Headache Gauge: a real-life calendar-based tool for headache monitoring

DOI: https://doi.org/10.1007/s10072- 021- 05080- x

Abstract-Summary This study aimed to validate a semi-quantitative composite score tool, “Headache Gauge” (HG), to monitor the treatment effect in primary headaches in everyday clinic practice, adjustable to any chosen timeframe.

A cohort validation study of HG was performed in primary headache patients, recovering their clinical data and patient-related outcome measures (PROMs) for headache (HIT-6, MIDAS, HURT), work impact (WPAIQ), quality-of-life (SF-12), and mood (STAI, ZUNG).

HG score distribution, its relation to clinical variables, its internal consistency,

and its convergent validity were determined.

HG was plotted in 233 patients: 90.1% females, age average 37 years, 86% with

migraine, 27% with chronic headaches, and 28% with medication overuse.

HG ranged from 0.21 to 58.3 in this sample, higher in chronic headaches (HG

16) and medication overuse (HG 15).

Extended: Headache Gauge (HG) was developed to monitor disease activity in clinical practice—it consists of a weighted average using calendar-based measures, and aims to translate impact into one percentage value, over any time measure ade- quate for our evaluation; its purpose is not to serve as a comprehensive outcome measure, but rather as a global indicator of disease activity helping clinical decision-making.

Introduction To make things more difficult, primary headache disorders are syndromes involving several symptoms [157]: pain, cognition, gastrointestinal, stimulus aversion, auto- nomic dysfunction, that fluctuate in intensity, frequency, and clinical relevance in different attacks in each patient, and differ across patients.

The need to monitor all these variables produced several patient-related outcome

measures (PROMs) focusing on different aspects of headache impact.

The recommended tool to monitor treatment effects in headache patients in clini- cal practice are headache calendars—recommended by most headache-related sci- entific institutions such as the EHF/LTB [158] and NICE [159].

Headache Gauge (HG) was developed to monitor disease activity in clinical practice—it consists of a weighted average using calendar-based measures, and aims to translate impact into one percentage value, over any time measure adequate for our evaluation; its purpose is not to serve as a comprehensive outcome measure, but rather as a global indicator of disease activity helping clinical decision-making.

Methods The following variables are used: Evaluated time period (N)—number of days to consider in the calculation, including headache and headache-free days Headache

3.2 Medical history

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days—number of days with headache in the chosen time period (ep) Attack duration (AT), ordinal scale: (1) short-lasting, < 2-h attacks; (2) half-day lasting attacks; (3) full-day lasting attacks; and (4) overnight/24-h attacks Attack disability (AD), ordi- nal scale: (1) being able to function with pain; (2) pain interfering with normal activities; (3) pain preventing normal activities; and (4) bedridden or hospitalized Categories of attack duration and disability were chosen by the authors based on usual categories of the most frequently used headache calendars.

The study protocol included routine clinical evaluation, recording of headache- related data (diagnosis, disease duration, preventive treatment use, changes in treat- ment strategies in the current visit, and disease activity measures—headache frequency in the former 30 days, average attack intensity, and average attack dura- tion collected from calendar data).

Results Most followed up patients had a change in their treatment at the first visit (124, 84.9%), 24 (16.4%) on acute treatment, 64 (43.8%) on preventives and 36 (24.7%) on both; there were no differences in treatment strategies between patients that were followed up and those who were not (chi-square = 7.231, p = 0.06) HG scores ranged from 0.21 to a maximum of 58.33, with a median of 7.5 (Q1–Q3: 4.17–14.17).

Patients who had changes in treatment from the first to the second visits (n = 124) had changes in headache frequency (median 1st visit = 6.80, Q1–Q3: 6.00–15.0, versus 6.74, Q1–Q3: 4.47–9.94, Wilcoxon signed-rank test, Z = − 3.310, p = 0.001) and on median HG scores (median 1st visit  =  8.33, Q1–Q3: 4.22–14.28, versus 4.89, Q1–Q3: 2.99–8.31 on follow-up, Wilcoxon signed-rank test, Z = −5.495, p < 0.001).

Discussion Significant correlations with these scores are a measure of concurrent validity of HG and reflect that time spent with headache is a relevant driver of headache-related disability, as perceived by patients.

Test-retest reliability was not as high as desirable, but that can be excepted in episodic disorders such as primary headaches, in which natural history is one of spontaneous fluctuations in frequency of attacks, even without intervention [160]; on the other hand, HG was sensitive to change in treated patients, which supports its use in clinical setting.

Given all these facts, HG seems to be an adequate and versatile semi-quantitative measure with intrinsic value that uses data routinely collected in clinic and trans- lates headache impact; therefore, it can be applied in routine clinical practice to monitor treatment effect.

Acknowledgement A machine generated summary based on the work of Gil-Gouveia, Raquel; Marques, Inês Brás; Parreira, Elsa Paixão; Martins, Isabel Pavão; Oliveira, António Gouveia. 2021 in Neurological Sciences.

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3 Diagnosis

Dilemma of migraine diagnosis and management among non-neurologists