Validation of the Headache Impact Test (HIT-6) in patients with chronic migraine

Background: The Headache Impact Test (HIT)-6 was developed and has been validated in patients with various types of headache. The objective of this study was to report the psychometric properties of the HIT-6 among patients with chronic migraine. Methods: Data came from two international, multicenter, randomized, double-blind, placebo-controlled clinical trials of chronic migraine patients (N = 1,384) undergoing prophylaxis therapy. Confirmatory factor analysis and differential item functioning (DIF) analysis were used to test the latent structure and cross-cultural comparability of the HIT-6. Reliability, construct validity, and responsiveness were assessed. Two sets of criterion groups were used: (1) 28-day headache frequency: <10, 10-14, and >= 15 days; (2) sample quartiles of the total cumulative hours of headache: <140, 140 to <280, 280 to <420, and >= 420 hours. Two sets of responsiveness categories were defined as reduction of <30%, 30% to <50%, or >= 50% in (1) number of headache days and (2) cumulative hours of headache. Results: Measurement invariance tests supported the stability of the HIT-6 latent structure across studies. DIF analysis supported cross-cultural comparability. Good reliability was observed across studies (Cronbach's a: 0.75-0.92; intraclass correlation coefficient: 0.76-0.80). HIT-6 scores correlated strongly (-0.86 to -0.59) with scores of the Migraine-Specific Quality-of-Life Questionnaire. Analysis of variance indicated that HIT-6 scores discriminated across both types of criterion groups (P<0.001), across studies and time points. HIT-6 change scores were significantly higher in magnitude in groups experiencing greater improvement (P<0.001). Conclusion: All measurement properties were consistently verified across the two studies, supporting the validity of the HIT-6 among chronic migraine patients.