Development of a measure to assess acceptance of headache: The Headache Acceptance Questionnaire (HAQ)

Cephalalgia. 2020 Jul;40(8):797-807. doi: 10.1177/0333102420907596. Epub 2020 Feb 18.


Background: Disability resulting from headache disorders is attributable in part to avoidant coping. Acceptance of pain connotes a willingness to experience pain in the service of life values, such that meaningful activities and goals are pursued despite pain. Acceptance facilitates positive health outcomes but has rarely been investigated in headache. Because headache disorders manifest differently than other forms of chronic pain, the present study sought to develop and validate a measure of acceptance of headache.

Methods: Forty-five candidate items were developed and, with input from an expert panel, reduced to 24 items. Five items were eliminated following administration to a development sample and exploratory factory analysis. Nineteen items were administered to a validation sample for confirmatory factory analysis and assessment of psychometric properties.

Results: Factor analysis produced a unidimensional six-item measure, the Headache Acceptance Questionnaire (HAQ). The HAQ evidenced good internal consistency, convergent validity with headache disability and related psychological constructs, and divergent validity with social desirability. The measure also distinguished between headache diagnostic groups.

Conclusions: Pending further validation in clinical settings, the HAQ may have utility in assessing psychological responses to headache symptoms, identifying targets of treatment for interventions that focus on reducing avoidance, and studying mechanisms of change.

Keywords: Acceptance and Commitment Therapy; Pain acceptance; disability; migraine.

MeSH terms

  • Adaptation, Psychological
  • Adolescent
  • Adult
  • Female
  • Headache / psychology*
  • Humans
  • Male
  • Psychometrics / instrumentation*
  • Surveys and Questionnaires*
  • Young Adult