A six-item short-form survey for measuring headache impact: the HIT-6.

Kosinski M, Bayliss MS, Bjorner JB, Ware JE Jr, Garber WH, Batenhorst A, Cady R, Dahlof CG, Dowson A, Tepper S.

QualityMetric Incorporated Lincoln, RI 02865, USA. mkosinski qualitymetric.com

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.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14651415&dopt=Abstract headache medicine




Using item response theory to calibrate the Headache Impact Test (HIT) to the metric of traditional headache scales.

Bjorner JB, Kosinski M, Ware JE Jr.

Quality Metric Incorporated, Lincoln, RI 02895, USA. jbjorner qualitymetric.com

BACKGROUND: Item response theory (IRT) scoring of health status questionnaires offers many advantages. However, to ensure 'backwards comparability' and to facilitate interpretations of results, we need the ability to express the IRT score in the metrics of the traditional scales. OBJECTIVES: To develop procedures to calibrate IRT-based scores on the Headache Impact Test (HIT) into the metrics of the traditional headache scales. To assess the degree to which the calibrated HIT scores agree with the observed traditional scores and lead to the same conclusions in group comparisons. METHODS: We used telephone interview data (n = 1016) and Internet data (n = 1103) from general population surveys of recent headache sufferers. Analyses were conducted in four steps: (1) develop IRT models for all items, (2) for each IRT score level, calculate the expected score on each of the traditional scales (calibration), (3) adjust this calibrated score for measurement error in the IRT score, (4) for each of the traditional scales, assess agreement between calibrated HIT scores and observed scores using intraclass correlation (ICC) and evaluate the agreement of mean scores and the relative validity (RV) in discriminating among groups differing in migraine diagnosis, headache severity, and change in impact over time. RESULTS: For the traditional categorical questionnaire items (the Migraine Specific Questionnaire (MSQ) and the Headache Disability Inventory (HDI)) the calibrated HIT agreed with the observed traditional scores: ICC's were between 0.80 and 0.94. In RV analyses the maximum mean difference between the observed and expected scores was 1.7 points on a 0-100 scale for comparisons at one point in time. Analyses of change over time and analyses calibrating scores from the fixed-form HIT-6 to the metric of other questionnaires were also satisfactory although less precise. Analysis of non-standard questionnaire items (e.g. On how many days in the past 3 months did you have a headache, from the HIMQ and the MIDAS) required special IRT models. Agreement was less good: ICC's were between 0.56 and 0.61 and the maximum mean differences were 2.9 (on a 0-270 scale) and 3.8 (on a 0-450 scale) in RV analyses at one point in time. The ability of the calibrated scale scores to discriminate between groups was at least as good as the ability of the observed sum scales and often remarkably better. CONCLUSION: The theoretical advantage of IRT models in scale calibration is supported by our results. This approach to achieving comparability of new and widely-used scales and accelerating the accumulation of interpretation guidelines based on previous work warrant testing for measures of other generic and disease-specific concepts.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14651417&dopt=Abstract headache medicine




Children who suffer from headaches--a narrative of insecurity in school and family.

Odegaard G, Lindbladh E, Hovelius B.

Department of Primary Health Care Research, Lund University, S-22185 Lund, Sweden.

BACKGROUND: Headaches are common among schoolchildren, who seem to be afflicted increasingly. AIM: To analyse children's descriptions of their headaches and their thoughts about them, it being assumed that children have insight into the conditions that affect their health. DESIGN OF STUDY: Interview study. SETTING: Two state schools in the city of Malmo, Sweden. METHOD: Fourteen children aged between ten and 12 years, who had gone to the school nurse more than once during the previous two-month period complaining of a headache, took part in thematically structured interviews. Qualitative analysis was performed, aimed at identifying the basic themes involved. RESULTS: The children were found to consistently associate their headaches with conditions in school, specifically with more theoretically-oriented subjects (maths or Swedish), a noisy and disorderly school environment, and insecure relations with classmates. The second theme they took up was insecurity or conflict within the family. Reports of this constituted a major part of the children's accounts of their life situation, despite their failing to link such matters with their headaches. Many of the children considered their patterns of reacting, such as feeling unable to cope or becoming angry, as contributing to their getting headaches. CONCLUSIONS: The children related their headaches consistently to everyday situations and to their relations with others. This highlights the need for broadening the consultation in terms of including personal and contextual factors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14694697&dopt=Abstract headache medicine




Postmenopausal hormone therapy and migraine headache.

Misakian AL, Langer RD, Bensenor IM, Cook NR, Manson JE, Buring JE, Rexrode KM.

University of California-San Diego School of Medicine, San Diego, California, USA.

BACKGROUND: Estrogen withdrawal has been described as a trigger for migraine headache, and some studies suggest that estrogen and progestin may exacerbate migraine. No population-based studies have examined the association between hormone therapy (HT) and migraine among postmenopausal women. METHODS: To examine the association between HT and migraine headache in postmenopausal women, we used self-report of HT use, HT characteristics, and migraine headache within the past year among 17,107 postmenopausal female health professionals enrolled in the Women's Health Study. RESULTS: Analyses were restricted to the 17,107 of 21,788 postmenopausal women who were postmenopausal at baseline and who were never (38.5%) or current (61.5%) users of HT. Of these, 1,909 (11.2%) experienced migraine headache within the last year. Women with migraine headache were significantly younger, had a younger age at menopause, were more likely to have had a surgical menopause, and were more likely to be current users of HT. After adjusting for age, race, smoking, alcohol use, ever use of oral contraception, age at menopause, and menopause type, the odds ratio (OR) for migraine headache was 1.42 (95% CI 1.24-1.62) for women who were current users of HT compared with never users. ORs were similar for users of estrogen alone (OR 1.39, 95% CI 1.14-1.69) and users of both estrogen and progestin (OR 1.41, 95% CI 1.22-1.63). CONCLUSIONS: In this cross-sectional study, current HT use was associated with higher rates of migraine headache than nonuse. Clinical trials are needed to determine if HT increases the incidence of migraine in postmenopausal women.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14709191&dopt=Abstract headache medicine




Reliability of the nitroglycerin provocative test in the diagnosis of neurovascular headaches.

Sances G, Tassorelli C, Pucci E, Ghiotto N, Sandrini G, Nappi G.

Headache Unit, University Centre for Adaptive Disorders and Headache, IRCCS C Mondino Foundation Institute of Neurology, Pavia, Italy. grazia.sances mondino.it

Nitroglycerin administration provokes spontaneous-like migraine attacks in migraine and cluster headache (CH) patients. Nitroglycerin-induced migraine-like headache has been used as an experimental model of migraine. In this paper, we evaluate the possibility of using the nitroglycerin provocative test (NPT) as a supportive measure in the diagnosis of primary neurovascular headaches by assessing its reliability on a large population and adopting strict criteria for rating the response as positive or negative. Our population consisted of 197 migraineurs, 42 subjects suffering from cluster headache and 53 healthy controls. In migraine without aura, the test sensitivity was 82.1%, specificity 96.2% and accuracy 85.5%, while in subjects suffering from migraine with aura, the reliability of the NPT was less satisfactory (sensitivity 13.6%, specificity 96.2% and accuracy 72%). In CH patients tested during the active phase of the disease the sensitivity was 80.6%, specificity 100% and accuracy 92.9%. NPT is an easy, low-cost and reliable method for supporting the diagnosis of migraine without aura and cluster headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14728706&dopt=Abstract headache medicine




The pattern--reversal visual evoked potentials in children with migraine with aura and without aura.

Bockowski L, Sobaniec W, Smigielska-Kuzia J, Kulak W, Solowiej E.

Department of Pediatric Neurology, Medical University of Bialystok, SP DSK, ul. Waszyngtona 17, 15-274 Bialystok, Poland. bockow kki.pl

PURPOSE: Studies of the visual evoked potentials (VEP) in migraine have yielded contradictory results. Several investigators suggested that VEP may be helpful test in diagnosis of a child with headache. The aim of our study was to compare interictal pattern-reversal visual evoked potentials (PR-VEP) in children and adolescents with migraine and tension-type headaches and to evaluate VEP parameters in migraine with and without aura. MATERIAL AND METHODS: The study was carried out in 93 children and adolescents aged 7-18 years with attack headaches. RESULTS: 51 children had diagnosed migraine. In this group 30 children (59%) had migraine without aura (MO), 12 children (23.5%) migraine with aura (MA) and 9 (17.5%) patients other variants of migraine (MV): hemiplegic, ophthalmoplegic, basilar. In control group 42 children were classified as tension-type headaches. All children had PR-VEP performed in headache-free period, without prophylactic treatment. The P100 mean latency was significantly longer in migraine than in tension-type headache. Amplitudes N1-P100 and P100-N2 were significantly larger in migraneurs compared with tension-type headache. The mean amplitudes of N1-P100 and P100-N2 were significantly lower in MA compared with group MO. There were no statistically significant differences of other PR-VEP parameters between MA, MO, MV. If we compare individual results of each patient with migraine with mean value +/- 2 standard deviations (SD) of tension-type headaches group, only 25% have VEP abnormalities of latency or amplitude above 2SD value in tension-type headache group. CONCLUSIONS: The diagnosis of migraine in children actually remains predominantly based on medical history, due to low sensitivity and specificity of electrodiagnostic tests in headaches. However PR-VEP may support the diagnosis of migraine in some cases. VEP could be also helpful method in studying the pathogenesis of different forms of migraine. VEP abnormalities in migraine can be related to a cortical spreading depression and a central neurotransmitter alterations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14737964&dopt=Abstract headache medicine




Relationship between chronic tension-type headache, cranial hemodynamics, and cerebrospinal pressure: study involving provocation with sumatriptan.

Hannerz J, Jogestrand T.

Department of Neurology, Karolinska Hospital, Huddinge University Hospital, Stockholm, Sweden.

OBJECTIVE: To study the relationship between chronic tension-type headache, cranial hemodynamics, and cerebrospinal pressure. BACKGROUND: Cerebrospinal pressure has been found to be above 200 mm in about 50% of patients with chronic tension-type headache. METHODS: Heart rate, blood pressure, common carotid artery diameter and blood flow, and craniovascular resistance and pain at regular intervals before, during, and after head-down tilt-a procedure which increases cerebrospinal pressure, were recorded. After head-down tilt, subcutaneous injections of either placebo or 6 mg of sumatriptan were administered. Chronic tension-type headache intensity before and after withdrawal of 20 mL of cerebrospinal fluid was documented. Cerebrospinal pressure and chronic tension-type headache intensity were measured after subcutaneous injection of 6 mg of sumatriptan. RESULTS: Head-down tilt provoked an increase of headache compared with baseline. Common carotid artery blood flow decreased and craniovascular resistance increased after sumatriptan injection, but not after placebo injection. The pain decreased after head-down tilt and placebo injection, but not after sumatriptan injection. Chronic tension-type headache intensity decreased in all 4 patients studied after withdrawal of 20 mL of cerebrospinal fluid. Cerebrospinal pressure increased in 5 patients with chronic tension-type headache after subcutaneous injection of 6 mg of sumatriptan with slight or no increase of pain. CONCLUSION: The results indicated that cerebrospinal pressure or intracranial venous pressure (or both) are related to chronic tension-type headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14756854&dopt=Abstract headache medicine