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Background The degree to which work-related difficulties are recognized in headache research is poor and often carried out with inadequate information such as “reduced ability to work as usual”, which do not capture at all the variety of difficulties and the factors that impact over them. The aim of this paper is to present the validation of the HEADWORK questionnaire, which addresses the amount and severity of difficulties in work-related tasks and the factors that impact over them. Methods We developed a set of items based on a previous literature review and patients’ focus groups and tested it on a wide set of patients with episodic and chronic migraine attending eight different Italian headache centers. HEADWORK factor structure was assessed with exploratory and confirmatory factor analysis; internal consistency and construct validity were addressed as well. Results The validation sample (N = 373) was mostly composed of patients with episodic migraine without aura (64.3%) and of females (81%). Factor analysis retrieved two different scales: “Work-related difficulties”, composed of eleven items which explain 67.1% of the total variance, and “Factors contributing to work difficulties”, composed of six items which explain 52.1% of the total variance. Both HEADWORK subscales have good measurement properties, with higher scores being associated to higher disability, lower quality of life, lower productivity, higher headache frequency and pain intensity. Conclusions HEADWORK is a 17-item, two-scale questionnaire addressing the impact of migraine on work-related difficulties in terms of difficulties in general or specific skills, and the factors contributing to these difficulties, defined as negative impact on work tasks. It can be used to address disability weights for the purpose of calculating the burden of migraine, and to assess the balance between therapeutic and side effects of medication on productivity.

Background: The World Health Organization has classified headache as the 14th cause of disabling illnesses. Millions of people are affected by this pathology, especially during their working life. Surprisingly, subjects affected by headache, in particular by migraine, present a low degree of self-awareness of their pathology, and they do not usually consult any headache center[1]. For this reason migraineurs often go towards serious complications, such as chronicization or drug abuse. We investigated, in a selected population of workers, employees of the Ospedali Riuniti in Ancona, the number of people affected by headache and their awareness. We also investigated the drugs used to verify the use of a specific therapy for such a diffused pathology. Methods: We submitted all types of health workers (physicians, nurses, technicians, sanitary operators) to an anonymous questionnaire concerning the presence of headache and its characteristics. Particularly, we investigated if these subjects referred to their general practitioner or to a headache center for their symptoms. We also tried to understand the drugs employed by these people. The type of drugs and the category of the working activity were synthesized as two different ordinal variables. Difference in the distribution of the different drug categories was evaluated with χ2 test. Statistics was performed with SPSS 13.0 for Windows systems. Results: We enrolled 1,700 consecutive subjects: 18.1% of the population (308 patients) resulted affected by migraine. Only a minimum part of these patients had consulted a headache center in their life. Subjects tended not to take any drugs for their acute attack of headache, or took significantly more non-steroidal anti-inflammatory drugs (NSAIDs) in respect to triptans. Distribution of the use of the drugs resulted significantly different (p < 0.0001) with χ2 test. Conclusions: Migraineurs, also in presence of more than one attack in their life, typically showed low self-awareness about their condition and usually did not refer to a specialistic headache center. Consequently, the use of specific molecules, such as triptans, presented a very low diffusion. These results reflect international literature, but on the other hand, underline a very unsatisfactory knowledge about migraine and its possible consequences[2, 3]. Moreover, these data are especially worrisome because they are representative of a hospital population. Better education and awareness about such a prevalent and disabling pathology and its management should be favored.

Background OnabotulinumtoxinA injection according to PREEMPT protocol is a second-line therapy for chronic migraine (CM)[1]. While its efficacy on frequency of headache has been demonstrated[2], our current clinical experience indicates that patients report benefits regardless of reduction of frequency of attacks, as Lipton et al previously showed[3]. The present study aimed at assessing the impact of botulin injection on intensity, quality and perception of pain in patients with CM.