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Updated: Nov 1, 2025
In Vivo Protocol of Controlled Subconcussive Head Impacts for the Validation of Field Study Data
Published on: April 18, 2019
Reference Values for the Headache Impact Test-6 Questionnaire
Megan N Houston1, Haley A Bookbinder1, Sean P Roach2
1Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY.
Objective:
To determine reference values for the Headache Impact Test-6 (HIT-6) in a young, physically active cohort and to examine the influence of sex, concussion history, headache history, and competitive sport level on HIT-6 scores.
Design:
Cross-sectional.
Setting:
United States Service Academy.
Participants:
United States Service Academy cadets (N=2678) completed an HIT-6 questionnaire as part of their annual concussion baseline assessment. Cadets with a recent concussion were excluded from baseline testing.
Interventions:
Not applicable.
Main Outcome Measures:
Reference values were calculated and stratified by sex, concussion history, headache history, and competitive sport level. Mann-Whitney U and Kruskal-Wallis tests were used to examine the effect of sex, concussion history, headache history, and competitive sport level on HIT-6 scores (P<.05).
Results:
Of the 3599 cadets baselined, 2687 cadets (23% female) agreed to participate in the study and completed the HIT-6. Female participants reported significantly worse HIT-6 scores compared with male participants both with (P<.001) and without (P<.001) a concussion history. In both sexes, participants with a headache history reported worse scores than those with no headache/concussion history and a concussion history (all P<.005). Female cadets who participated in intramural athletics reported worse HIT-6 scores at baseline than female intercollegiate athletes (P=.003).
Conclusions:
This is the first study to stratify HIT-6 data by sex, concussion history, headache history, and sport level in a collegiate population at risk for concussions. Sex and headache history appear to influence HIT-6 scores and should be given special consideration when interpreting health-related quality of life deficits due to headache.
