The Headache-Attributed Lost Time (HALT) Indices: measures of burden for clinical management and population-based research

DOI: https://doi.org/10.1186/s10194- 018- 0837- 3

Abstract-Summary The burden attributable to headache disorders has multiple components: a simple measure summarising them all does not exist.

The Migraine Disability Assessment (MIDAS) instrument has proved useful, estimating productive time lost in the preceding 3 months due to the disabling effect of headache.

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We developed adaptations of MIDAS for purposes of the Global Campaign against Headache, embracing epidemiological studies and the provision of clinical management aids.

We reviewed the structure, content, wording and scoring of MIDAS and made revisions, developing the Headache-Attributed Lost Time (HALT) Indices in three versions.

HALT-7/30 was a variant of HALT-30: focusing only on lost work time for population- based studies of headache-attributed burden, it enquired into lost days in the preceding month (30 days) and week (7 days).

Three versions of the HALT Indices serve different purposes as measures of

headache-attributed burden, and offer different means of scoring.

In studies using HALT as a population measure, there is no need to reflect the states of individuals, whereas a measure over shorter periods than 3 months is likely to be more reliable through better recall.

Extended: The burden attributable to headache disorders has multiple compo- nents: there are many ways in which recurrent or persistent headache can damage life [50].

The Migraine Disability Assessment (MIDAS) instrument developed by Stewart

and Lipton [237] has proved extremely useful.

We reviewed the structure, content, wording and scoring of MIDAS and made

revisions, having in mind the purposes.

Three versions of the HALT Indices have been developed to serve different pur-

poses as measures of headache-attributed burden (see below).

Background The burden attributable to headache disorders has multiple components: there are many ways in which recurrent or persistent headache can damage life [50].

Even developing a measure of one aspect of burden that is applicable equally to

all of the important headache disorders is a challenge.

It is important to recognise that, despite its name, MIDAS is not truly a measure of disability: unless headache is very severe, people have an element of choice in whether or not to take time out of work or other activities when affected by headache. Because productive time is an important casualty of headache, its measurement

is highly relevant to assessment of burden attributable to headache.

This manuscript describes the development and use of various adaptations to

MIDAS: the Headache-Attributed Lost Time (HALT) Indices.

Methods Over 10  years, this was employed, usually as a module imported into the much larger Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire [50], in published population-based stud- ies in China [4], India [263], Nepal [264], Pakistan [265], Ethiopia [266], Zambia [204], Russia [267], Lithuania [268], Italy [269] and eight other countries of the European Union [131], and in other studies not yet completed or published in Mongolia, Saudi Arabia, Morocco, Peru and Guatemala.

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Learning from these studies, we developed alternative versions that might be bet- ter adapted both for certain population studies and for purposes of aiding clinical management.

Further studies made use of one or more versions in different settings: estimation of headache-attributed burden in a workforce in Turkey [270, 271], headache ser- vice quality evaluation in headache centres around Europe [272, 273] and education of primary-care physicians in headache management in Estonia [274, 275].

Results In its first five questions, MIDAS enquired into days affected by headache during the preceding 3 months (90 days) [237].

As did MIDAS, the original HALT (which later became known as HALT-90) recorded days affected by headache during the preceding 3  months (90  days) [237, 276].

Of these, HALT-30 kept the same structure, question format and wording except

that “3 months” was replaced by “1 month”.

HALT-7/30 was a variant of HALT-30: focusing only on lost work time, it

enquired into lost days in the preceding month (30 days) and week (7 days).

Discussion Other purposes for which headache impact might be measured in individuals are found in studies of populations and groups, often conducted as needs assessments to inform health policy and resource allocation [4, 50, 131, 204, 263–271, 277].

In studies of large groups using HALT as a population measure, there is no lon- ger a need to reflect the states of individuals, whereas a measure over shorter periods than 3 months is likely to be more reliable through better recall [50].

HALT-30 quantifies each individual’s headache burden over the preceding

30 days.

For population-based studies of headache-attributed burden, including financial cost, HALT-7/30 enquires into lost work days only, in the preceding month (30 days) and week (7 days).

HALT can generate three summed scores from the first four questions, the unit of each being whole days per period of enquiry: (a) lost work time; (b) lost house- hold work time; and c) total lost productive time—the sum of (a) and (b).

Acknowledgement A machine generated summary based on the work of Steiner, T. J.; Lipton, R. B.; Jumah, M. Al; Al-Khathami, A.; Allena, M.; Andrée, C.; Ayzenberg, I.; Braschinsky, M.; Gil-Gouveia, R.; Gökmen, G.; Gururaj, G.; Herekar, A.; Katsarava, Z.; Kissani, N.; Kulkarni, G.; Lainez, M.; Lampl, C.; Lantéri-Minet, M.; Linde, M.; Luvsannorov, O.; Manandhar, K.; Mbewe, E.; Quispe, G.; Rao, G.; Rastenytė, D.; Risal, A.; de la Torre, E. Ruiz; Schramm, S.; Selekler, M.; Stokes, H.; Brackett, A. C. Stokes; Stovner, L. J.; Tassorelli, C.; Tekle-Haimanot, R.; Vriezen, P.; Yu, S.-Y.; Zebenigus, M. 2018 in The Journal of Headache and Pain.

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