How to Interpret the HIT-6 Headache Assessment
The HIT-6 is scored from 36 to 78 points, with a score of ≥60 indicating severe impact, 56-59 substantial impact, 50-55 moderate impact, and ≤49 little to no impact; a decrease of ≥6 points represents clinically meaningful improvement in patients with chronic migraine. 1
Scoring Categories and Clinical Interpretation
The HIT-6 provides four distinct impact categories that directly correlate with headache severity and quality of life impairment 2:
- Severe impact (≥60 points): Indicates the highest level of disability; 66% of headache patients consulting general practitioners fall into this category 2
- Substantial impact (56-59 points): Represents significant functional impairment requiring intervention 2
- Moderate impact (50-55 points): Indicates measurable but less severe disability 2
- Little to no impact (≤49 points): Minimal functional impairment from headaches 2
Using HIT-6 to Guide Treatment Decisions
The Mayo Clinic recommends using the HIT-6 as a standard tool in primary care to monitor chronic migraine patients and establish treatment plans. 3
The HIT-6 score should inform your clinical decision-making in the following ways:
- Scores ≥60: These patients require aggressive intervention with both acute and preventive therapy, as they experience severe disability 2
- Preventive therapy consideration: When HIT-6 scores remain elevated despite optimized acute treatment, this signals the need for preventive medications 3
- Treatment monitoring: Reassess HIT-6 scores at follow-up visits to objectively measure treatment response 3
Defining Meaningful Treatment Response
A reduction of ≥6 points on the HIT-6 total score represents clinically meaningful improvement in chronic migraine patients. 1
This threshold was established through rigorous anchor-based and distribution-based methods in chronic migraine populations 1. When evaluating treatment efficacy:
- ≥6-point decrease: Indicates the patient has experienced meaningful functional improvement 1
- <6-point change: Suggests treatment adjustment is needed 1
For individual item analysis, meaningful improvement varies by question 1:
- Items 1-3 (severe pain, limits daily activities, need to lie down): A 1-category improvement (e.g., from "Sometimes" to "Rarely") is clinically meaningful 1
- Items 4-6 (too tired, fed up/irritated, limits concentration): A 2-category improvement (e.g., from "Always" to "Sometimes") is clinically meaningful 1
Correlation with Other Clinical Measures
The HIT-6 demonstrates strong validity across multiple dimensions 4:
- Headache frequency: Scores discriminate well between patients with <10-14, and ≥15 headache days per month 4
- Quality of life: HIT-6 correlates strongly (r = -0.59 to -0.86) with the Migraine-Specific Quality-of-Life Questionnaire 4
- Diagnostic groups: Scores are significantly higher in migraine patients compared to other headache types 2
Practical Application in Clinical Practice
Implement the HIT-6 at baseline and every 2-3 months during treatment to objectively track functional impact and guide therapy adjustments. 3
The HIT-6 has excellent psychometric properties for clinical use 5, 6:
- Reliability: Internal consistency (α = 0.89), test-retest reliability (0.80), with 95% confidence intervals of ±5 points for 88% of respondents 5
- Validity: Accurately classifies migraine probability 88.7% of the time at recommended cut-off scores 5
- Responsiveness: Sensitive to self-reported changes in headache impact over time 5
Common Pitfalls to Avoid
- Do not use HIT-6 scores in isolation: Always combine with headache diaries documenting attack frequency, duration, and medication use to get the complete clinical picture 3
- Do not ignore persistently high scores: HIT-6 scores ≥60 despite treatment indicate the need for treatment escalation or specialist referral 3
- Do not overlook medication overuse: High HIT-6 scores with frequent acute medication use (>2 days/week) suggest medication-overuse headache, which requires a different management approach 3