Outcome Measurement in Behavioral Headache Research: Headache Parameters and Psychosocial Outcomes

Abstract

The experience of pain is complex and includes multiple dimensions or aspects, such as sensory and affective (among others). Headache includes not only pain, but also associated symptoms that can further diversify the relevant dimensions. Subjective ratings of head pain, sampled daily, have come to be regarded as the "gold standard" in behavioral headache research. Primary measures of headache include the attack frequency or headache days per month. Secondary measures of headache may include headache activity/index, headache duration, peak headache severity, and/or frequency of severe headaches per month. Secondary measures of disability and quality of life include Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT), Headache Disability Inventory (HDI). Secondary nonheadache measures include medication consumption, psychiatric symptoms, stress and coping, treatment satisfaction and preference, side effects, and others. Researchers should include not only primary measures of headache, but also secondary measures, disability and quality of life, and nonheadache measures. All measures should be clearly defined and reported. A baseline period that is adequate for each measure needs inclusion and a minimum of 4 weeks is recommended for primary headache measures. Specific suggestions for future research directions are provided.

The Working Mechanism of Manual Therapy in Participants With Chronic Tension-Type Headache

“…According to the International Headache Society classification 21 of headache attributed to medication overuse, we excluded participants with an intake of triptans, ergotamines, or opioids on 10 or more days per month or of simple analgesics on 15 or more days per month on a regular basis for at least 3 months. 2 Participants were also excluded if they had received manual therapy in the 2 months before the study or were not able to read and write Dutch.…”

“…A reduction in headache days of 50% or greater was the clinically relevant outcome. 2 A significant difference of 87.5% versus 27.5% in outcome was found in favor of manual therapy, compared to usual care by the general practitioner, in participants with CTTH. 8 The extent to which specific elements (mobilization, isometric training of neck flexors, or posture correction) contribute to the effectiveness of manual therapy is unknown, and information about the working mechanisms of manual therapy in participants with headache is urgently needed.…”

“…As described by Andrasik et al, 2 we defined a 50% or greater reduction in headache days as the clinically relevant outcome (yes, 1; no, 0). To measure frequency of headache days, participants kept a headache diary to report their headaches during 2-week periods before the baseline and follow-up measurements.…”

Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised, clinical trial

“…We have used the guidelines of the International Headache Society (IHS) for the design of randomised clinical trials for headache to develop the randomisation procedure, outcome measurements and statistical analysis. [21] The procedures and design of this study are approved by …”

Psychological Treatment for Headache: A Pilot Study on the Efficacy of Joint Psychoeducational Group and Relaxation Training

“…According to Andrasik et al [28], we considered as outcome indicators both direct measures of headache (headache days per month) and indirect measures (disability due to headache and medications used). In particular, we examined:…”