Assessment of Head Awareness in Patients with Chronic Migraine Using the Fremantle Headache Awareness Questionnaire: Turkish Version, Validity, and Reliability Study.

INTRODUCTION

In chronic migraine (CM), patient-reported outcome measures (PROMs) are important, as headaches may be related to impaired proprioception and somatic bodily awareness in the chronicity. This study aimed to adapt the Fremantle Headache Awareness Questionnaire (FreHAQ) to Turkish.

METHODS

Patients aged 18-70 were included in the study. After cross-cultural adaptation of the questionnaire, demographic-clinical information was recorded. Numeric Pain Rating Scale (NPRS), Migraine Disability Assessment (MIDAS), Headache Impact Test-6 (HIT-6), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS) and FreHAQ were evaluated for structural validity. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were also performed. Intraclass Correlation Coefficient (ICC) and Cronbach's α values were calculated for reliability.

RESULTS

A total of 180 patients (mean age was 39.94±13.14 years) were included. Headache attacks occurred 17.12±4.53days/month, with 7.57±2.1 intensity. Item-total correlations ranged from 0.079 to 0.673. Cronbach's α value was above 0.811. FreHAQ had good test-retest reliability (ICC=0.851, n=73) and high internal consistency (Cronbach's α=0.919). The absence of a significant difference between baseline and retest scores (p=0.06) supported the temporal stability of FreHAQ. FreHAQ correlated with NPRS, MIDAS, HIT-6, HADS, and PCS (p<0.01). EFA identified a two-factor structure, explaining 56.98% of the variance (proprioceptive-motor awareness (items 1-6,9) and shape-size awareness of the head (items 7,8)). CFA showed acceptable model fit.

CONCLUSION

The Turkish version of FreHAQ is a valid and reliable tool to assess perceptual impairments in CM and is significantly associated with psychosocial factors. Monitoring body awareness in chronic headache can be important for PROMs.