Headache Medicine 2021, 12(3):247-254 p-ISSN 2178-7468, e-ISSN 2763-6178

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DOI: 10.48208/HeadacheMed.2021.36

Headache Medicine

Original

Brazilian version of headache management self-efcacy scale

Rebeca Veras de Andrade Vieira

1,2

, Fernando Kowacs

3,4

, Renata Gomes Londero

3,5

Liselotte Menke Barea

4,6

, Vanise Grassi

, Isadora Silveira Ligório

, Francielle Machado Beria

William Barbosa Gomes

, Gustavo Gauer

Universidade do Vale do Rio dos Sinos, São Leopoldo, Rio Grande do Sul, Brazil.

Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.

Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Abstract

Background

Headache-management self-efcacy has been associated with pain severity and headache-re-

lated disability.

Objective

The aim of this study was to test the cross-cultural adaptation and psychometric properties of

a Brazilian version of the Headache Management Self-Efcacy Scale (HMSE) in a sample of

patients coming from three tertiary headache centers in Brazil.

Methods

137 migraine outpatients completed the Headache Management Self-Efcacy Scale (HMSE)

and measures of psychopathological symptoms, pain catastrophizing, depression, anxiety,

quality of life and headache-related disability.

Results

HMSE-10 showed good reliability (α = 0.84) and adequate corrected item-total correlation,

ranging from 0.46 to 0.64. HMSE-10 was positively correlated with 6 of 8 domains of overall

health status and negatively correlated with psychopathological symptoms, depression, anxiety,

pain catastrophizing, headache-related disability, headache frequency and headache inten-

sity. The difference between the means of the episodic and chronic headache patients had

a magnitude of moderate effect in all the study measures, being headache-related disability

the largest one found (d = 0.68). Along with headache intensity and depression, self-efcacy

beliefs were predictors of headache-related disability.

Conclusions

The Brazilian short version of Headache Management Self-Efcacy Scale (HMSE-10) was

revealed as a valid and reliable measure of headache-specic Efcacy Scale beliefs.

Rebeca Veras de Andrade Vieira

+55 (51) 98118-6440

rebecavieirapsico@gmail.com

Edited by:

Marcelo Moraes Valença

Keywords:

migraine

self-efcacy

disability

psychometrics

catastrophization

migraine disorders

Received: October 9, 2021

Accepted: October 22, 2021

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Vieira RVA, Kowacs F, Londero RG, Barea LM, Grassi V, Ligório I, Beria FM, Gomes WB, Gauer G

Brazilian version of headache management self-efficacy scale

Introduction

n the context of headache management, self-efcacy (SE)

beliefs refer to patient’s condence that they can take

actions to prevent headache episodes or manage head-

ache-related pain and disability.

In young people, head-

ache management self-efcacy is considered an important

resilience factor, with an impact on functional capacity and

school functioning.

Moreover, it has been shown that SE

beliefs mediate the association between pain severity and

disability

, moderates the relationship between headache

frequency and frequency of stressful events

, being con-

sidered a psychological factor relevant to all headache

patients.

In the case of chronic migraine patients with

medication overuse, SE beliefs are considered one of the

psychological dimensions that should be targeted in order

to reduce negative effects on functioning and quality of life.

Even though being highly self-efcacious represents a

key factor in successful headache management, it is still

observed in Brazil an absence of instruments to evaluate

SE beliefs in these patients. The aim of the present study

was to test the cross-cultural adaptation and psychometric

properties of a Brazilian version of the Headache

Management Self-Efcacy Scale (HMSE) in a sample of

patients from three tertiary headache centers in Brazil.

Methods

Participants

The sample was composed by 137 patients with a migraine

diagnosis made by experienced neurologists according

to International Classication of Headache Disorders 3

Edition - Beta version (2013).

Exclusion criteria were

having a psychotic disorder, a cognitive impairment, or the

patient lacking time. The age of participants ranged from

18 to 65 years old (M = 43.70; SD = 12.74). Patients were

selected among the outpatients registered at the Headache

Unit of the Hospital de Clnicas de Porto Alegre (HCPA)

and o Irmandade Santa Casa de Misericórdia de Porto

Alegre (ISCMPA), both reference public hospitals, as well

as at the Headache Unit of the Hospital Moinhos de Vento

(HMV), a reference private hospital in South Brazil. All

three headache centers are in city of Porto Alegre, state

capital of Rio Grande do Sul, Brazil.

Instruments

Interview

A semi structured interview was held to characterize the

sample and to evaluate clinical headache parameters,

such as duration of disorder in years (DD), time patient

has been in treatment (DT), headache frequency in the last

three months (HF), headache intensity attributed by the

participants to their pain in the last three months in a scale

ranging from 0–10 (HI), and screening for medication

overuse headache diagnosis.

Headache Management Self-Efficacy Scale (HMSE)

The instrument was developed by French et al.

and

aims to assess individual´s perception of their ability to

take actions to prevent and to manage headaches and

headache-related disability. The scale consists of 25 items,

which were generated by individuals experienced in the

treatment of chronic headache problems and include items

both inquiring about individual´s condence in their ability

to prevent and to manage their headaches episodes. The

items are rated on a 7-point scale ranging from 1=strongly

disagree to 7=strongly agree. The instrument shows

excellent reliability, with Cronbach's at 0.90 for the 25-

item total scale.

Self-Reporting Questionnaire (SRQ)

It is a questionnaire for the screening of psychiatric disorders

at the primary care level

composed by 24 questions

subdivided in two sections: 20 questions aim at “neurotic”

disorders detection and the remaining four questions track

“psychotic” disorders. The “neurotic” disorders correspond

to mood, anxiety and somatoform disorders, assessed by

the SCID-IV -TR (Structured Clinical Interview for DSM-IV-

TR)

. In the present study we used only the rst section

(neurotic disorders). The individual fullls criteria for a

possible neurotic disturbance by scoring 7 or more points

in this subscale.

Short Form Health Questionnaire (SF-36)

The instrument is an indicator of overall health status and

has eight scaled scores: vitality (VT), physical functioning

(PF), bodily pain (BP), general health perceptions (GH),

physical role functioning (PR), emotional role functioning

(ER), social role functioning (SF), and mental health (MH).

Headache Impact Test (HIT-6)

This is a 6-item questionnaire used to measure the impact

of headaches on usual daily activities, including work,

school, social activities, pain intensity, fatigue and bedtime,

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Vieira RVA, Kowacs F, Londero RG, Barea LM, Grassi V, Ligório I, Beria FM, Gomes WB, Gauer G

Brazilian version of headache management self-efficacy scale

frustration, and concentration difculties.

Each item is

answered on a 5-point Likert scale (6 = never, 8 = rarely,

10 = sometimes, 11 = very often, 13 = always). The higher

the score obtained, the greater the degree of impact. The

instrument has good internal consistency, with Cronbach's

alpha of 0.79.

Pain Catastrophizing Scale (PCS)

The instrument was to assess catastrophizing as a style of

negative cognitions related to pain (“catastrophizing” refers

to a unique construct, evaluated from three dimensions:

magnication, rumination and helplessness. The instrument

shows a good level of internal consistency, with Cronbach's

alphas varying from 0.86 to 0.93 among magnication,

rumination and helpless subscales.

Patient Health Questionnaire 9 (PHQ-9) and

Generalized Anxiety Disorder 7 (GAD-7)

PHQ-9 and GAD-7 are instruments for the evaluation of

depression and anxiety according to the criteria of the

Diagnostic and Statistical Manual of Mental Disorders

(DSM-IV), respectively.

PHQ-9 is composed of nine items,

distributed on a 4-point Likert scale: "0" (not at all) to "3"

(nearly every day). The total score varies from 0 to 27,

being considered a positive indicator of major depression

the value greater or equal to 10 is an instrument composed

of seven items, distributed on a 4-point Likert scale: "0"

(not at all) to "3" (nearly every day). The sum of the

scores ranges from 0 to 21. Values greater than or equal

to 10 are positive indicators for anxiety disorders. In

the headache eld, both PHQ-9 and GAD-7 have been

considered reliable and valid screening instruments for

major depressive disorders and generalized anxiety

disorders in patients with migraine.

16, 17

Statistical Analysis

Descriptive statistics were performed for the

sociodemographic and clinical data of participants.

Psychometric properties of HMSE were analyzed using

factorial exploratory analysis principal axis method, with

Oblimin rotation and considering eigenvalues above

of 1, internal stability and convergent validity. Internal

stability was analyzed using Cronbach’s α coefcient and

convergent validity was investigated by correlating (HMSE)

scores with the Self-Reporting Questionnaire (SRQ), PHQ-9,

GAD-7, Pain Catastrophizing Scale (PCS), HIT-6 (Headache

Impact Test), and SF-36. To evaluate possible associations

between SE beliefs and sociodemographic measures, we

run Pearson correlations for continuous variables (age)

and t-test or ANOVA for categorical variables (income,

educational level, marital status and laboral status). To

compare possible mean differences in study measures in

chronic, episodic migraine and group comparisons, t-tests

were conducted, and effect size was calculated using the

Cohen's D index. A linear multiple regression analysis

(Enter method) was conducted to examine the relative

contribution of headache intensity, headache frequency,

psychopathological symptoms (SRQ), depression (PHQ-

9), anxiety (GAD-7), and SE beliefs to the prediction of

headache-related disability. Inferential statistics were run

using SPSS (Statistical Package for Social Sciences) version

22, adopting a 5% signicance level.

Results

A total of 137 patients from the three headache centers

were included. Because some patients could not full ll

all the instruments, the number of patients included in

the calculation varied from 106 to 137 in each measure.

Table 1 shows sociodemographic and clinical data of the

sample.

Table 1. Sociodemographic and Clinical Data of the Sample (n=137)

Sex Female (n = 122, 89.1%); Male (n = 15, 10.1%)

Age 44.05 (12.8)

Education

(%)

Elementary=52 (35.3%); High School=51 (34.7%);

Professional=11 (7.5%); College=19 (12.9%); Post-

graduate=14 (9.6%)

Income (in current minimum

wages)

Laboral Status

Until=15 (10.2%); From 1 to 3=69 (46.9%); From

3 to 5=43 (29.3%); From 5 to 10=13 (8.8%); More

than 10= 7(4.8%)

Employed= 69 (46.9%); Unemployed= 78 (53.1%)

Marital status Single = 37 (25.2%); Married = 60 (40.8%); Live with

partner = 28 (19%); Divorced = 17 (11.6%); Widowed

= 5 (3.4%)

Diagnosis

DD (years)

Episodic Migraine = 109 (75.2%); Chronic Migraine

= 21 (14.5%);

Medication Overuse Headache = 15 (10.3%)

22.67 (14.89)

DT (years) 9.91 (10.44)

HF/HI 28.97 (24.98)/8.23 (1.95)

Mean (standard deviation); DD = Duration of disease (in years), DT =

duration of treatment (in years), HF = headache frequency in the last three

months (in days), HI= headache intensity attributed by the participants to

their pain in the last three months in a scale ranging from 0–10

In order to explore the underlining theoretical structure

of the HMSE in the Brazilian sample, an exploratory

factor analysis was applied. The Kaiser-Meyer-Olkin

(KMO) measure of sampling adequacy was satisfactory

(KMO=0.84) and Bartlett's test of sphericity was signicant.

A one-factor solution was supported and accounted for

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Brazilian version of headache management self-efficacy scale

25% of variance in the items. Factor loadings ranged

from 0.13 to 0.72. When factor analysis was re-runned

excluding items with factor loading above 0.30, the items

left accounted only for 30% variance.

As in the study carried out by Cano-Garca and coworkers

we chose to select only the items with the highest factorial

loading (above 0.50). The items selected and their

respective factor loadings are presented on Table 2.

Table 2. HMSE-10 items and their respective factor loadings

Item Number- Brazilian Version of the item

Original version of the item (italic)

Factor loading

4 - Há coisas que eu posso fazer para reduzir a dor de cabeça.

There are things I can do to reduce headache pain.

0.65

6- Uma vez que a dor de cabeça começa, não há nada que eu

possa fazer para controlá-la*.

Once I have a headache there is nothing I can do to control it.*

0.57

11- Nada que eu faço impede que uma dor de cabeça leve se

torne forte*.

Nothing I do will keep a mild headache from turning into a bad

headache*.

0.56

13- Eu consigo fazer coisas para controlar o quanto as dores de

cabeça interferem na minha vida

I can do thing to control how much my headaches interfere with

my life.

0.74

15- Eu consigo fazer coisas para controlar o quanto dura uma

dor de cabeça.

I can do things that will control how long a headache lasts.

0.61

17- Quando não estou sob muito estresse, eu consigo prevenir

muitas dores de cabeça.

When I’m not under a lot of stress, I can prevent many headaches.

0.57

19- Eu consigo evitar que uma dor de cabeça leve atrapalhe o

meu dia,

se eu mudar a maneira como lido com a dor

I can keep a mild headache from disrupting my day by changing

the way I respond to the pain.

0.67

22- Há coisas que eu posso fazer para prevenir dores de cabeça.

There are things I can do to prevent headaches.

0.71

24- Eu consigo controlar a intensidade de uma dor de cabeça.

I can control the intensity of headache pain

0.64

25- Eu consigo fazer coisas para enfrentar as minhas dores de

cabeça.

I can do things to cope with my headaches.

0.75

Extraction Method: Principal Component Analysis.

In this new version, KMO was also satisfactory (KMO=0.87)

and Bartlett's test of sphericity was signicant. Thus, a

shortened version with 10 items of HMSE was obtained

for the Brazilian sample. Finally, HMSE-10 proved to

be satisfactory, with items accounting for 42% of total

variance. Cronbach’s α coefcient demonstrated good

internal consistency for HMSE-10 (α = 0.84) and adequate

corrected item-total correlation, ranging from 0.46 to 0.64.

Descriptive Statistics for Study Measures are presented in

Table 3.

Table 3. Descriptive Statistics of Study Measures (n=137)

Measure Mean (SD) Range Number of patients

HMSE- 10 43.84 (13.34) 60 135

PHQ-9 10.27 (6.65) 27 136

GAD-7 10.22 (6.16) 21 137

PCS 42.76 (12.04) 46 135

SRQ 10.09 (4.94) 20 137

HIT-6 62.03 (7.9) 38 137

SF-36

PF 62.91(29.32) 100 134

RP 39.93 (42.71) 100 134

BP 39.40 (22.27) 90 134

GH 6.81 (1.68) 8 134

VT 12.38 (3.80) 18 106

SF 57.56 (28.80) 100 134

RE 38.06 (43.48) 100 134

MH 55.01 (10.88) 68 134

Note. SD = standard deviation. physical functioning (PF), physical role

functioning (RP) role, bodily pain (BP), general health perceptions (GH),

vitality (VT), social role functioning (SF), emotional role functioning role

(RE), and mental health (MH).

The convergent validity was evaluated associating the

HMSE-10 score with other health-related measures and

the results are presented in Table 4. There was a lack of

correlation between SE beliefs and sociodemographic

variables (age, education, laboral status, income,

and marital status). HMSE-10 demonstrated a positive

correlation with 6 of 8 domains of overall health status

(physical functioning, physical role functioning, general

health perceptions, vitality, social role functioning,

emotional role, functioning role) and negative correlation

with psychopathological symptoms, depression, anxiety,

pain catastrophizing, headache-related disability,

headache frequency and headache intensity.

A comparison between variables means in the episodic and

chronic patients’ groups is shown at Table 5. Signicant

differences were observed in almost all variables between

control and clinical groups. The lack of difference was

showed only in physical functioning and vitality. The

difference between the means of the episodic and chronic

headache patients had a magnitude of moderate effect

in all the study measures according to statistical power

analysis guidelines.

The difference in HIT-6 was the

largest one found (d = 0.68), showing that in the Brazilian

sample chronic migraine patients suffer from a greater

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Vieira RVA, Kowacs F, Londero RG, Barea LM, Grassi V, Ligório I, Beria FM, Gomes WB, Gauer G

Brazilian version of headache management self-efficacy scale

Table 4. Correlations between HMSE-10 and other measures

Variáble 1 2

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

1- HMSE-10 -

2-SRQ -,21* -

3- PHQ-9 -,29** ,78** -

4-GAD-7 -,21* ,60** ,69** -

5- PCS -,36** ,41** ,41** ,49** -

6-HIT-6 -,34** ,52** ,55** ,43** ,45** -

7- PF

,24** -,53**

-,43** -,25** -,12 -,32** -

8-RP ,24** -,53** -,45** -,30** -,25** -,41** ,56** -

9-BP ,14 -,54** -,51** -,48** -,32** -,50** ,57** ,60** -

10- GH ,33** -,46** -,42** -,46** -,37** -,38** ,38** ,35** ,35** -

11- VT ,23* -,67** -,59** -,50** -,37** -,43** ,37** ,49** ,55** ,36** -

12- SF ,29** -,59** -,65** -,54** -,37** -,49** ,41** ,47** ,49** ,36** ,53** -

13- RE ,21* -,56** -,44** -,33** -,23** -,35** ,43** ,65** ,51** ,28** ,61** ,57** -

14-MH ,11 -,33** -,43** -,44** -,22** -,20* ,28** ,19* ,33** ,24** ,20* ,35** ,24** -

17 15-HF -,25** ,29** ,24** ,20* ,16 ,30** -,23** -,19* -,25** -,29** -,18 -,23** -,23** -,08 -

16-HI -,19* ,32** ,30** ,26** ,26** ,49** -,18* -,24** -,24** -,27** -,18 -,16 -,09 ,04 ,28** -

17-DD ,05 ,06 -,05 ,01 -,02 -,02 -,16 -,12 -,06 ,15 -,01 -,02 ,-05 ,03 ,07 ,02 -

18-DT ,10 -,04 -,01 -,10 -,06 ,06 ,00 -,12 -,05 ,14 -,01 ,05 -,05 ,12 ,18* ,09 ,49** -

<0.05; **

<0.01. HMSE-10 Headache Management Self-Efcacy Scale-10, SRQ Self-Reporting Questionnaire, PHQ-9 Patient Health Questionnaire

9, GAD-7 Generalized Anxiety Disorder, PCS Pain Catastrophization Scale, HIT-6 Headache Impact Test SF-36, PF physical functioning, RP physical role

functioning, BP bodily pain, GH general health perceptions, VT vitality, SF social role functioning, RE emotional role functioning role, MH mental health, HF

headache frequency, HI headache intensity, DD Duration of disease (in years), DT duration of treatment (in years)

Table 5. Study measures means in chronic, episodic and group comparisons

Measures

Mean (SD)

t-value; Cohen’s

CM EM

HMSE 135 37.97 (15.18) 45.73 (12.17)

= −2.67 (133); p < 0.01; d = 0.56

SRQ 137 11.56 (4.37) 9.65 (5.03)

= 1.94 (135); p < 0.05; d = 0.41

HIT-6 137 65.79 (6.69) 60.84 (7.90)

= 3.25 (135); p < 0.001; d = 0.68

PCS 135 46.58 (11.28) 41.61 (12.07)

= 2.03 (133); p < 0.05; d = 0.43

PHQ-9 134 12.84 (6.34) 9.49 (6.62)

= 2.50 (132); p < 0.05; d = 0.52

GAD-7 137 12.25 (5.75) 9.55 (6.12)

= 2.21 (135); p < 0.001; d = 0.45

134 54.69 (28.51)

65.49 (29.24)

= −1.83 (132); p > 0.05

RP 134 25.78 (39.39) 44.36 (42.92)

= −2.18 (132); p < 0.05; d = 0.45

BP 134 32.19 (17.73) 41.67 (23.13)

= −2.13 (132); p < 0.05; d = 0.46

GH 106 6.16 (1.91) 7.00 (1.55)

= −2.29 (132); p < 0.05; d = 0.49

VT 134 11.52 (3.94) 12.61 (3.75)

= -1,22 (104); p > 0.05;

SF 134 46.09 (26.46) 61.15 (28.68)

= −2.64 (132); p < 0.01; d = 0.55

RE 134 19.79 (36.77) 43.79 (44)

= −3.07 (132); p < 0.01; d = 0.60

MH 134 55.25 (10.28) 54.94 (11.11)

= 0.14 (132); p > 0.05; d = 0.03

<0.05; **

<0.01. CM Chronic migraine; EM Episodic migraine; HMSE Headache Management Self-Efcacy Scale, SRQ Self-Reporting Questionnaire,

PHQ-9 Patient Health Questionnaire 9, GAD-7 Generalized Anxiety Disorder, PCS Pain Catastrophization Scale, HIT-6 Headache Impact Test, PF physical

functioning, RP physical role functioning, BP bodily pain, GH general health perceptions, VT vitality, SF social role functioning, RE emotional role

functioning role, MH mental health

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Brazilian version of headache management self-efficacy scale

impact on their daily lives compared to episodic migraine

patients, which is in line with previous studies.

20, 21

Table 6 shows a multiple regression analysis conducted

to test the contribution of headache frequency, headache

intensity, psychopathological symptoms, depression,

anxiety, and SE beliefs to the prediction of headache-

related disability. Along with headache intensity and

depression, SE beliefs accounted for 43% (R

adjusted =

0.43;

=17.47;

<0.01) of variance in headache-related

disability.

Table 6. Regression Analysis for Headache-Related Disability (N=131)

Variable Beta t Sig

SRQ 15 1.33 .19

HF .07 .93 .38

HI .31 4.30 <.001**

PHQ-9 .26 2.21 .03*

GAD-7 .03 .37 .72

HMSE-10 -.17 -2.38 .02*

<0.05; **

<0.01. By the estimation method Enter. Durbin-Watson: 2.04

Discussion

The present study revealed that the Brazilian short version

of Headache Management Self-Efcacy Scale (HMSE-

10) is a valid and reliable measure of SE beliefs for

Brazilian headache patients. HMSE-10 was applied in

a heterogeneous sample of migraine patients regarding

to sociodemographic (education, income) and clinical

measures (headache frequency and intensity), which

allows for greater exibility of future scale applications.

The instrument showed good internal consistency, with

Cronbach’s α = 0.84 and adequate corrected item-total

correlation.

The HMSE-10 showed a mild, but signicant positive

correlation with 6 of 8 domains of overall health status

measured by SF-36. In turn, HMSE-10 scores were

negatively associated with psychopathological symptoms,

depression, anxiety and pain catastrophizing, headache-

related disability, headache frequency and headache

intensity. These ndings are in line with previous empirical

studies

22-24

and reinforce that along with other psychological

issues (e.g., psychiatric comorbidity, pain catastrophizing,

coping styles) SE beliefs evaluation is relevant to headache

treatment.

The lack of correlation between SE beliefs and

sociodemographic variables (age, education, laboral

status, income, and marital status) points to the relevance

of the other psychological variables which SE beliefs are

associated. Lastly, no correlations were observed between

SE beliefs and time of disease or time of treatment.

These results support the idea that it is indeed necessary

interventions focused on these beliefs for them to be

modied. Time of living with the disease or time in treatment

by themselves do not modify SE. According to the founder

of the concept of self-efcacy, psychological interventions

serve as a means of creating and strengthening SE

beliefs.

Although our clinical sample was not compared to a

control group, it showed anxiety (GAD-7), depression

(PHQ-9) and psychopathological symptoms (SRQ) mean

scores above cutoff points. These results are consistent

with the vast literature about the psychiatric comorbidity

observed in migraine patients, mainly depression and

anxiety.

26-27

Moreover, along with headache intensity and

depression, SE beliefs accounted for 43% (R

adjusted =

0.43;

=17.47;

<0.01) of variance in headache-related

disability, supporting that SE beliefs play a key role in

adaptation to headaches.

Even with satisfactory results for the purpose of the study,

some limitations should be mentioned. First, although

the sample was composed of individuals of different

educational and socioeconomic levels, it is possible to

have a regional bias, since patients were recruited only

in Southern Brazil. Second, the patients were all from

headache units, which increases the sample bias for those

who are not in treatment.

Our ndings have clinical and research implications. In

presenting our ndings and their consonance with previous

studies, we hope that clinicians will consider including the

investigation of SE beliefs into their clinical practice and

that researchers may take these cognitions as a useful

indicator of a good response to the proposed treatments.

In brief, the Brazilian Short Version of Headache

Management Self-Efcacy (HMSE-10) was considered a

valid and reliable measure of headache management self-

efcacy beliefs. The HMSE-10 correlations with a variety

of relevant clinical measures reinforce its utility in both

clinical and research settings.

Acknowledgments: We thank Professor Kenneth Holroyd

for providing the copy of original version of HMSE and

for the valuable contributions in the process of adaptation

of the instrument. Furthermore, our sincere gratitude to

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Vieira RVA, Kowacs F, Londero RG, Barea LM, Grassi V, Ligório I, Beria FM, Gomes WB, Gauer G

Brazilian version of headache management self-efficacy scale

Juliana Scibicio for the rened statistical advice.

Abbreviations: HMSE Headache Management Self-Efcacy

Scale, SRQ Self-Reporting Questionnaire, PHQ-9 Patient

Health Questionnaire 9, GAD-7 Generalized Anxiety

Disorder, PCS Pain Catastrophizing Scale, HIT-6 Headache

Impact Test SF-36 Short Form Health Questionnaire 36 (SF-

36) , Physical functioning (PF), Role functioning/ physical

(RP), Bodily pain (BP), General health (GH), Vitality

(VT), Social functioning (SF), Role functioning/emotional

(RE), Mental health (MH), HF Headache frequency, HI

Headache intensity, DD Duration of disease (in years), DT

duration of treatment (in years)

Disclosures: No conicts of interest have been reported by

the authors.

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