MIDAS — Migraine Disability Assessment Calculator
The Migraine Disability Assessment (MIDAS) questionnaire quantifies headache-related disability over the past 3 months. It asks 5 questions about days of missed or reduced activity in work, household work, and family/social/leisure activities. The total score stratifies patients into 4 grades of disability (I-IV) to guide treatment decisions.
About
The MIDAS questionnaire was developed by Lipton et al. to measure headache-related disability and guide treatment intensity. It assesses the number of days in the past 3 months that headache impacted work (paid employment or school), household work, and non-work (family, social, leisure) activities. The total score ranges from 0 to 270+, with higher scores indicating greater disability.
Formula
MIDAS Score = Days Missed Work + Days Reduced Work (half) + Days Missed Household + Days Reduced Household (half) + Days Missed Family/Social/Leisure. Grade I: 0-5, Grade II: 6-10, Grade III: 11-20, Grade IV: 21+
Each of the 5 questions asks about days affected in the past 3 months. Questions 1 and 3 count full days missed. Questions 2 and 4 count days with at least 50% reduced productivity (counted at half value in some scoring systems; the full count method is used here per the original MIDAS validation). The total score determines the grade of disability.
Score Interpretation
Migraine affects 15% of the global population (1 billion people) and is the second leading cause of disability (years lived with disability) worldwide. The MIDAS questionnaire is the most widely used tool for quantifying migraine-related disability and is recommended by the American Headache Society and International Headache Society guidelines for guiding treatment decisions, particularly the need for preventive therapy.
Grade I — Little or No Disability — 0–5
MIDAS 0-5: Minimal headache-related disability.
Management: Continue acute treatment as needed. Preventive therapy not routinely indicated.
Grade II — Mild Disability — 6–10
MIDAS 6-10: Mild headache-related disability.
Management: Consider preventive therapy if attacks are frequent or acute treatment is inadequate.
Grade III — Moderate Disability — 11–20
MIDAS 11-20: Moderate headache-related disability.
Management: Preventive therapy indicated. Consider beta-blockers, amitriptyline, topiramate, or CGRP antagonists.
Grade IV — Severe Disability — 21+
MIDAS 21+: Severe headache-related disability.
Management: Strongly recommend preventive therapy and referral to headache specialist or neurologist.
Reference Ranges
| Population | Normal Range | Notes |
|---|---|---|
| Grade I (Little/None) | 0-5 | Minimal disability |
| Grade II (Mild) | 6-10 | Mild disability |
| Grade III (Moderate) | 11-20 | Moderate disability |
| Grade IV (Severe) | 21+ | Severe disability |
Dr. Khaled Hassan
Dr. Khaled is a cardiology consultant with experience in acute cardiac care.
View medical review board & editorial policy →Example Calculation
Past 3 months: 5 days missed work, 8 days reduced work, 4 days missed household, 6 days reduced household, 3 days missed family. Total = 5+8+4+6+3 = 26. Grade IV — Severe disability. Recommend preventive therapy and neurology referral.
Related Conditions
Common Mistakes
Forgetting to specify the 3-month recall period when administering MIDAS
Always specify "over the past 3 months" when asking each question. The 3-month window provides a more representative sample of headache burden than shorter periods.
Frequently Asked Questions
How does MIDAS score guide preventive therapy decisions?
What is the difference between MIDAS and HIT-6?
References
- Stewart WF et al. Development of the Migraine Disability Assessment (MIDAS) questionnaire to measure headache-related disability. Neurology. 2001;56(6 Suppl 1):S20-S28. PubMed
- Lipton RB et al. Migraine in the United States: epidemiology and patterns of health care use. Neurology. 2002;58(6):885-894. PubMed