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Disease & Conditions >>> Headache Articles & News



Realizing The Impact Of Headaches On Your Life



By: Richard B. Lipton, MD

How bad are your headaches? When a migraine strikes, it may seem like the worst pain in the world and you would do anything to stop it. Once the attack is over, you may push the problem out of your mind, hoping youíve had your last horrible migraine and your life will never again be turned upside down by pain.

Ironically, while coworkers or family members sometimes suspect them of exaggerating their pain, migraine sufferers may tend to deny or underestimate the severity of their illness during their headache-free periods. That denial can create a powerful barrier to finding effective treatment. Studies have shown that only about one-third of U.S. migraine sufferers are receiving medical care at any given point in time. When over-the-counter medications relieve pain and disability they are an excellent option, but many people who rely on self-treatment would benefit from medical care.



The Impact Questionnaire
The disability resulting from headache (for example, work absenteeism or reduced functioning at work, school or home) is the greatest dollars-and-cents cost associated with this illness. Since level of pain is subjective and hard to measure, a tool for assessing headache-related disability could be quite useful for evaluating the need for treatment and the success of treatment.

With Dr. Walter Stewart at Johns Hopkins I have developed a questionnaire for capturing information about pain and headache-related disability, to help doctors and patients evaluate the impact of headache on the individualís daily life. We have tested the Headache Impact Questionnaire with 172 migraine sufferers who were identified and enrolled in the study after more than 5000 phone interviews (identifying 800 migraine sufferers) with randomly selected households. By comparing each volunteerís answers with their entries in a headache diary, we demonstrated the questionnaireís accuracy in capturing headache information. By testing and re-testing another group of 117 volunteers we showed that the questionnaire yielded consistent results: Respondents gave similar answers upon re-testing 4-8 weeks later.

The Headache Impact Questionnaire that has been tested and validated requires some mathematics to analyze the results. A simpler self-test version is now in development. In the meantime, you may get some insight into your own headache-related disability simply by recording the answers to the items on the Headache Impact Questionnaire (see below). These answers may help you explain to your doctor how headaches are affecting your life.



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Communicating with Your Doctor
Studies have shown that doctors and patients may not communicate about headache-related disability. When headache sufferers complain of terrible pain, doctors tend to respond with reassurance, "Donít worry, itís only a migraine." Patients often donít say how the headache attacks are affecting their lives, and doctors are trained to focus on symptoms and diagnosis rather than the impact of the illness. However, if the patient spells out the impact of the painó"Iím missing 2 days of work every month and I might get fired" or "I couldnít take care of my baby while I was sick"ódoctors usually respond taking the problem more seriously.

We hope that use of the Headache Impact Questionnaire will help to improve doctor-patient communication. First of all, it draws the patientís and the doctorís attention to the impact of migraine. Headache-related disability is expressed as so many hours or days of lost productivity and functioning, so itís relatively simple to measure the impact of headache at the time of the first doctorís visit, and later to track the effectiveness of the prescribed therapy. For people experiencing significant disability and reduced functioning because of headache, using the Headache Impact Questionnaire may help assess the need for more aggressive or expensive treatment.

We also hope that the Headache Impact Questionnaire will prove useful to researchers involved in population-based studies of headache severity or in evaluating the effectiveness of various treatment options. In fact, the questionnaire is now being tested in clinical trials of new headache medications.

--Richard B. Lipton, MD. The Headache Unit, Montefiore Medical Center and the Departments of Neurology and Epidemiology, Albert Einstein College of Medicine. Bronx, NY
The Impact of Headache
Question Response
On how many days in the last 3 months have you had a headache? _______
How would you rate the pain from your headaches on a scale from 0 to 10 (0 is ‘no pain at all’ and 10 is ‘pain as bad as it can be’)? _______
How many days in the last 3 months have you been kept from work activities (work or school) for at least half of the day because of your headaches? _______
When you have a headache while you work (work or school), how much is your ability to work reduced? (0% is ‘not reduced at all’ and 100% is ‘unable to work’). _______
How many days in the last 3 months have you been kept from doing housework or chores for at least half of the day because of your headaches? _______
How much is your ability to do housework or chores reduced? (0% is ‘not reduced at all’ and 100% is ‘unable to work’). _______
How many days in the last 3 months have you been kept from non-work activities (family, social or recreational) because of your headaches? _______
How much is your ability to engage in non-work activities (family, social or recreational) reduced? (0% is ‘not reduced at all’ and 100% is ‘unable to do activities’). _______





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