Understanding Your MIDAS Score: The Complete Guide

When you tell your doctor "migraines are ruining my life," they need a way to quantify that. How many days? How much impact? Is it getting better or worse? That is exactly what the MIDAS questionnaire was designed to measure.

MIDAS (Migraine Disability Assessment Scale) is the most widely used validated tool for measuring migraine-related disability in clinical practice. It is cited in treatment guidelines from the American Headache Society, the European Headache Federation, and NICE (National Institute for Health and Care Excellence) as a recommended instrument for guiding treatment decisions.

Understanding your MIDAS score — and knowing how to use it in conversations with your doctor — can be the difference between being undertreated and getting the care you need.

What Is MIDAS?

MIDAS was developed by neurologists Dr. Richard Lipton and Dr. Walter Stewart and first published in 2001 (Stewart et al., 2001). It was specifically designed to be:

• Brief — only 5 scored questions
• Patient-administered — you fill it out yourself, no clinician needed
• Validated — tested in multiple large studies confirming its reliability and clinical utility
• Actionable — scores directly map to treatment recommendations

The questionnaire has been translated into over 30 languages and validated in populations worldwide, making it a universal standard in headache medicine.

The 5 MIDAS Questions

Each question asks about the number of days affected in the last 3 months (90 days):

Your total MIDAS score = Q1 + Q2 + Q3 + Q4 + Q5

The 2 Supplementary Questions (Not Scored)

MIDAS also includes two additional questions that do not contribute to the total score but provide valuable clinical context:

• Question A: How many days did you have a headache in the last 3 months? (Headache frequency)
• Question B: On a 0-10 scale, how painful were these headaches on average? (Average pain intensity)

These help your doctor understand the full picture — a patient with few headaches but very severe ones has a different profile than a patient with many mild headaches.

MIDAS Grade Interpretation

Your total score maps to one of four disability grades:

What the Scores Actually Mean in Real Life

To help you interpret your score:

• MIDAS 0-5: You might miss 1-2 work days and a couple of social events over 3 months. Migraines are an occasional nuisance but not life-altering
• MIDAS 6-10: You are losing about a week of full productivity per quarter. Activities are being canceled or significantly reduced
• MIDAS 11-20: You are losing 2-3 weeks of productive life per quarter. This level of disability affects career advancement, relationships, and mental health
• MIDAS 21+: You are losing nearly a month or more of productive life per quarter. This is severely disabling and represents a medical condition that demands comprehensive treatment
• MIDAS 50+: This represents catastrophic disability. Some patients score in the 60-100+ range — these individuals may need specialized headache center care

How Doctors Use MIDAS Scores

Treatment Decision Framework

MIDAS scores directly inform treatment intensity. The American Headache Society and clinical guidelines use a stratified care model based on disability:

Tracking Treatment Response

One of the most powerful uses of MIDAS is re-assessment over time. By retaking the questionnaire every 3 months, you create an objective record of whether your treatment is working:

• Score dropping from Grade IV to Grade II → treatment is working
• Score unchanged after 3 months on preventive → treatment may need adjustment
• Score worsening → urgent re-evaluation needed

This data is far more useful than subjective impressions, which are notoriously unreliable for chronic conditions.

Insurance and Documentation

MIDAS scores are recognized by insurance companies, disability evaluators, and workplace accommodation programs. A documented Grade III or IV score supports:

• Prior authorization for CGRP inhibitors and other newer medications
• Disability accommodation requests under the ADA
• Short-term disability claims
• Workers' compensation cases where migraines affect job performance

MIDAS vs. HIT-6: What Is the Difference?

Both MIDAS and HIT-6 are validated headache assessment tools, but they measure different things:

Tips for Accurate Scoring

Getting an accurate MIDAS score is essential — underreporting leads to undertreatment.

Do:

• Count partial days — if a migraine reduced your productivity by 50%+ for even part of the day, count it
• Include presenteeism — being physically present at work but unable to function at full capacity counts for Q2
• Count household work broadly — cooking, cleaning, grocery shopping, childcare, errands, yardwork all count
• Use your migraine diary to get accurate day counts instead of relying on memory
• Be honest — the score is for your benefit, to get you the right treatment
• Think about the full 3 months — it is easy to undercount when looking back over 90 days

Don't:

• Don't count days where headache reduced productivity by less than 50% — MIDAS specifically asks about days with at least 50% reduction
• Don't include non-headache sick days — MIDAS is only about headache-related disability
• Don't round down — if you are uncertain whether something counts, include it
• Don't take MIDAS during an attack — pain affects judgment. Take it on a headache-free day when you can think clearly

What to Do With Your Score

Grade I-II (Score 0-10)

Your migraines are causing limited disability. Focus on:

• Effective acute treatment (have you tried triptans if OTC medications are insufficient?)
• Trigger identification and management using our Trigger Checklist
• Lifestyle optimization (regular sleep, meals, exercise, hydration)
• Monitoring — retake MIDAS in 3 months to catch any worsening

Grade III (Score 11-20)

Your migraines are significantly impacting your quality of life. Take action:

1. Bring your MIDAS score to your next doctor appointment and explicitly request a discussion about preventive medication
2. Start tracking with a migraine diary if you are not already
3. Ask about migraine-specific acute treatments (triptans, gepants) if you are only using OTC medications
4. Consider a neurologist referral if your primary care provider is not managing your migraines effectively

Grade IV (Score 21+)

Your migraines are causing severe disability that demands comprehensive treatment:

1. Schedule a neurology or headache specialist appointment — learn when and how to prepare
2. Bring your MIDAS score, headache diary, and medication history to the appointment
3. Ask about CGRP-targeting medications (the newest and most targeted migraine preventives)
4. Discuss a comprehensive treatment plan that may include both preventive and acute medications, lifestyle medicine, and potentially neuromodulation
5. Ask about disability accommodations at work if appropriate

References

1. 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):S20-28. PubMed

2. Stewart WF, Lipton RB, Whyte J, et al. An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology. 1999;53(5):988-994. PubMed

3. Lipton RB, Stewart WF, Sawyer J, Steiner JF. Clinical utility of an instrument assessing migraine disability: the Migraine Disability Assessment (MIDAS) questionnaire. Headache. 2001;41(9):854-861. PubMed

4. 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

5. American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019;59(1):1-18. PubMed

The MIDAS questionnaire is a validated clinical instrument. Scores should be discussed with a healthcare provider for proper interpretation and treatment planning.