Interictal burden in migraine: a systematic review of conceptual domains and measurement properties of instruments.

Authors

Cornelius Angerhöfer, Yutaro Fuse, Samuel Van Langenhove, Thomas Canning, Alice C von Alvensleben, Sheharyar Ahmad, Ane Murillo, Laia Boada, Maria M Roque, Antoinette MaassenVanDenBrink, Christian Lampl, European Headache Federation School of Advanced Studies (EHF-SAS)

Published in

The journal of headache and pain. Volume 27. Issue 1. Jul 23, 2026. Epub Jul 23, 2026.

Abstract

Migraine imposes significant burden not only during acute attacks but also during headache-free interictal periods. Several patient-reported outcome measures (PROMs) have been used to assess this interictal burden, yet the quality of their measurement properties has not been systematically evaluated.
To identify instruments used to assess interictal burden in migraine, evaluate their measurement properties using the COSMIN methodology, and synthesize the conceptual domains of interictal burden.
A systematic search of MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science Core Collection was conducted from database inception to 20 February 2026. Studies evaluating measurement properties of PROMs assessing interictal burden or migraine impact in migraine populations were eligible. The COSMIN risk-of-bias checklist and criteria for good measurement properties were applied. Findings were synthesized in accordance with PRISMA 2020.
Among 29 included studies, three instruments were identified: the Migraine Interictal Burden Scale-4 (MIBS-4; 26 studies), the Eurolight questionnaire (1 study), and the Fear of Attacks Inventory (FAMI; 2 studies). Seven conceptual domains of interictal burden were identified: functional impairment, social and relational impact, psychological and emotional distress, cognitive dysfunction, sensory symptoms, physical symptoms, and behavioral modifications. Evidence of measurement properties was concentrated in construct validity (19 studies) and responsiveness (8 studies). Structural validity, internal consistency, test-retest reliability and content validity were sparsely evaluated. The MIBS-4 demonstrated consistent convergent and known-groups validity and sensitivity to change across preventive therapies, including CGRP-targeted treatments and onabotulinumtoxinA.
The MIBS-4 is the most widely used instrument for assessing interictal burden. Despite encouraging evidence of construct validity and responsiveness, comprehensive psychometric studies addressing content and structural validity, reliability, and measurement error, alongside conceptual work towards broader interictal burden assessment, are needed.
PROSPERO CRD420261296323; Clinical trial number: not applicable.

PMID:
42498937
Bibliographic data and abstract were imported from PubMed on 25 Jul 2026.

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