care 1995; 33(Suppl 4): AS264–AS279.

    Google Scholar 

  15. Bjorner JB, Ware JE, Kosinski M, Diamond M, Tepper S, Dowson A, Bayliss MS, Batenhorst AS. Validation of the Headache Impact TestTM using patient-reported symptoms and headache severity. In: Olesen J, Steiner TJ, Lipton RB (eds), Reducing the Burden of Headache. Oxford University Press, 2003.

  16. Kincaid JP, Fishburne RP, Rogers RL, Chissom BS. Derivation of New Readability Formulas (Automated Readability Index, Fog Count and Flesch Reading Ease Formula) for Navy Enlisted Personnel. Memphis, TN: Naval Air Station, 1975.

    Google Scholar 

  17. Lipton RB, Hamelsky SW, Kolodner KB, Steiner TJ, Stewart WF. Migraine, quality of life, and depression: A population-based case-control study. Neurology 2000; 55(5): 629–635.

    Google Scholar 

  18. Meletiche DM, Lofland JH, Young WB. Quality-of-life differences between patients with episodic and transformed migraine. Headache 2001; 41(6): 573–578.

    Google Scholar 

  19. Monson MJ, Lainez MJ. Quality of life in migraine and chronic daily headache patients. Cephalalgia 1998; 18(9): 638–643.

    Google Scholar 

  20. Osterhaus JT, Townsend RJ, Gandek B, et al. Measuring the functional status and well-being of patients with migraine headaches. Headache 1994; 34: 337–343.

    Google Scholar 

  21. Edmeads J, Lainez JM, Brandes JL, Schoenen J, Freitag F. Potential of the Migraine Disability Assessment (MIDAS) Questionnaire as a public health initiative and in clinical practice. Neurology 2001; 56: S29–S34.

    Google Scholar 

  22. Carr-Hill R, Jenkins-Clarke S, Dixon P, et al. Do minutes count? Consultation lengths in general practice. J Health Ser Res Policy 1998; 3: 207–213.

    Google Scholar 

  23. Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML. Burden of migraine in the United States: Disability and economic costs. Arch Intern Med 1999; 159(8): 813–818.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. QualityMetric Incorporated Lincoln, RI, USA

    M. Kosinski, M.S. Bayliss, J.B. Bjorner, J.E. Ware Jr. & W.H. Garber

  2. National Institute of Occupational Health, Copenhagen, Denmark

    J.B. Bjorner

  3. Harvard University School of Public Health, Waltham, MA, USA

    J.E. Ware Jr.

  4. Health Assessment Lab, Waltham, MA, USA

    J.E. Ware Jr.

  5. Tufts University School of Medicine, Boston, MA, USA

    J.E. Ware Jr.

  6. GlaxoSmithKline, Research Triangle Park, NC, USA

    A. Batenhorst

  7. Headache Care Center, Springfield, MO, USA

    R. Cady

  8. Gothenburg Migraine Clinic, Sweden

    C.G.H. Dahlöf

  9. Kings College Hospital, London, UK

    A. Dowson

  10. The New England Center for Headache, Stamford, CT, USA

    S. Tepper

Authors
  1. M. Kosinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.S. Bayliss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J.B. Bjorner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J.E. Ware Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W.H. Garber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Batenhorst
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Cady
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C.G.H. Dahlöf
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Dowson
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Tepper
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kosinski, M., Bayliss, M., Bjorner, J. et al. A six-item short-form survey for measuring headache impact: The HIT-6™. Qual Life Res 12, 963–974 (2003). https://doi.org/10.1023/A:1026119331193

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1026119331193

  • Headache impact
  • Headache impact test (HIT™)
  • Health-related quality of life (HRQOL)
  • HIT-6
  • HIT
  • Item response theory (IRT)
  • Migraine
  • Reliability
  • Validation