neurology

HIT-6 — Headache Impact Test

6-item screening test of headache impact on daily life (Kosinski 2003). Each item 6, 8, 10, 11, or 13 points. Total 36–78. Higher = more impact.

Q1. When you have headaches, how often is the pain severe?*

Q2. How often do headaches limit your ability to do usual daily activities?*

Q3. When you have a headache, how often do you wish you could lie down?*

Q4. In past 4 weeks, how often have you felt too tired to do work / activities because of your headaches?*

Q5. In past 4 weeks, how often have you felt fed up or irritated because of your headaches?*

Q6. In past 4 weeks, how often did headaches limit your ability to concentrate on work or daily activities?*

Score interpretation

Little or no impact 36–49

→ Reassure. Acute therapy as needed. Consider trigger diary.

Some impact 50–55

→ Optimise acute therapy. Consider preventive trial if frequency ≥4/month. Lifestyle.

Substantial impact 56–59

→ Begin preventive (propranolol / topiramate / amitriptyline per NICE CG150). Headache diary, identify medication-overuse.

Severe impact 60–78

→ Specialist headache clinic. Multiple preventives, CGRP mAbs (NICE TA682/764/765), botulinum toxin for chronic migraine (TA260).

Interpretation bands for the HIT-6. Apply clinical judgement and local guidance.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.