Family Impact of Migraine: Development of the Impact of Migraine on Partners and Adolescent Children (IMPAC) Scale

Abstract

ObjectiveTo describe the development of the Impact of Migraine on Partners and Adolescent Children (IMPAC) scale.BackgroundAlthough existing data and clinical experience suggest that the impact of migraine is pervasive and extends beyond the individual with migraine, no validated tools exist for assessing the impact of migraine on the family.MethodsThe Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a longitudinal study of people with migraine in the United States. The Family Burden Module (FBM) of the CaMEO Study contained an item pool of 53 questions derived through literature review, clinician input, and patient focus groups pertaining to the following concepts: impact of migraine on family interpersonal relationships, activities, well‐being, finances, and health‐related quality of life. Respondents with migraine (ie, probands) were categorized into 4 groups based on household composition: migraine probands with partners/spouses and children (M‐PC), migraine probands with partners/spouses only (M‐P), migraine probands with child(ren) only (M‐C), and migraine probands without a partner/spouse or child(ren) (M‐O). The IMPAC scale was developed in 3 steps: (1) exploratory factor analysis and item reduction, (2) bifactor analysis, confirmatory factor analysis, and scoring, and (3) reliability and construct validity analyses.ResultsThe analysis of data from 13,064 respondents to the FBM meeting criteria for migraine yielded a 12‐item IMPAC scale, with 4 items applying to all of the groups, 4 more items applying to the groups with partners (M‐P and M‐PC), and 4 additional items to the groups with children (M‐C and M‐PC). Item responses can be summed and converted into a scoring system assessing mild (<0.5 SD below mean; IMPAC scale Grade I), moderate (0.5 SD below to <0.5 SD above mean; Grade II), severe (0.5‐<1.5 SD above mean; Grade III), and very severe (≥0.5 SD above mean; Grade IV) family impact. Test information curves relating to the IMPAC scale for each household type indicated adequate reliability across a large range of family burden severity (from ∼1 SD below to ∼3 SD above mean) and IMPAC scores showed moderate‐to‐large correlations with other validated tools (range, ± 0.38‐0.52), providing support for construct validity.ConclusionsWe developed a questionnaire to assess family burden attributed to migraine that is brief, robust, and psychometrically sound, with a simple scoring algorithm that can be applied to various household compositions. This questionnaire may be valuable in research settings to provide quantifiable data on the impact of migraine on family dynamics and in clinical settings to facilitate conversations about family burden as a target and a motivation for better treatment.

Content Validity of HIT‐6 as a Measure of Headache Impact in People With Migraine: A Narrative Review

“…32 Migraine (793) At least 75% of focus group participants (3 focus groups, n = 10-15 per group) listed pain relief as important or very important Hartmaier et al, 1995 34 Migraine (82) Migraine impairments were generated from 6 one-on-one interviews with migraine patients. Presented to 76 new patients to indicate if they experienced an impairment or not and to rate impairments for importance, "throbbing head pain" was an impairment experienced by 91% and has a mean importance of 4.47 on a 1-5 scale Mannix et al, 2016 36 Migraine (literature review/9 articles) "… intensity of the migraine often had a direct and immediate impact on their ability to function …" Peters et al, 2005 37 Migraine (13) "Impact was a relative concept that was influenced by pain severity and headache frequency" Ruiz de Velasco et al, 2003 38 Migraine (29) "And when the pain is very, very severe there are times when I can't get to sleep because of the pain" "The pain is excruciating, unbearable" "… because your whole body hurts, and you feel pain when there is any kind of noise, light, anything at all …" "In my case, for example, I was in pain every Sunday …"…”

“…26 Additional PROMs located in the course of the literature search were also reviewed, again focusing on content validation information. These PROMs included Headache Activities of Daily Living Index, 27 Completeness of Response Survey, 28 Impact of Migraine on Partners and Adolescent Children scale, 29 Functional Assessment in Migraine questionnaire, 30 Migraine-Specific QoL instrument, 31 Patient Perceptions of Migraine questionnaire 32 (and its revised version 33 ), and 24-hour Migraine QoL Questionnaire. 34 The basic search function of the National Library of Medicine, via PubMed (with minimal use of filters or specific field identifiers), was used (eg, "headache impact test" [All Fields]).…”

When Mom Has Migraine: An Observational Study of the Impact of Parental Migraine on Adolescent Children

“…Although using a validated measure of parental illness impact has several advantages, including being able to compare this sample to previous studies in different neurologic conditions, it is also likely we failed to capture potentially important domains of the impact of parental migraine on children. Future studies should consider using both the PIIS-R (14) and the Impact of Migraine on Partners and Adolescent Children Scale (IMPACS) 25 and to more fully capture the impact of parental migraine on children. Finally, this study relied on survey methodology, which allowed us to evaluate the impact of parental migraine on children quantitatively.…”

Migraine Burden of Disease: From the Patient's Experience to a Socio‐Economic View

“…A longitudinal, U.S. internet‐based study investigated the impact of migraine on the family from the perspective of patients and their spouses . The survey employed a questionnaire that was specifically designed to provide quantifiable data on the impact of migraine on family . Usable data came from 58,418 (72.3%) of those who responded to the survey .…”