Montefiore Headache Center, Montefiore Medical Center, Bronx, NY 10471, USA.
Headache. 2012 Jan;52(1):3-17. doi: 10.1111/j.1526-4610.2011.02046.x. Epub 2011 Nov 22.
The Headache Impact Test-6 (HIT-6) has been demonstrated to be a reliable and valid measure that assesses the impact of headaches on the lives of persons with migraine. Originally used in studies of episodic migraine (EM), HIT-6 is finding increasing applications in chronic migraine (CM) research.
(1) To examine the headache-impact on persons with migraine (EM and CM) using HIT-6 in a large population sample; (2) to identify predictors of headache-impact in this sample; (3) to assess the magnitude of effect for significant predictors of headache-impact in this sample.
The American Migraine Prevalence and Prevention study is a longitudinal, population-based study that collected data from persons with severe headache from 2004 to 2009 through annual, mailed surveys. Respondents to the 2009 survey who met International Classification of Headache Disorders 2 criteria for migraine reported at least 1 headache in the preceding year, and completed the HIT-6 questionnaire were included in the present analysis. Persons with migraine were categorized as EM (average <15 headache days per month) or CM (average ≥15 headache days per month). Predictors of headache-impact examined include: sociodemographics; headache days per month; a composite migraine symptom severity score (MSS); an average pain severity rating during the most recent long-duration headache; depression; and anxiety. HIT-6 scores were analyzed both as continuous sum scores and using the standard, validated categories: no impact; some impact; substantial impact; and severe impact. Group contrasts were based on descriptive statistics along with linear regression models. Multiple imputation techniques were used to manage missing data.
There were 7169 eligible respondents (CM = 373, EM = 6554). HIT-6 scores were normally distributed. After converting sum HIT-6 scores to the standard categories, those with CM were significantly more likely to experience "severe" headache impact (72.9% vs 42.3%) and had higher odds of greater adverse headache impact compared with persons with EM (OR = 3.5, 95% CI = 2.77-4.41, P < .0001). Significant predictors of adverse headache impact in both groups included younger age, higher MSS score, higher average long-duration headache pain severity rating, and depression. Lower annual household income, anxiety, and higher standardized headache day frequency predicted adverse headache impact in EM but not CM. With few exceptions, gender, race, and body mass index did not significantly predict adverse headache impact. Finally, rates of depression were more than double among persons with CM (CM = 25.2%, EM = 10.0%), and rates of anxiety were nearly triple (CM = 23.6%, EM = 8.5%).
This work further establishes HIT-6 as a useful instrument for characterizing CM and understanding the increased disease related burden. Persons with CM had significantly higher odds of greater adverse headache impact, when compared with EM. Predictors of greater headache impact for both groups included higher MSS scores, higher average headache pain severity, and depression. Additional predictors unique to EM included higher average household income, younger age, higher standardized headache day frequency, and anxiety. This finding may be related to differences in sample size and power. Further exploration is warranted.
头痛影响测试-6（HIT-6）已被证明是一种可靠且有效的衡量标准，可评估偏头痛患者头痛对生活的影响。最初用于发作性偏头痛（EM）的研究，HIT-6 在慢性偏头痛（CM）研究中的应用越来越多。
（1）使用 HIT-6 在大量人群样本中评估偏头痛患者的头痛影响；（2）确定该样本中头痛影响的预测因素；（3）评估该样本中对头痛影响有显著预测作用的因素的效应大小。
美国偏头痛患病率和预防研究是一项纵向、基于人群的研究，通过年度邮寄调查，从 2004 年至 2009 年期间从严重头痛患者中收集数据。参加 2009 年调查且符合国际头痛疾病分类第 2 版偏头痛标准的患者报告在前一年至少有 1 次头痛，并完成了 HIT-6 问卷，被纳入本分析。偏头痛患者分为 EM（平均每月头痛<15 天）或 CM（平均每月头痛≥15 天）。分析的头痛影响预测因素包括：社会人口统计学；每月头痛天数；偏头痛症状严重程度综合评分（MSS）；最近一次长时间头痛期间的平均疼痛严重程度评分；抑郁；和焦虑。HIT-6 评分既可以作为连续总和评分进行分析，也可以使用标准的、经过验证的类别进行分析：无影响；有些影响；实质性影响；严重影响。基于描述性统计和线性回归模型进行组间比较。采用多重插补技术处理缺失数据。
有 7169 名合格的受访者（CM=373，EM=6554）。HIT-6 评分呈正态分布。将总和 HIT-6 评分转换为标准类别后，CM 患者经历“严重”头痛影响的可能性显著更高（72.9% vs. 42.3%），与 EM 患者相比，发生更大不利头痛影响的几率更高（OR=3.5，95%CI=2.77-4.41，P<.0001）。两组中不利头痛影响的显著预测因素均包括年龄较小、MSS 评分较高、平均长时间头痛疼痛严重程度评分较高和抑郁。较低的年家庭收入、焦虑和较高的标准化头痛日频率预测 EM 中不利头痛影响，但不预测 CM。除了少数例外，性别、种族和体重指数对不利头痛影响的预测均无显著差异。最后，CM 患者的抑郁率是 EM 患者的两倍多（CM=25.2%，EM=10.0%），焦虑率几乎是 EM 患者的三倍（CM=23.6%，EM=8.5%）。
这项工作进一步确立了 HIT-6 作为一种有用的工具，用于描述 CM 和了解增加的疾病相关负担。与 EM 相比，CM 患者发生更大不利头痛影响的可能性显著更高。两组中头痛影响更大的预测因素均包括 MSS 评分较高、平均头痛疼痛严重程度较高和抑郁。EM 中特有的其他预测因素包括较高的平均家庭收入、年龄较小、较高的标准化头痛日频率和焦虑。这一发现可能与样本量和功效的差异有关。进一步的探索是必要的。
