The HIT-6, explained — what each score means and how to bring it to your doctor

If MIDAS is the “how many days have you lost?” question, HIT-6 is the “how bad is it when it happens?” question. Both are validated, both are accepted by neurologists worldwide, and most insurance companies want to see both before approving advanced migraine treatments.

HIT-6 takes 60 seconds. Six questions, each scored on the same 5-point scale. Here’s how it works, what your score means, and why this is one of the few patient-administered tests your doctor will actually trust.

The 6 questions

For each question, choose one answer. Each answer is worth a specific number of points: Never = 6, Rarely = 8, Sometimes = 10, Very Often = 11, Always = 13.

1. When you have headaches, how often is the pain severe?
2. How often do headaches limit your ability to do usual daily activities including household work, work, school, or social activities?
3. When you have a headache, how often do you wish you could lie down?
4. In the past 4 weeks, how often have you felt too tired to do work or daily activities because of your headaches?
5. In the past 4 weeks, how often have you felt fed up or irritated because of your headaches?
6. In the past 4 weeks, how often did headaches limit your ability to concentrate on work or daily activities?

Sum the points from all 6 answers. Total ranges from 36 (all “Never”) to 78 (all “Always”).

You can score it instantly with our HIT-6 calculator, or work it out by hand below.

The grading scale

Score	Impact level	Meaning
49 or less	Little or no impact	Headaches barely affect daily life
50–55	Some impact	Noticeable, but mostly manageable
56–59	Substantial impact	Headaches are interfering with significant parts of life
60–78	Severe impact	Headaches are dominating your daily experience

The threshold most neurologists watch for is 56. Below it, conservative management. At or above, the conversation usually shifts to preventive medication.

Why neurologists trust HIT-6

HIT-6 was developed in 2003 by Kosinski and colleagues at QualityMetric (now Optum) using item-response-theory analysis on a much larger 54-item headache impact survey. The 6 questions were chosen because they had the highest discriminative power — meaning they reliably separate people with severe impact from those with mild impact, with minimal redundancy.

It’s been validated across:

• Languages: 50+ official translations
• Conditions: migraine, tension-type headache, chronic daily headache, post-traumatic headache
• Settings: clinical practice, clinical trials, large epidemiological studies

That validation is why your neurologist will accept the score even though you filled it out at your kitchen table. The questions were designed to be answered by patients without supervision.

What HIT-6 captures that MIDAS misses

MIDAS asks “how many days?” That’s a volume question — it counts disability in days lost.

HIT-6 asks “how bad is the experience?” That’s an intensity question — it captures the quality of headache days.

Why both matter:

• A patient with 2 attacks/month, both 9/10 severity scores low on MIDAS but very high on HIT-6
• A patient with 15 attacks/month, all 4/10 scores high on MIDAS but moderate on HIT-6

Both patients deserve different treatment approaches. Using only one scale gives an incomplete picture.

When HIT-6 changes treatment

Three real treatment-decision points where HIT-6 above the threshold makes a difference:

1. CGRP inhibitor approvals (Aimovig, Emgality, Ajovy, Vyepti). Most US insurers require HIT-6 ≥ 60 or MIDAS ≥ 11 alongside documented failure of 2–3 first-line preventives. A high HIT-6 with a moderate MIDAS still qualifies.
2. Botox for chronic migraine. A high HIT-6 in someone with 15+ headache days/month is the textbook profile for Botox candidacy.
3. Disability accommodations at work. Documented HIT-6 in the severe range supports requests for reasonable accommodations under the ADA (US) or equivalent legislation in other countries.

If you’re heading to a neurologist appointment hoping for one of the above, your HIT-6 score on paper is more persuasive than your description.

How HIT-6 fails

It’s a snapshot of the last 4 weeks. If your last 4 weeks were unusually good or unusually bad, the score reflects that, not your typical state.

Workarounds:

• Re-score every 4–6 weeks rather than once a year. The trend over time is more useful than any single value.
• Note any unusual circumstances alongside the score (e.g., “started a new preventive 3 weeks ago” or “high-stress quarter at work”)

For long-term tracking, a digital tracker like Migra auto-recalculates HIT-6 from your logged attacks every time you ask, so the score is always current — no 4-week lookback memory required.

What HIT-6 does not measure

• Trigger patterns — use a migraine diary for that
• Medication response — track which abortives worked separately
• Aura patterns — needs symptom-level logging
• Pain location — needs attack-level logging

HIT-6 is one number. It does that one thing very well. Don’t try to make it carry more weight.

How to bring it to your doctor

1. Score it the morning of your appointment so it’s fresh
2. Write the date you completed it
3. Bring it alongside your MIDAS score and any logged attack data
4. List your top 3 most-frequent triggers if you know them
5. List the names and approximate frequency of every prescription medication you’ve used in the last 3 months

That single page transforms the conversation. The neurologist who sees “HIT-6 = 64, MIDAS = 28, 12 sumatriptan in 90 days, primary triggers: weather + sleep” can make a decision in 30 seconds. The neurologist who hears “I get a lot of really bad migraines” cannot.

The data isn’t optional. It’s the substrate of every meaningful migraine appointment.