LAUSR

Headache disorders are largely prevalent worldwide. Given their high lifetime prevalence, and in particular among people of working age, they determine relevant difficulties in workrelated activities and constitute a huge social security problem. The cost associated to headache disorders in Europe was estimated at €173 billion per year, with most of such a cost being due to reduced productivity and absenteeism, particularly among those with episodic and chronic migraine (CM) [1]. Although researchers and clinicians acknowledge that these patients report limitations with work-related activities, the available information on the kind of activities that are mostly impaired as well as the information on the actual impact of headache disorders on daily work life is poor. As shown in a previous literature review, little information was found, and this was limited to skills such as problem solving, and activities such as speaking and driving and, of course, for general statements such as difficulties at work [2]. However, such statements are generally expressed in terms of Breduced work performance^ or Binability to work as usual,^ whose content is unclear as it is a function of the job tasks and the amount of demand from the workplace. Based on these conclusions, we planned a study in order to return to patient-derived data to get more appropriate results, with the final aim to produce a new questionnaire meant to address the amount and the severity of the difficulties with work-related tasks and, in parallel, the factors that may contribute to these difficulties. We collected qualitative data from a set of focus groups in which employed patients with different types of headache provided information on their difficulties with specific tasks. The results of this qualitative analysis enabled us to address a set of relevant themes which refer to activities (e.g., reading, writing, speaking), personal factors (e.g., attention, stress), correlated symptoms (e.g., pain, being numb), and contextual elements (e.g., office, colleagues, noise, light) [3]. These themes were jointly used, together with those from the literature review, to produce a preliminary version of the BHEADWORK Questionnaire.^ The questionnaire is divided in two sections. The first is composed of 13 items that address the degree to which headaches determined difficulties with a set of work-related tasks: patients had to provide an answer on a 5-step scale which range from Bno difficulty^ to BI was unable to do it.^ The