Defining the requirements for a headache service goes some way to meeting patients' needs, but what is also required is the ability to determine whether headache management is delivering the most effective outcome for the individual sufferer.

The Headache Under-Response to Treatment (HURT) index was created in 2006 at an expert consensus panel meeting at the World Health Organization and is one of LTB's essential management tools. Its purpose is to guide patients and healthcare providers, specifically by showing whether headache treatment is optimal and, if not, how it might beneficially be changed.

While HURT can facilitate discussions between patients and healthcare providers, validation studies are needed to demonstrate that it can do what it aims to do: improve clinical management and outcome. The first of these studies is now underway in Denmark, Germany, the UK and Italy. It will be applied to patients in secondary care initially, with a range of headache disorders. The question this study will answer is: does HURT reliably recognise what is and what is not best outcome?

In total, 300 patients across the four countries will complete the HURT index (comprising eight questions in total) a month before their first appointment at a secondary-care specialist headache centre. They will be asked to complete the index a second time at the appointment a month later, while they wait in the waiting room. Comparing the results from the first and second questionnaires will determine the test-retest reliability of HURT (a key part of ensuring that it records what it is intended to).

The headache specialist will then look after the patient as normal. This is predicted to take between 1-6 months in each patient, as is usually the case with headache management. It is assumed that the headache specialist will secure the best possible outcome for each patient. Once this has been achieved, the patient will complete the HURT index for the third and last time. Results from this third questionnaire will determine the ability of HURT to recognise this change - essential if the index is to have clinical utility.

Results are expected in the latter half of 2009.

For more information on the HURT index visit the Lifting The Burden website at http://www.l-t-b.org.