The Headache Impact Test (HIT-6) is a 6-item, self-report questionnaire that measures how much headache interferes with daily functioning — pain, social role, energy, cognition, and psychological distress. It takes 2–5 minutes, produces a score from 36–78, and is commonly used to track persistent post-traumatic headache alongside standard concussion follow-up.
What the HIT-6 Measures
The HIT-6 was developed as a short-form successor to the longer Headache Impact Test, designed to capture the functional burden of headache rather than pain intensity alone. Its six items ask the patient to rate, on a five-point frequency scale (never, rarely, sometimes, very often, always), how headaches affect:
- Pain severity
- Limitations on usual daily activities
- Desire to lie down
- Fatigue/reduced vitality
- Feeling "fed up" or irritable
- Difficulty concentrating
Because it asks about functional impact rather than frequency or intensity in isolation, the HIT-6 is useful for tracking how disabling a patient's headaches are over time — which matters more clinically than raw pain scores when deciding on treatment intensity or return-to-activity timing.
Administration
The HIT-6 is a self-administered paper or digital questionnaire. Most patients complete it in 2–5 minutes with no clinician time required for administration. It is typically given at intake and then repeated at follow-up intervals to track trend — a single score in isolation is less useful than a trajectory across visits.
Scoring and Interpretation
Total scores range from 36 to 78. Commonly cited interpretive bands, drawn from headache and migraine population research, are:
| Score | Impact |
|---|---|
| ≤49 | Little or no impact |
| 50–55 | Some impact |
| 56–59 | Substantial impact |
| ≥60 | Severe impact |
These bands are widely used in clinical and research settings, but they were derived primarily from migraine and chronic headache populations, not specifically from post-concussion or post-traumatic headache cohorts. Clinicians should treat them as commonly used impact-severity descriptors rather than validated diagnostic cutoffs for post-concussion headache specifically, and should weigh trend over time and clinical context alongside the raw number. For the underlying psychometric development and population data, see the peer-reviewed HIT-6 validation literature (opens in a new tab).
Clinical Use Case
Headache is one of the most persistent and disabling post-concussion symptoms, and it frequently outlasts other symptom domains. The HIT-6 gives clinicians a quick, standardized way to:
- Screen for headache-related functional impairment at intake
- Track whether headache burden is improving, plateauing, or worsening across follow-up visits
- Support decisions about escalating headache-specific treatment (vestibular therapy, pharmacologic management, referral to headache specialty care)
- Document functional impact for the medical record, independent of subjective pain descriptions alone
It is frequently used alongside the Post-Concussion Symptom Scale (PCSS), which captures headache as one item within a broader symptom inventory, giving clinicians both a granular headache-specific measure and a whole-symptom-burden view.
Billing Context
The HIT-6 is a brief self-report screening instrument. It is generally not billed as a standalone neuropsychological test. Depending on how it is administered and documented, it is typically:
- Bundled into the evaluation and management (E/M) visit when reviewed as part of a standard follow-up, or
- Captured under 96146 (automated administration and scoring) when delivered and scored through a computerized platform, or
- Included as part of a brief standardized emotional/behavioral or symptom screen when billed alongside other short instruments in a technician-administered battery
Actual code selection depends on who administers the instrument, how it is scored, and payer-specific policy — always verify current requirements before billing. When HIT-6 data feeds into structured between-visit monitoring rather than a single office-visit screen, it may also support documentation for Remote Therapeutic Monitoring codes such as 98978, since RTM billing is built around monitoring device/software data generated between visits, not the instrument itself.
Where It Sits in the Kavera Protocol
Within Kavera's Headache module and Concussion module, the HIT-6 is one instrument in the broader assessment battery delivered to patients between visits. It is commonly paired with symptom-scale and sleep instruments to build a fuller picture of post-injury recovery, since headache, sleep disruption, and overall symptom burden tend to interact and compound one another during concussion recovery. See related guidance on headache after concussion and sleep dysfunction after concussion.
How Kavera Handles This
HIT-6 is the core instrument in the Headache module and runs alongside PCSS for post-traumatic headache. Kavera sends it on your cadence, bands the score, and shows disability trend before the visit. That serial record is what supports RTM documentation for headache patients. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials.
FAQ
Is a HIT-6 score of 60 or higher diagnostic of chronic migraine or post-traumatic headache?
No. A score of 60 or higher indicates severe headache-related functional impact according to commonly used interpretive bands, but the HIT-6 is a screening and monitoring tool, not a diagnostic instrument. Diagnosis of a specific headache disorder requires clinical evaluation.
How often should the HIT-6 be repeated during concussion recovery?
There is no single mandated interval. In most protocols it is repeated at intake and at subsequent follow-up visits, or on a between-visit monitoring cadence, so clinicians can track whether headache-related functional impact is trending up, down, or holding steady.
Can the HIT-6 be billed on its own under a neuropsychological testing code?
Generally no. As a brief self-report screener, it is typically bundled into an E/M visit or, when computer-administered and scored, captured under a code like 96146. It does not carry a dedicated standalone CPT code of its own.
Does the HIT-6 replace a full headache history and exam?
No. It quantifies functional impact as a monitoring tool but does not replace a clinical headache history, exam, or evaluation for red-flag symptoms warranting imaging — see concussion red flags: when to image.
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