{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:12:17Z","timestamp":1788567137978,"version":"build-2803163510"},"reference-count":30,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cephalalgia"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Available 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\u2013Migraine Scoring System (EMHA-MSS) with the aim of improving patient communication with healthcare professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Cross-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                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009280 had complete HIT-6\/MIDAS). Second, the EMHA-MSS was administered to a validation cohort of Spanish patients (\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      \u2009=\u2009504). Third, we undertook cross-language analyses using a separate English-language dataset from English-speaking patients (\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      \u2009=\u200951). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The EMHA-MSS demonstrated unidimensional structure with excellent Confirmatory Factor Analysis fit (Comparative Fit Index\u2009=\u20091.000, Tucker-Lewis Index\u2009=\u20091.000, Root Mean Square Error of Approximation\u2009=\u20090.000, Standardized Root Mean Residual\u2009=\u20090.003). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 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\u2019 perceptions and enhancing the understanding between them and healthcare providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03331024261471185","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:44:32Z","timestamp":1788389072000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["EMHA migraine scoring system: A novel, valid, and reliable metric to capture severity, align with patients, and facilitate communication"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0796-4702","authenticated-orcid":false,"given":"Patricia","family":"Pozo-Rosich","sequence":"first","affiliation":[{"name":"Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain"},{"name":"Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute (VHIR), Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5525-0267","authenticated-orcid":false,"given":"Edoardo","family":"Caronna","sequence":"additional","affiliation":[{"name":"Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain"},{"name":"Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute (VHIR), Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena Ruiz","family":"De La Torre","sequence":"additional","affiliation":[{"name":"European Migraine and Headache Alliance (EMHA), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0951-5804","authenticated-orcid":false,"given":"Messoud","family":"Ashina","sequence":"additional","affiliation":[{"name":"Department of Neurology, Danish Headache Center, Copenhagen University Hospital\u2013Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7238-0036","authenticated-orcid":false,"given":"Pablo","family":"Irimia","sequence":"additional","affiliation":[{"name":"University Clinic of Navarra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette","family":"MaassenVanDenBrink","sequence":"additional","affiliation":[{"name":"Erasmus MC Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4691-3388","authenticated-orcid":false,"given":"Dimos D.","family":"Mitsikostas","sequence":"additional","affiliation":[{"name":"Aeginition Hospital, National and Kapodistrian University of Athens"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1756-1181","authenticated-orcid":false,"given":"Christian","family":"Lampl","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Barmherzige Br\u00fcder Linz, Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Gil-Gouveia","sequence":"additional","affiliation":[{"name":"Hospital da Luz, Hospital da Luz Lisboa"},{"name":"Center for Interdisciplinary Research in Health, Universidade Cat\u00f3lica Portuguesa, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal Mohammad","family":"Amin","sequence":"additional","affiliation":[{"name":"Rigshospitalet Glostrup, University of Copenhagen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3140-6882","authenticated-orcid":false,"given":"Gisela M.","family":"Terwindt","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hurtado","sequence":"additional","affiliation":[{"name":"Prescient Healthcare Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Fairley","sequence":"additional","affiliation":[{"name":"Prescient Healthcare Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3260-5904","authenticated-orcid":false,"given":"Peter J.","family":"Goadsby","sequence":"additional","affiliation":[{"name":"King Abdullah University of Science and 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