Abstract
The Global Campaign against Headache, directed by the non-governmental organization Lifting The Burden (LTB) in official relations with the World Health Organization (WHO), aspires to reduce the global burden of headache. Ultimately this calls for improvements in headache management, largely in primary care, where most people with headache receive medical care. In support, LTB is developing a range of headache management aids for primary care. Presently, no single instrument covers the range of assessment and decision-making necessary for successful headache management, and few make the important link between assessment and clinical advice. Expressly to fill this gap, LTB has developed a new instrument: the Headache Under-Response to Treatment (HURT) Questionnaire, an eight-item, self-administered questionnaire addressing headache frequency, disability, medication use and effect, perceptions of headache “control” and knowledge of diagnosis. This instrument is intended not only to evaluate current headache outcomes and assess the need for and response to treatment, but also to provide guidance on appropriate actions towards treatment optimization. The first draft of the HURT was created by an expert consensus group, meeting at WHO headquarters in Geneva, Switzerland. The final version came about through multiple refinements following psychometric testing. Assessment of clinical utility is ongoing in multiple countries.
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Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210.
•• World Health Organization and Lifting The Burden: Atlas of headache disorders and resources in the world. Geneva, WHO; 2011. The Atlas of Headache Disorders presents data on prevalence, burden, treatment, costs, education, and unmet needs in headache worldwide acquired through in a questionnaire survey of neurologists, general practitioners and patients’ representatives from 101 countries, performed from October 2006 until March 2009. Additional relevant data from epidemiological studies were compiled through a systematic review and supplemented by data gathered in population-based studies undertaken within the global campaign.
Silberstein SD, Olesen J, Bousser M-G, et al. The international classification of headache disorders: 2nd Edition. Cephalalgia. 2004;24 suppl 1:1–160.
Lifting The Burden: The Global Campaign against Headache. HURT (Headache Under-Response to Treatment) Index (v 2.2). Available at http://www.l-t-b.org./assets/96/AB9C64EE-D800-01AB-1FAC446E25B0DF88_document/HURT_NY_revision.pdf. Accessed March 2012.
Steiner TJ. World Headache Alliance: lifting the burden: the global campaign against headache. Lancet Neurol. 2004;3:204–5.
Steiner TJ. Lifting The Burden: the global campaign to reduce the burden of headache worldwide. J Headache Pain. 2005;6:373–7.
• Steiner TJ, Birbeck GL, Jensen R, et al. Lifting the Burden: the first 7 years. J Headache Pain. 2010;11:451–5. This article describes the history, conception, guiding principles, goals, and accomplishments of the Lifting the Burden Campaign from 2003 to 2010 as well as works in progress and future plans..
Lipton RB, Bigal ME, Amatniek JC, Stewart WF. Tools for diagnosing migraine and measuring its severity. Headache. 2004;44:387–98.
Steiner TJ. National and international action plans for improving headache diagnosis. In: Olesen J, editor. Classification and diagnosis of headache disorders. Oxford: Oxford University Press; 2004. p. 265–71.
Frishberg BM, Rosenberg JH, Matchar DB, et al., for the U.S. Headache Consortium. Evidence-based guidelines in the primary care setting: neuroimaging in patients with nonacute headache. Available at http://www.aan.com/professionals/practice/guideline/index.cfm. Accessed February 2012.
Matchar DB, Young WB, Rosenberg JH et al. Multispecialty consensus on diagnosis and treatment of headache: pharmacological management of acute attacks. Available at http://www.aan.com/professionals/practice/guideline/index.cfm. Accessed February 2012.
Steiner TJ, Paemeleire K, Jensen R, et al. European principles of management of common headache disorders in primary care. J Headache Pain. 2007;8:S3–47.
Dodick DW. Clinical clues and clinical rules: primary versus secondary headache. Adv Stud Med. 2003;3:S550–5.
Maizels M, Houle T. Results of screening with the brief headache screen compared with a modified ID Migraine. Headache. 2008;48:385–94.
Lipton RB, Dodick D, Sadovsky R, et al. A self-administered screener for migraine in primary care: the ID Migraine validation study. Neurology. 2003;61:375–82.
Maizels M, Wolfe WJ. An expert system for headache diagnosis: the Computerized Headache Assessment tool (CHAT). Headache. 2008;48:72–8.
• Jensen R, Tassorelli C, Rossi P, et al. A basic diagnostic headache diary (BDHD) is well accepted and useful in the diagnosis of headache: a multicentre European and Latin American study. Cephalalgia. 2011;31:1549–60. Researchers investigated the BDHD at headache centers throughout Europe and Latin America. When used in conjunction with clinical interview, the BDHD provides health care professionals with information complete for diagnosis significantly more frequently than interview alone..
Lipton RB, Bigal ME, Ashina S, et al. Cutaneous allodynia in the migraine population. Ann Neurol. 2008;63:148–58.
Andrasik F. Migraine and quality of life: psychological considerations. J Headache Pain. 2001;2:S1–9.
Andrasik F. Psychophysiological disorders: headache as a case in point. In: Andrasik F, editor. Comprehensive handbook of personality and psychopathology, volume two: adult psychopathology. Hoboken: Wiley; 2006. p. 409–22.
• Buse DC, Rupnow MF, Lipton RB. Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life. Mayo Clin Proc. 2009;84:422–35. This article reviews multiple domains of assessment necessary for comprehensive headache care. It introduces and describes the development and psychometric data for the MPQ-5 and MIBS-4 and reviews empirical and guidelines supported pharmacologic and nonpharmacologic approaches to migraine management. Also, several strategies are recommended to improve office visit communication with the intention of improving migraine impact assessment and treatment planning..
Leonardi M, Steiner TJ, Scher AT, Lipton RB. The global burden of migraine: measuring disability in headache disorders with WHO’s Classification of Functioning, Disability, and Health (ICF). J Headache Pain. 2005;6:429–40.
Bussone G, Usai S, Grazzi L, et al. Disability and quality of life in different primary headaches: results from Italian studies. Neurol Sci. 2004;25:S105–7.
Solomon GD, Skobieranda FG, Gragg LA. Quality of life and well-being of headache patients: measurement by the medical outcomes study instrument. Headache. 1993;33:351–8.
Bigal ME, Rapoport AM, Lipton RB, et al. Assessment of migraine disability using the Migraine Disability Assessment (MIDAS) questionnaire: a comparison of chronic migraine with episodic migraine. Headache. 2003;43:336–42.
Bigal ME, Serrano D, Reed M, Lipton RB. Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology. 2008;71:559–66.
Buse DC, Manack A, Serrano D, et al. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. J Neurol Neurosurg Psychiatry. 2010;81:428–32.
Lipton RB, Liberman JN, Kolodner KB, et al. Migraine headache disability and health-related quality-of-life: a population-based case–control study from England. Cephalalgia. 2003;23:441–50.
Ware Jr JE, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.
Ware Jr JE, Sherbourne CD. The MOS 36-item short-form survey (SF-36): I. Conceptual framework and item selection. Med Care. 1996;30:473–83.
Solomon GD. Evolution of the measurement of quality of life in migraine. Neurology. 1997;48:S10–5.
Martin BC, Pathak DS, Sharfman MI, et al. Validity and reliability of the migraine-specific quality of life questionnaire (MSQ Version 2.1). Headache. 2000;40:204–15.
Wagner TH, Patrick DL, Galer BS, Berzon RA. A new instrument to assess the long term quality of life effects from migraine: development and psychometric testing of the MSQOL. Headache. 1996;36:484–92.
El Hasnaoui A, Vray M, Richard A, MIGSEV Group, et al. Assessing the severity of migraine: development of the MIGSEV scale. Headache. 2003;43:628–35.
Stewart WF, Lipton RB, Simon D, et al. Reliability of an illness severity measure for headache in a population sample of migraine sufferers. Cephalalgia. 1998;18:44–51.
Blumenfeld AM, Varon SF, Wilcox TK, et al. Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 2011;31:301–15.
Stewart WF, Lipton RB, Kolodner KB, et al. Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers. Pain. 2000;88:41–52.
Hershey AD, Powers SW, Vockell ALB, et al. Development of a questionnaire to assess disability of migraines in children. Neurology. 2001;57:2034–9.
Steiner TJ. The HALT and HART indices. J Headache Pain. 2007;8:S22–5.
Kosinski M, Bayliss MS, Bjorner JB, et al. A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res. 2003;12:963–74.
Pathak DS, Chisolm DJ, Weis KA. Functional Assessment in Migraine (FAIM) questionnaire: development of an instrument based upon the WHO’s International Classification of Functioning, Disability, and Health. Value Health. 2005;8:591–600.
Cramer JA, Silberstein SD, Winner P. Development and validation of the Headache Needs Assessment (HANA) survey. Headache. 2001;41:402–9.
Dahlof CGH, Dimenäs E. Migraine patients experience poorer subjective well-being/quality of life even between attacks. Cephalalgia. 1995;15:31–6.
Jacobson GP, Ramadan NM, Aggarwal SK, Newman CK. The Henry ford Hospital Disability Inventory (HDI). Neurology. 1994;44:837–42.
Jacobson GP, Ramadan NM, Norris L, Newman CW. Headache disability inventory (HDI): short-term test-retest reliability and spouse perceptions. Headache. 1995;35:534–9.
Buse DC, Bigal ME, Rupnow MFT, et al. The Migraine Interictal Burden Scale (MIBS): results of a population-based validation study. Headache. 2007;47:778.
Scher AI, Bigal ME, Lipton RB. Comorbidity of migraine. Curr Opin Neurol. 2005;18:305–10.
Breslau N, Davis GC, Andreski P. Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults. Psychiatry Res. 1991;37:11–23.
Blanchard EB, Andrasik F, Evans DD, et al. Behavioral treatment of 250 chronic headache patients: a clinical replication series. Behav Ther. 1985;16:308–27.
Jacob RG, Turner SM, Szekely BC, Eidelman BH. Predicting outcome of relaxation therapy in headaches: the role of “depression.”. Behav Ther. 1983;14:457–65.
Holroyd KA, Holm JE, Hursey KG, et al. Recurrent vascular headache: home-based behavioral treatment vs. abortive pharmacological treatment. J Consult Clin Psychol. 1988;56:218–23.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Press; 2000.
Spitzer RL, Kroenke K, Williams JBW, and the Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282:1737–44.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.
Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50:613–21.
Beck AT, Steer RA, Garbing MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77–100.
Beck AT, Steer RA. Manual for the beck depression inventory. San Antonio: Psychological Corporation; 1993.
Beck AT, Epstein N, Brown G, Steer R. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7.
Weathers FW, Litz BT, Herman DS, et al. The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Proceedings of the Annual Conference of the International Society for Traumatic Stress Studies. San Antonio, Texas; October 25, 1993.
Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther. 1996;34:669–73.
Prins A, Ouimette P, Kimerling R, et al. The primary care PTSD screen (PC–PTSD): development and operating characteristics. Primary Care Psychiatry. 2004;9:9–14.
Weathers FW, Huska JA, Keane TM. PCL-C for DSM-IV. Boston: National Center for PTSD Behavioral Science Division; 1991.
Saper JR, Lake AE. Borderline personality disorder and the chronic headache patient: review and management recommendations. Headache. 2002;42:663–74.
Hathaway SR, McKinley JC. The Minnesota multiphasic personality inventory manual. New York: Psychological Corporation; 1983.
Werder DS, Sargent JD, Coyne L. MMPI profiles of headache patients using self regulation to control headache activity. Headache. 1981;21:164–9.
Nicholson RA, Houle TT, Rhudy JL, Norton PJ. Psychological risk factors in headache. Headache. 2007;47:413–26.
Heath RL, Saliba M, Mahmassani O, et al. Locus of control moderates the relationship between headache pain and depression. J Headache Pain. 2008;9:301–8.
Martin NJ, Holroyd KA, Penzien DB. The headache-specific locus of control scale: adaptation to recurrent headaches. Headache. 1990;30:729–34.
VandeCreek L, O’ Donnell F. Psychometric characteristics of the Headache-Specific Locus of Control Scale. Headache. 1992;32:239–41.
Bandura A. Social foundations of thought and action. A social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.
French DJ, Holroyd KA, Pinell C, et al. Perceived self efficacy and headache-related disability. Headache. 2000;40:647–56.
Marlowe N. Stressful events, appraisal, coping, and recurrent headache. J Clin Psychol. 1986;54:247–56.
Nicholson RA, Hursey KG, Nash J. Moderators and mediators of behavioral treatment for headache. Headache. 2005;45:513–9.
Smith T, Nicholson R. Are changes in cognitive and emotional factors important in improving in headache impact and quality of life? Headache. 2006;46:878.
Bond D, Dirge K, Rubingh C, et al. Impact of a self-help intervention on performance of headache management behaviors: a self-efficacy approach. Internet J Allied Health Sci Pract. 2004;2:1–12.
Nicholson RA, Nash J, Andrasik F. A self-administered behavioral intervention using tailored messages for migraine. Headache. 2005;45:1124–39.
Ellis A. Reason and emotion in psychotherapy. New York: Lyle Stewart; 1962.
Holroyd KA, Drew JB, Cottrell CK, et al. Impaired functioning and quality of life in severe migraine: the role of catastrophizing and associated symptoms. Cephalalgia. 2007;27:1156–65.
Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995;7:524–32.
• Buse DC, Andrasik F, Sollars CM. Headaches. In: Andrasik F, Goodie J, Peterson A, editors. Biopsychosocial assessment in clinical health psychology: a handbook. New York: Guilford Press; 2012. This chapter reviews the utility and psychometric properties of a range of instruments useful for headache clinical practice and research in multiple domains..
Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology. 2000;55:754–62.
Matchar DB, Harpole L, Samsa GP, et al. The headache management trial: a randomized study of coordinated care. Headache. 2008;48:1294–310.
Andrasik F, Grazzi L, Usai S, et al. Non-pharmacological approaches to treating chronic migraine with medication overuse. Neurol Sci. 2009;30 Suppl 1:S89–93.
Grazzi L, Andrasik F, Usai S, Bussone G. Treatment of chronic migraine with medication overuse: is drug withdrawal crucial? Neurol Sci. 2009;30 Suppl 1:S85–8.
Silberstein SD. Chronic daily headache. J Am Osteopath Assoc. 2005;105 Suppl 2:S23–9.
Dowson AJ, Tepper SJ, Baos V, et al. Identifying patients who require a change in their current acute migraine treatment: the Migraine Assessment of Current Therapy (Migraine-ACT) questionnaire. Curr Med Res Opin. 2004;20:1125–35.
• Lipton RB, Kolodner K, Bigal ME, et al. Validity and reliability of the migraine-treatment optimization questionnaire. Cephalalgia. 2009;29:751–9. This article describes the development and psychometric evaluation of the MTOQ-5. It also reviews treatment optimization and related clinical concepts..
Revicki DA, Kimel M, Beusterien K, et al. Validation of the revised patient perception of migraine questionnaire: measuring satisfaction with acute migraine treatment. Headache. 2006;46:240–52.
Chatterton ML, Lofland JH, Shechter A, et al. Reliability and validity of the migraine therapy assessment questionnaire. Headache. 2002;42:1006–15.
Lipton RB, Serrano D, Buse DC, et al. The Migraine Prevention Questionnaire (MPQ): development and validation. Headache. 2007;47:770–1.
Buse DC, Pearlman SH, Reed ML, et al. Opioid use and dependence among persons with migraine: results of the AMPP study. Headache. 2012;52:18–36.
Radat F, Irachabal S, Lafittau M, et al. Construction of a medication dependence questionnaire in headache patients (MDQ-H) validation of the French version. Headache. 2006;46:233–9.
Akbik H, Butler SF, Budman SH, et al. Validation and clinical application of the Screener and Opioid Assessment for Patients with Pain (SOAPP). J Pain Symptom Manage. 2006;32:287–93.
Butler SF, Budman SH, Fernandez KC, et al. Development and validation of the current opioid misuse measure. Pain. 2007;130:144–56.
Buse DC, Steiner TJ, Serrano D, et al. Psychometric validity of the lifting the burden Headache Under-Response to Treatment (HURT) Index: a new instrument developed to improve management of headache. Headache. 2010;50:S42–3.
Buse DC, Steiner TJ, Serrano D, et al. The Headache Under-Response to Treatment (HURT) index: an outcome measure to improve management of headache, especially in primary care. Neurology. 2010;74 Suppl 2:A323.
Al Jumah M, Al Khathaami A, Kojan S, et al. HURT Index in primary care: reliability and impact on headache management and patients’ satisfaction. J Neurol. 2010;257:S98.
Acknowledgements
The authors acknowledge the individuals who contributed to the development and testing of the HURT Questionnaire, including Dr. Manuela Fontebasso; Dott. Francesco S. Mennini; Susan W. Broner, MD; Ms. L. Ulla C. Schultz; and the members of the Lifting The Burden Outcome Measures Working Group. Additionally, we want to thank Daniel Serrano, PhD and Michael L. Reed, PhD for their work on the development and psychometric testing of the HURT Questionnaire, and Frank Andrasik, PhD for contributing psychometric information contained in this review.
Disclosures
Dr. Dawn C. Buse has received honoraria from Allergan Pharmaceuticals, Merck, Inc., MAP Pharmaceuticals, NuPathe, and Novartis. Dr. Timothy J. Steiner has received grants, honoraria, and/or research support from Actavis, AstraZeneca, Bayer Healthcare, and Merck and Co., and is a member of an advisory board to Bayer Healthcare. C. M. Sollars: none. Dr. Rigmor Højland Jensen is a member of the scientific advisory boards of Allergan Pharmaceuticals, ATI, Medotech, Neurocore, and Merck, Inc., and has received honoraria from Pfizer, Allergan, ATI, Medotech, Neurocore, and Merck, Sharpe, & Dohme. Dr. Mohammed A. Al Jumah has received research grants support or honoraria from Merck, Serono, Pfizer, Bayer, and Novartis. Dr. Richard B. Lipton has received grants and/or honoraria from Advanced Bionics, Allergan Pharmaceuticals, Endo Pharmaceuticals, GlaxoSmithKline, Minster, Merck, Inc., Neuralieve, Novartis, OrthoMcNeil, Pfizer, and ProEthics/KOWA.
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Buse, D.C., Sollars, C.M., Steiner, T.J. et al. Why HURT? A Review of Clinical Instruments for Headache Management. Curr Pain Headache Rep 16, 237–254 (2012). https://doi.org/10.1007/s11916-012-0263-1
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DOI: https://doi.org/10.1007/s11916-012-0263-1