MIDAS vs HIT-6: Which Migraine Assessment Should You Use?

If you are living with migraine and want to communicate the true burden of your condition to a healthcare provider, two validated questionnaires stand out: the Migraine Disability Assessment (MIDAS) and the Headache Impact Test (HIT-6). Both are widely used in clinical practice, recommended by headache societies, and available as free self-report tools.

But they measure different things. Understanding when and why to use each — or both — can significantly improve how you track your migraine burden and discuss treatment goals with your doctor.

What Is the MIDAS Score?

The Migraine Disability Assessment (MIDAS) was developed by Stewart, Lipton, and colleagues and first published in 1999. It has since become one of the most widely used migraine disability instruments worldwide (Stewart et al., 1999; Stewart et al., 2001).

What MIDAS Measures

MIDAS focuses specifically on productivity loss caused by migraine over the past 3 months. It asks 5 scored questions:

1. Days of missed work or school
2. Days where work/school productivity was reduced by half or more
3. Days of missed household work
4. Days where household productivity was reduced by half or more
5. Days of missed social, family, or leisure activities

The total score (sum of all 5 answers) is graded on a 4-level scale:

Strengths of MIDAS

• Concrete and countable: Answers are specific day-counts, making the score easy to interpret
• 3-month window: Captures cumulative burden, not just how you feel today
• Treatment-guiding: Many guidelines use MIDAS grades to guide preventive treatment decisions
• Change-sensitive over long periods: Good for evaluating whether a treatment strategy works over months

Limitations of MIDAS

• Relies on recall over 3 months, which may be inaccurate without a diary
• Does not capture pain severity, emotional impact, or functional impairment on non-missed days
• May underestimate burden for people who push through attacks without missing work

What Is the HIT-6 Score?

The Headache Impact Test (HIT-6) was developed by a multidisciplinary team and published in 2003 (Kosinski et al., 2003). Unlike MIDAS, it takes a broader view of headache impact beyond just missed days.

What HIT-6 Measures

HIT-6 asks 6 questions covering:

1. Pain severity ("When you have headaches, how often is the pain severe?")
2. Activity limitation
3. Wish to lie down
4. Fatigue/tiredness
5. Irritability/frustration
6. Difficulty concentrating

Each question has 5 response options (Never / Rarely / Sometimes / Very Often / Always) scored 6-13 points. Total scores range from 36 to 78.

Strengths of HIT-6

• Multi-dimensional: Captures pain, function, cognition, and mood — not just productivity
• Quick snapshot: Reflects your current state, useful for frequent reassessment
• Validated for episodic and chronic migraine: Works across the full spectrum
• Sensitive to change: A 2.3-point change is considered clinically meaningful (Smelt et al., 2014)

Limitations of HIT-6

• Subjective frequency terms ("sometimes," "very often") may be interpreted differently by different people
• Does not provide a specific disability grade linked to treatment guidelines
• Single-timepoint assessment without a defined recall period

MIDAS vs HIT-6: Key Differences

When to Use Which

Use MIDAS when: - Preparing for a first appointment with a headache specialist - Determining whether you qualify for preventive treatment - Demonstrating migraine severity to an employer or insurer - Evaluating treatment effectiveness over a 3-month period

Use HIT-6 when: - Monitoring impact between appointments - Tracking week-to-week or month-to-month changes - Capturing the emotional and cognitive burden (not just missed days) - Assessing patients who rarely miss work but still suffer significant impact

Why Use Both Together

The most comprehensive approach is to use both assessments together. A person might have a low MIDAS score (Grade I — few missed days) but a high HIT-6 score (60+ — severe daily impact), indicating they are pushing through attacks at significant personal cost. Conversely, someone with high MIDAS but moderate HIT-6 may have infrequent but completely disabling attacks.

Using both tools gives your clinician two complementary data points: - MIDAS shows the cumulative productivity cost - HIT-6 shows the experiential burden

Together, they paint a complete picture that neither instrument captures alone.

Track Your Scores Over Time

Both scores become more valuable when tracked longitudinally. If you take MIDAS every 3 months and HIT-6 monthly, you build a trend that clearly shows whether your treatment is working:

• MIDAS declining from Grade IV to Grade II over 6 months = clear improvement
• HIT-6 dropping from 65 to 54 over 3 months = measurable treatment response

Our MIDAS Calculator and HIT-6 Calculator both save your results and display score history charts, so you can easily track changes over time.

References

1. Stewart WF, Lipton RB, Kolodner KB, Liberman J, Sawyer J. Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalalgia. 1999;19(2):107-114. PubMed

2. Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56(6 Suppl 1):S20-S28. PubMed

3. Kosinski M, Bayliss MS, Bjorner JB, et al. A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res. 2003;12(8):963-974. PubMed

4. Smelt AFH, Assendelft WJJ, Terwee CB, Ferrari MD, Blom JW. What is a clinically relevant change on the HIT-6 questionnaire? An estimation in a primary-care population of migraine patients. Cephalalgia. 2014;34(1):29-36. PubMed

5. Yang M, Rendas-Baum R, Varon SF, Kosinski M. Validation of the Headache Impact Test (HIT-6) across episodic and chronic migraine. Cephalalgia. 2011;31(3):357-367. PubMed

This comparison is based on the original validation studies and clinical guidelines. Both MIDAS and HIT-6 are self-report screening instruments, not diagnostic tools. Discuss your results with a healthcare provider for personalized treatment decisions.