HIT-6 (Headache Impact Test, 6-item) is a brief self-report questionnaire measuring headache impact over the past 4 weeks. It’s been a widely-used clinical instrument since 2003 — both in research and standard headache practice — for tracking treatment response visit-to-visit.
The 4-week window makes it particularly useful for monitoring whether a new acute or preventive medication is helping; the MIDAS quarterly window is too long to detect short-term changes.
The 6 questions
Each rated on a 5-point frequency scale (Never / Rarely / Sometimes / Very often / Always), with point values 6 / 8 / 10 / 11 / 13:
- Severity — When you have headaches, how often is the pain severe?
- Limitation of daily activities — How often do headaches limit your ability to do usual daily activities including household work, school, social activities?
- Wishing to lie down — When you have a headache, how often do you wish you could lie down?
- Fatigue — In the past 4 weeks, how often have you felt too tired to do work or daily activities because of your headaches?
- Frustration / annoyance — In the past 4 weeks, how often have you felt fed up or irritated because of your headaches?
- Concentration — In the past 4 weeks, how often did headaches limit your ability to concentrate on work or daily activities?
Sum the 6 item scores. Range: 36 (lowest impact, all “Never”) to 78 (highest impact, all “Always”).
Score interpretation
| Band | Score | Meaning |
|---|---|---|
| Little or no impact | 36–49 | Headaches don’t substantially affect life |
| Some impact | 50–55 | Mild interference |
| Substantial impact | 56–59 | Meaningful interference |
| Severe impact | 60–78 | Major life disruption |
A clinically meaningful change in HIT-6 is approximately 2.3 points (sometimes cited as 5 points for a more conservative threshold). Smaller changes can be within the measurement noise; larger changes likely represent real treatment effect.
HIT-6 vs MIDAS
| Feature | HIT-6 | MIDAS |
|---|---|---|
| Recall window | 4 weeks | 3 months |
| Items | 6 | 5 + 2 informational |
| Output | 36–78 score | Day-based score |
| Time to complete | ~60 seconds | ~90 seconds |
| Best for | Visit-to-visit tracking | Quarterly grading |
In practice, many headache clinics administer both:
- MIDAS at the initial visit and every 3–6 months for baseline and trend grading.
- HIT-6 at every visit for shorter-term treatment response tracking.
Where HIT-6 fits clinically
The score informs several decisions:
- Treatment effectiveness — has HIT-6 dropped meaningfully after starting a new preventive?
- Preventive medication discussion — sustained scores in the severe range (60+) suggest current management isn’t sufficient.
- Disability documentation — for workplace accommodations, insurance prior authorisations, or disability claims.
- Goal-setting — many patients set HIT-6 reduction as an explicit treatment target with their clinician.
Where Hermly fits
Hermly doesn’t currently administer HIT-6 in-app. The data inputs (frequency, severity, “how often did you wish to lie down”) require explicit user response on a fixed schedule — something Hermly could add but hasn’t yet.
The doctor report does include the underlying data (frequency, severity, attack-day counts) that a clinician can use to contextualise a separately-administered HIT-6.
Adding the formal questionnaire as a monthly in-app prompt is a reasonable future feature — particularly because HIT-6’s short 4-week window makes it well-suited for monthly self-administration alongside the existing monthly report.
Where to take HIT-6
The official version is at headachetest.com, freely available. It takes about 60 seconds.
The result is most useful when tracked over time — a single HIT-6 score is informative but limited; a series across months shows whether treatment is moving in the right direction.
What this isn’t
Not a diagnostic tool. HIT-6 measures impact; it doesn’t identify headache type or guide treatment choice. The score is one input among many that a clinician uses to make management decisions.