EMHA migraine scoring system: A novel, valid, and reliable metric to capture severity, align with patients, and...

BackgroundAvailable instruments to quantify migraine-related disability, such as the Headache Impact Test (HIT-6) and Migraine Disability Assessment Test (MIDAS), have certain limitations (e.g., recall bias, overlooking interictal burden), and do not always facilitate patient-doctor communication. We developed a migraine scoring system, namely the European Migraine and Headache Alliance-Migraine Scoring System (EMHA-MSS) with the aim of improving patient communication with healthcare professionals.MethodsCross-sectional, descriptive, quantitative study conducted between June 2024 and March 2025. First, we used exhaustive diary registries from 319 Spanish-speaking patients for a pilot study (of whom n = 280 had complete HIT-6/MIDAS). Second, the EMHA-MSS was administered to a validation cohort of Spanish patients (N = 504). Third, we undertook cross-language analyses using a separate English-language dataset from English-speaking patients (N = 51). The pilot benchmarking analyses used an exploratory three-item version of the scale with different scoring, whereas the final psychometric analyses used the four-item EMHA-MSS.ResultsThe EMHA-MSS demonstrated unidimensional structure with excellent Confirmatory Factor Analysis fit (Comparative Fit Index = 1.000, Tucker-Lewis Index = 1.000, Root Mean Square Error of Approximation = 0.000, Standardized Root Mean Residual = 0.003). Acute treatment reliability was identified as the main factor driving reclassification between severity categories when comparing EMHA-MSS and HIT-6 or MIDAS (comparisons used an exploratory 3-item EMHA-MSS with different scoring in the pilot cohort). Our model provided an excellent fit, supported the expected factorial structure, and demonstrated that factor scores could be reliably calculated. The EMHA-MSS showed good to excellent test-retest reliability. Cross-language validity was demonstrated for the English version using configural and metric invariance, as well as partial scalar invariance.ConclusionThe EMHA-MSS highlighted the importance of treatment reliability, pain and attack intensity, and frequency in classifying patients with migraine and evaluating the severity of the disease. This novel scoring system could facilitate tailored management and monitoring of migraine over time, potentially improving alignment with patients' perceptions and enhancing the understanding between them and healthcare providers.