Headache-Specific Locus of Control Scale

Abstract

The Headache-Specific Locus of Control Scale (HSLOCS) is a specialized psychological instrument designed to assess an individual’s perceived control over the onset, severity, and management of headache pain. Developed primarily for use with adolescents, this scale adapts Julian Rotter’s Locus of Control construct specifically to the domain of headache experience. It aims to quantify the degree to which adolescents attribute control over their headaches to internal factors (self-management and behavior), powerful external factors (doctors, medication, or healthcare providers), or chance/fate (uncontrollable external circumstances).

Keywords

Headache, Locus of Control, Pain Management, Adolescents, Health Beliefs, Internal Control, External Control, Health Psychology, Chronic Pain.

Authors

David S. Holroyd, Donald B. Penzien, and colleagues.

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Purpose

The primary purpose of the HSLOCS is to provide clinicians and researchers with a standardized measure of health beliefs specific to headaches. Understanding an adolescent’s locus of control regarding their headache condition is crucial because these beliefs significantly influence adherence to treatment regimens, coping strategies, and overall prognosis. Individuals who score highly on internal control are generally expected to engage more proactively in self-care behaviors, such as stress reduction and proper medication timing.

Conversely, high scores on powerful others or chance dimensions may indicate reliance on external intervention or fatalistic acceptance, which can impede effective self-management of chronic pain conditions. The scale is therefore a valuable tool for tailoring psychological interventions and educational programs aimed at improving the self-efficacy of young patients suffering from recurrent headaches.

Construct

The scale measures the construct of domain-specific Locus of Control, which posits that individuals differ in the extent to which they believe they control outcomes in their lives. Applied to headache management, the HSLOCS is structured around three distinct subscales, mirroring standard health locus of control models:

• Internal Locus of Control (ILOC): Measures the degree to which the individual believes their own actions (e.g., managing stress, relaxing, taking care of oneself) influence the occurrence or severity of headaches.
• Powerful Others Locus of Control (POLOC): Measures the belief that external agents, primarily medical professionals and prescribed treatments, are responsible for preventing and treating headaches.
• Chance Locus of Control (CLOC): Measures the belief that headaches are random, unpredictable, and determined by fate, luck, or uncontrollable external forces, rendering personal effort ineffective.

Validity

Studies examining the HSLOCS have demonstrated robust validity evidence. Construct validity has been established through correlations between the subscale scores and theoretically relevant measures, such as general pain coping mechanisms, headache disability scales (e.g., Pediatric Migraine Disability Assessment Scale), and measures of self-efficacy. For example, higher Internal Locus of Control scores typically correlate negatively with headache-related interference and positively with active coping strategies.

Criterion validity is supported by findings that the subscales predict clinically relevant outcomes. The Internal Control score often predicts better adherence to non-pharmacological therapies (like biofeedback or relaxation training), while high Chance scores are frequently associated with higher levels of psychological distress and poorer treatment outcomes, particularly in chronic pain populations.

Reliability

The reliability of the HSLOCS is generally considered high across its three subscales. Measures of Internal Consistency, typically calculated using Cronbach’s alpha, consistently yield coefficients in the acceptable to excellent range (e.g., .75 to .90) for the Internal, Powerful Others, and Chance subscales. This indicates that the items within each subscale reliably measure the same underlying construct.

Furthermore, Test-Retest Reliability, assessed over periods ranging from a few weeks to several months, demonstrates stability in adolescents’ headache-specific locus of control beliefs, suggesting that the scale measures relatively stable cognitive orientations rather than transient mood states. This stability is crucial for assessing treatment effects over time.

Factor Analysis

The structure of the HSLOCS has been consistently supported by psychometric analysis. Initial and subsequent studies employing exploratory and confirmatory Factor Analysis have validated the theoretical three-factor model. The 33 items load distinctly onto the three hypothesized factors: Internal Control, Powerful Others, and Chance/External.

This distinct factor structure confirms that the scale successfully differentiates between the sources of perceived control relevant to headache management. The clarity of the factorial structure reinforces the scale’s utility in clinical settings for assessing specific cognitive barriers or facilitators to effective pain management in adolescents.

Instrument

Test Type: Self-report questionnaire / Psychological scale

Format: 33 items, typically administered using a Likert-type response scale (e.g., ranging from “Strongly Disagree” to “Strongly Agree”).

Language Available: Primarily English (with potential translations available in research literature).

Population Group: Clinical and non-clinical populations experiencing recurrent headaches.

Age Group: Adolescents (typically 12–18 years).

Population Details: Originally validated on samples of adolescents diagnosed with various headache types, including migraine and tension-type headaches.

Test Methodology: Respondents indicate their level of agreement with statements concerning the control of their headaches. Scoring involves summing item responses within the respective subscales (Internal, Powerful Others, Chance) to yield three independent scores.

Keywords

Locus of Control, Migraine, Tension Headache, Self-Efficacy, Behavioral Medicine, Internal Consistency, Psychometrics, Pediatric Pain.

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Authors

Author ORCID Identifier: N/A (Requires specific research, not provided in source.)

Affiliation Email addresses: N/A (Requires specific research, not provided in source.)

Correspondence Address: N/A (Requires specific research, not provided in source.)

Permissions & Fee and Test Year

The scale was initially published in 1990. Permissions are typically granted through the authors or the journal publisher for research and clinical applications. Specific fee structures depend on the usage context.

Reference’s

The original publication describing the Headache-Specific Locus of Control Scale for Adolescents can be found here: http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.1990.hed3011729.x/abstract

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Items of the Headache-Specific Locus of Control Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Taking medicine as prescribed keeps headaches from getting worse.
2. Doctors keep me from getting headaches.
3. My headaches aren’t as bad if doctors take good care of me.
4. I usually get over a headache when I get good medical help.
5. Seeing my doctor regularly is the best way to control my headaches.
6. My doctor’s treatment can help my headaches.
7. If I don’t have the right medicine‚ my headaches are a problem.
8. Only my doctor can give me ways to prevent headaches.
9. When I have headaches‚ I should talk to a doctor.
10. When my doctor makes a mistake I am the one to suffer with headaches.
11. Just seeing my doctor helps my headaches.
12. When I push myself too hard I get headaches.
13. By not becoming stressed out or overly active I can prevent headaches.
14. When I worry I am more likely to have headaches.
15. My actions influence whether I have headaches.
16. My headaches are worse when I’m stressed.
17. I can avoid some headaches if I relax.
18. I can prevent some headaches by avoiding stress.
19. I can prevent some headaches by not getting upset.
20. I am directly responsible for getting some headaches.
21. When I don’t take care of myself‚ I get headaches.
22. My headaches can be worse if I’m too active.
23. When I have a headache‚ nothing I can do will change it.
24. My headaches are beyond control.
25. I’m likely to get headaches no matter what I do.
26. No matter what I do‚ I will still have headaches.
27. I am completely at the mercy of my headaches.
28. If a headache is coming I will get it no matter what.
29. I’m just lucky when I don’t get headaches.
30. It’s a matter of fate whether I get a headache.
31. When I get headaches I have to let nature run its course.
32. Luck plays a big part in how soon my headache ends.
33. My not getting headaches is a matter of good fortune.