The Headache-Attributed Lost Time (HALT) Indices: measures of burden for clinical management and population-based research

Abstract

BackgroundThe burden attributable to headache disorders has multiple components: a simple measure summarising them all does not exist. The Migraine Disability Assessment (MIDAS) instrument has proved useful, estimating productive time lost in the preceding 3 months due to the disabling effect of headache. We developed adaptations of MIDAS for purposes of the Global Campaign against Headache, embracing epidemiological studies and the provision of clinical management aids.MethodsWe reviewed the structure, content, wording and scoring of MIDAS and made revisions, developing the Headache-Attributed Lost Time (HALT) Indices in three versions. Over 10 years, these were employed in multiple epidemiological and clinical studies in countries worldwide.ResultsIn the original HALT-90, we made no changes to the structure and scoring of MIDAS, but used wording in questions 1–4 that we believed would be more widely understood and more easily translated into other languages. Of the two alternative versions, HALT-30 kept the same structure, question format and wording except that “3 months” was replaced by “1 month”. HALT-7/30 was a variant of HALT-30: focusing only on lost work time for population-based studies of headache-attributed burden, it enquired into lost days in the preceding month (30 days) and week (7 days).ConclusionsThree versions of the HALT Indices serve different purposes as measures of headache-attributed burden, and offer different means of scoring. In studies using HALT as a population measure, there is no need to reflect the states of individuals, whereas a measure over shorter periods than 3 months is likely to be more reliable through better recall. Assessment of individual patients prior to treatment may best estimate impact if enquiry is made into the preceding 90 days, except in cases where headache is highly frequent. Follow-up in clinical management may be better served by assessments over 30 rather than 90 days.Electronic supplementary materialThe online version of this article (10.1186/s10194-018-0837-3) contains supplementary material, which is available to authorized users.

Economic burden of migraine in Latvia and Lithuania: direct and indirect costs

“…Steiner et al [35] considered workdays with productivity reduced to 50% or more of the expected productivity as days fully lost. This validated approach counterbalances those working days when the productivity was reduced by less than half of the expected, which are ignored otherwise [40, 41]. As personal impact in terms of lost useful time was surprisingly uniform across European countries [35], had we surveyed individuals suffering from migraine in Latvia and Lithuania might we arrived at very similar estimates.…”

“…This estimate includes workdays lost both due to sick leave and impairment; the authors estimate total productive time lost at work as the sum of workdays lost completely due to absenteeism and workdays with productivity reduced to 50% or more of the expected productivity. Steiner and Lipton [40] argue that this approach counterbalances those working days when the productivity was reduced by less than half of the expected, which are ignored otherwise. This approach has already been introduced by MIDAS and was validated in [41].…”

European headache federation consensus on the definition of resistant and refractory migraine

“…Ascertainment of debilitating attacks shall be done with clinical interview or with the use of validated scales in order to evaluate if headaches significantly interfere with a patient's ability to work, attend school, or participate in family or social activities. The EHF Expert Consensus Group did not choose to use cut scores at common validated instruments to measure function or disability such as the MIgraine Disability ASsessment (MIDAS) tool [19], the Headache Impact Test (HIT-6) scale [20], or the Headache-Attributed Lost Time (HALT) Indices [21]. We considered the fact that there is not one single Patient-Reported Outcome scale (PROs) including the magnitude of the impairment that a person with a migraine attack or frequent migraine suffers.…”

Productivity Losses Due to Migraine in Slovenia: An Analysis of Absenteeism and Presenteeism Costs Based on Administrative and Self-Reported Data

“…Different instruments have been used to assess illness-related productivity losses. Papers addressing migraine from a relevant systematic review (25) (28) and different versions of the HALT questionnaire (29). In our study, we combine both the administrative sick-leave database and the self-reported survey combining the WPAI used in some of the more recent studies (28) and the widely used MIDAS, which is also included in Slovenian national guidelines for migraine treatment (21).…”