ASSESSING HEADACHE SEVERITY - NEW DIRECTIONS

Headache is a heterogeneous condition that varies widely in global sev erity and in severity of individual attacks. Whereas recent efforts ha ve focused on improving the diagnostic criteria for classifying headac he, less effort has been directed toward developing reliable, valid, a nd clinically useful methods of assessing the impact or severity of he adache. Existing measures of severity include one or more of the follo wing weaknesses: (1) only pain intensity is assessed or the measure is incomplete in other ways, (2) measures have little or no prognostic v alue for relevant outcomes, (3) the reliability or the validity of the measure has not been assessed, or (4) the measure is too cumbersome f or clinical practice or field research. We describe a brief, simple me thod for grading the severity of headache, the Chronic Pain Index, whi ch assumes that a continuum of pain intensity and disability is the un derlying dimension of severity. Along this continuum, lower levels of severity are differentiated by pain intensity and higher levels by int erference with function. The prognostic value of the results from a se ven-item questionnaire for grading headache severity is compared with that of alternative measures. The Chronic Pain Index showed the strong est independent cross-sectional and prospective correlation with measu res of headache impact, depression, and use of healthcare services. Th ese results support the potential utility of brief methods of assessin g headache severity and exemplify the importance of including measures of interference with function when assessing severity.