Measuring headache day severity using multiple features in daily diary designs

James S. McGinley, Carrie R. Houts, R. J. Wirth, Richard B. Lipton

Research output: Contribution to journalArticlepeer-review


Objective: Though migraine is thought of as a symptom complex, symptoms are typically assessed one at a time. For use in clinical research, we developed a composite measure of headache day severity by combining eight well-known symptoms captured in daily diaries. Subjects and Methods: Data came from adults with a self-reported diagnosis of migraine (n = 4380) who provided daily diary information assessed using a novel digital platform. Nine observed features theoretically linked to headache day severity were analyzed using latent variable modeling to create a psychometrically robust headache day severity score. Logistic regression was used to assess the cross-sectional relationships of headache day severity scores against an array of clinically-relevant outcomes. Results: Participants were largely females (90%), approaching middle age (mean age of 37.3) and living in the United States (49%) or United Kingdom (23%). Findings supported a single latent headache day severity construct based on eight observed headache features. Headache day severity scores were associated with an increased odds of physician visits (Odds ratio[95% CI]: 1.71[1.32–2.21]), emergency department visits (4.12[2.23-7.60]), missed school/work (2.90[2.56–3.29]), missed household work (3.37[3.06–3.72]), and missed other activities (3.29[2.97–3.64]) (p <.0001 for all). Conclusions: Modern measurement techniques support a single headache day severity construct that reflects migraine is a symptom complex. The headache day severity scores were associated with external validators and initial visualizations showed how headache day severity scores can be applied broadly in clinical practice and research.

Original languageEnglish (US)
Pages (from-to)53-62
Number of pages10
Issue number1
StatePublished - Jan 2022


  • Headache severity
  • headache diaries
  • measurement

ASJC Scopus subject areas

  • Clinical Neurology


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