What HIT-6 can answer
A pain rating cannot show whether headaches made you miss work, stop cooking, lie down, lose patience, or read the same sentence again. HIT-6 gives those four weeks one number. Read it with a headache diary, unusual symptoms, and what you could not do. A high score means headaches affected life a lot.
Burden
How much headaches affected recent life
The six items cover pain, ordinary activity, needing to lie down, tiredness, irritability, and concentration. The total makes that impact easier to show when a pain number is not enough.
Change
Whether the four-week picture moved
A repeated score can support a treatment or recovery review when the version, time window, headache days, and medicines stay comparable.
Conversation
What needs a closer look
The item responses and diary can show whether the main loss was work, school, concentration, energy, plans, or the need to lie down.
HIT-6 cannot diagnose migraine, identify the cause of a headache, count headache days, choose a treatment, or decide whether a headache is an emergency. Those questions need the symptom history, examination, medicine review, and sometimes another test.
Save this test
Save the score, headache days, and effect on daily life
Store the score with its four-week dates, version, diary totals, and one concrete example of what changed. That makes a later comparison much easier to trust.
My Fog stores the score, dates, diary totals, and example you enter so you can compare four-week periods.
How age, pregnancy, and daily demands affect the score
HIT-6 uses one adult score for women and men. Age, pregnancy, menstrual timing, headache history, medicines, and daily duties can change what that score means in real life.
Children under 18
Researchers made and tested HIT-6 for adults. PedMIDAS is a disability tool for children. In one 2025 clinic study, the two scores often moved in the same direction, but this did not create child cutoffs for HIT-6. Use the tool chosen by the child's clinician. Also record school, play, sleep, vomiting, behavior changes, and new brain or nerve symptoms.
Adults of any sex
The score bands do not change for women and men. How common headaches are, menstrual or hormonal timing, blood loss, sleep, medicines, and freedom to stop work or caring duties can change what drives the score. Keep those facts with the score instead of adjusting it for sex.
Pregnancy and the six weeks after birth
HIT-6 may describe impact, but it must not delay care for a new, changing, or severe headache. During pregnancy or after birth, a lasting headache or thunderclap start can be an emergency. Vision changes, swelling, upper-belly or shoulder pain, trouble breathing, or high blood pressure raise the concern.
Older adults and a new headache
A new headache after age 50, vision problems, pain while chewing, weight loss, cancer or immune-suppression history, or headaches that change quickly need direct medical assessment. A low HIT-6 total cannot make those features safe.
How to complete HIT-6 the same way each time
Use an authorized HIT-6 version in a language you understand. The form is under copyright, so we explain the scoring and meaning but don't show the six questions.
Answer for the previous four weeks. Include all four weeks, not only today, your worst attack, or the days before your latest treatment change.
Use one response for every item: never, rarely, sometimes, very often, or always. The fixed point values are 6, 8, 10, 11, and 13. Add the six values once and check that the total is valid.
Keep the date, language, and version with the total. If you repeat it, use the same version and a complete four-week window so the comparison is easier to read.
Bring a short headache record. Include headache days, migraine-like days, pain-medicine days, treatment changes, and missed work or school. Add sleep, menstrual timing if relevant, pregnancy or recent birth, illness, injury, and any new nerve or brain symptoms.
Use the authorized six-item form
Complete all six items in one language and version. Use one form and keep the response choices as written.
Keep the four-week window
Use the same four-week recall period. Mark the start and end dates so a later score does not accidentally cover the same days.
Score the five response choices
Never scores 6, rarely 8, sometimes 10, very often 11, and always 13. Add all six values and check that the total falls inside the valid range.
Read impact, then add the missing context
Use the four impact bands, then add the diary counts, triggers, treatment changes, and what the headaches stopped you doing.
Use symptoms for urgency
Get urgent care for a sudden explosive headache, new weakness, trouble speaking, confusion, a seizure, or fever with a stiff neck. A serious pregnancy warning sign is also urgent, whatever the HIT-6 score.
How to read the four HIT-6 score bands
Find the band, then read the individual answers and the diary. The band describes impact during one four-week window. It does not name the headache or set the urgency.
Little or no impact
36 to 49: Little or no headache impact
Headaches had little or no measured effect during this four-week window. Keep the date and context. A low total does not rule out a dangerous new headache, a brief disabling attack, aura, or symptoms that the six items do not capture.
Some impact
50 to 55: Some headache impact
Headaches affected part of daily life. Look at which item and which real event changed, then compare the score with headache days, medicine days, sleep, work or school, and treatment changes.
Substantial impact
56 to 59: Substantial headache impact
Headaches had a substantial effect during the recall period. Bring the item responses and a diary to the review.
Severe impact
60 to 78: Severe headache impact
Headaches had a severe effect on recent life. Review the headache history, medicines, tasks you couldn't do, and ways to prevent attacks. The score alone does not make the headache an emergency or prove that treatment must change.
A score of 60 is not an emergency threshold
It means headaches had a severe effect during the recall period. A person with 45 can still have an urgent new headache, and a person with 70 may have long-standing headaches without an emergency. Use sudden onset, neurological change, injury, fever, and obstetric warning signs for triage.
See research details
A small score change may come from normal test variation or a different month. Compare the total with headache days, daily tasks, treatment changes, and the exact dates.
Keep each of the six answers with the HIT-6 total. Two people can reach the same score through different combinations of pain, fatigue, concentration problems, or missed activities.
The usual bands are 36 to 49, 50 to 55, 56 to 59, and 60 to 78. They group recent impact as little or none, some, substantial, or severe. They do not diagnose migraine, prove a cause, or replace red-flag triage.
The development study reported internal consistency of 0.89, alternate-form reliability of 0.90, and test-retest reliability of 0.80. Approximate 95% confidence intervals of plus or minus 5 points applied to 88% of respondents. Read a small change with the dates, diary, and treatment context.
Smelt and colleagues found within-person important-change estimates from minus 2.5 to minus 6 points in primary-care migraine. Houts and colleagues found that a fall of about 5 to 6 points was meaningful in chronic migraine trial data. Population, baseline burden, and purpose matter.
HIT-6 can separate groups with different average headache burden, but scores overlap. In a 2,049-person analysis, mean scores differed across chronic migraine, episodic migraine, and non-migraine headache groups. The questionnaire still cannot tell one person which headache disorder they have.
Researchers developed and validated HIT-6 in adults with headaches. Use an authorized version. An adult impact band may mean something different in a younger child.
Of 100 children aged 6 to 18, 96 children completed both HIT-6 and PedMIDAS, and the scores had a moderate correlation of 0.6. The study came from one headache clinic, the average age was 14, and 66% were female. It supports studying HIT-6 in children, not automatic adult scoring rules for every child.
A sudden explosive headache, new weakness, speech or vision change, confusion, seizure, fever with a stiff neck, or a headache after significant injury needs urgent assessment. During pregnancy or up to six weeks after birth, a severe persistent headache with vision change, swelling, upper-abdominal pain, breathing trouble, or high blood pressure needs prompt obstetric care.
Check the score and headache changes over four weeks
Use HIT-6 as a four-week summary. Use a short diary to show what changed. Keep headache days, attacks, medicines, sleep, meals, fluids, period timing, activity, and the tasks you had to stop with the score.
Keep a small headache diary beside the score
For each headache day, record start time, duration, main symptoms, possible trigger, medicine and time taken, relief, and what you could not do. Also count headache days and pain-medicine days. This shows whether the same total came from many moderate days or a few disabling attacks.
Keep meals, hydration, and sleep reasonably consistent
Aim for regular meals, ordinary hydration, a steady sleep and wake time, and movement that does not reliably worsen symptoms. Note caffeine, alcohol, skipped meals, poor sleep, illness, and menstrual timing. Change one manageable thing at a time so the next four weeks can answer a question.
Review medicine use without changing it alone
Record prescription, over-the-counter, and combination pain medicines, plus how many days each was used. Frequent acute-medicine use can become part of the headache problem. Do not stop a preventive medicine or change a pregnancy medicine from a score alone. Bring the record to the prescriber or pharmacist.
Choose the next question from what changed
If the score rose, first check whether headache days or sleep changed. Then note medicine changes, injury, infection, neck pain, missed meals, menstrual timing, or new nerve or brain symptoms. If it fell, ask whether daily function also improved.
Call 911 for a sudden explosive or worst-ever headache with new weakness, numbness, trouble speaking, confusion, seizure, fainting, or major vision loss. Seek urgent care for fever with a stiff neck, a severe headache after injury, or unfamiliar headaches that worsen fast. During pregnancy or within six weeks after birth, call obstetric care urgently for a severe or lasting headache. Vision changes, swelling, upper-belly pain, trouble breathing, or high blood pressure raise the concern. Get care first. The questionnaire can wait.
What to keep with a HIT-6 result
Keep these together
- Total score and all six item responses if available
- Start and end dates of the four-week recall window
- Authorized version and language
- Number of headache days and migraine-like days
- Number of days acute headache medicine was used
- New, stopped, or changed medicines and supplements
- The main activity, task, or responsibility affected
- New neurological symptoms, injury, illness, menstrual timing, pregnancy, or recent birth
Question for the visit
“Which items drove the total, how does the score match the headache diary, and would medicines, unusual symptoms, or pregnancy-related context change the next step?”
Sources for HIT-6 Headache Impact Test: Score and Meaning
Authorized HIT-6 access and patient use context
Headache quality measures and proprietary-instrument status
HIT-6 development, reliability, and individual-score uncertainty
Validation across episodic and chronic migraine and the four score bands
Important change estimates in primary-care migraine
Meaningful change in chronic migraine
2025 pediatric comparison with PedMIDAS
Headache danger signs and emergency care
Pregnancy and postpartum headache warning signs
See each claim's sources
procedure
HIT-6 uses six items, five fixed response weights, and a four-week recall period to produce one valid total.range
The common impact bands are 36 to 49, 50 to 55, 56 to 59, and 60 to 78.interpretation
The development study included 1,103 adults and reported internal, alternate-form, and test-retest reliability of 0.89, 0.90, and 0.80.limitation
Approximate 95% confidence intervals of plus or minus 5 points applied to 88% of respondents in the development study.interpretation
Published important-change estimates differ by population and purpose, so one score change should not be treated as universal.context
HIT-6 was developed and validated in adult headache populations, so adult bands should not be silently transferred to children.context
A 2025 single-center study of children aged 6 to 18 found moderate correlation between HIT-6 and PedMIDAS but did not establish universal pediatric bands.limitation
HIT-6 measures headache impact across groups but does not diagnose an individual headache disorder.safety
Headache urgency depends on symptoms such as sudden explosive onset or new neurological findings, not the HIT-6 total.safety
A severe persistent headache with warning signs during pregnancy or after birth needs prompt obstetric assessment.context
A headache diary adds attack timing, medicine use, triggers, and functional context that the total cannot show.diet
Regular meals, ordinary hydration, steady sleep, and recorded triggers can support headache management and make repeated scores easier to interpret.