Headaches are one of the most common illnesses suffered by individuals. But headache care lags behind other areas of medicine by 50 years or more in the opinion of some experts, largely because there hasn’t been enough research and funding for this disabling illness.
Why have we put so few resources into researching and improving headache care? In part because it’s always been hard to evaluate headache severity. But that’s improving, and we now have four accepted measures of how bad your headaches, including migraines, are.
One of the common definitions of headache severity is the number of attacks you experience during a 30-day period. This is commonly used to define migraines into chronic or episodic types. Chronic migraines are defined as 15 or more attacks per 30 days, while episodic migraine sufferers have fewer than 15 attacks per 30 days. Sometimes this measure is also used for tension headaches as well.
For cluster headaches, you might report individual headaches, but because they can recur at irregular intervals, they aren’t usually grouped into the chronic/episodic division.
Other times, people like to track the number of days you had headaches. This may be a better measure of the severity of impact on your life if, for example, you regularly have migraines lasting two or three days.
It’s also easier to track cluster headaches this way. Because so many headaches may occur within a short period of time, what’s often relevant is not how many individual headaches occurred, but how many days you suffered headaches.
Visual Analog Scale (VAS)
Measuring how painful your headache is poses its own problems. Pain is highly subjective, so creating a universal pain scale is hard. One of the most common ways to work around this is the visual analog scale (VAS), where you assign a number to your pain from 0 to 10, representing “no pain” to “the worst pain imaginable.”
It’s still subjective, but it gives a frame of reference, and it works especially well for communicating the severity of one headache attack compared to another.
Another way to try to establish the severity of your headaches is with the simple headache impact test, also called HIT-6 because it consists of six questions. Essentially, these questions are:
How frequently would you say you have severe headaches?
How often do headaches interfere with your daily activities?
How often do headaches make you wish you could just lie down?
How regularly do headaches make you feel too tired for activities?
How often do headaches make you feel fed up or irritable?
How often do headaches make it hard to concentrate?
The questions are answered multiple choice with possible answers ranging from “always” to “never.” Each answer has a numerical value, and the total is added up to give a final headache score that represents a somewhat validated measure of headache severity.
Do You Have Severe Headaches?
If you have severe headaches and your current treatment is not working to prevent or control them, TMJ might be a factor in your condition.