MIDAS (Migraine Disability Assessment Score) is a brief self-report questionnaire used clinically to quantify migraine- related disability over the past 3 months. It takes about 90 seconds to complete and produces a single number that helps clinicians make treatment decisions.
It’s one of the most commonly used disability assessments in headache practice — both in research and in real clinics — because it converts subjective “migraine is bad” into something trackable.
The 5 questions
The instrument asks for the number of days in the past 3 months that migraine has affected:
- Missed work or school days entirely due to migraine.
- Work or school days at reduced productivity (50% or less of normal effectiveness).
- Missed household work days entirely.
- Reduced productivity household work days (50% or less).
- Days missed family, social, or leisure activities because of migraine.
Plus two informational items:
- A. Number of days in the past 3 months with any headache.
- B. Average pain severity of headaches on a 0–10 scale.
Total MIDAS score = sum of the 5 numbered questions.
Score interpretation
The published grading bands:
| Grade | Score | Disability |
|---|---|---|
| I | 0–5 | Little or none |
| II | 6–10 | Mild |
| III | 11–20 | Moderate |
| IV | 21+ | Severe |
Clinical implications:
- Grade I: usually managed with acute treatment as needed.
- Grade II: preventive medication consideration starts here if attacks are frequent.
- Grade III: typically prompts preventive medication discussion.
- Grade IV: often triggers specialist referral, more aggressive preventive regimens, and disability documentation for work or school accommodations.
Why MIDAS exists
Headache severity is hard to measure in a way that’s both quick and comparable across patients. Pain ratings vary in interpretation; “number of headache days” misses severity; visit- to-visit recall is unreliable.
MIDAS is built around a clinically meaningful endpoint (disability) using anchor points (specific activity days) that are easier to recall accurately than pain levels. It also captures the dimensions of disability that matter clinically — being unable to work or attend school is more informative than just “the pain was bad”.
The validation history (Stewart 1999 and follow-ups) shows good test-retest reliability and predictive value for treatment benefit. It’s stable enough to be a useful trend marker over months and years.
MIDAS vs HIT-6
HIT-6 (Headache Impact Test, 6-item) is the other commonly used disability assessment. Key differences:
| Feature | MIDAS | HIT-6 |
|---|---|---|
| Recall window | Past 3 months | Past 4 weeks |
| Number of items | 5 + 2 informational | 6 |
| Output | Day-based score | 36–78 score |
| Best for | Quarterly tracking, severity grading | Visit-to-visit change |
Many practices use both — MIDAS for periodic comprehensive assessment, HIT-6 for tracking treatment response between visits.
Where Hermly fits
Hermly doesn’t currently compute the formal MIDAS questionnaire — the input requires user self-report on activity days that the app doesn’t track natively.
What Hermly’s doctor report does provide:
- Attack frequency (headache days, migraine days) over the past 3 months.
- Average pain severity across logged attacks.
- Distribution of attack durations.
This data lets a clinician quickly estimate MIDAS during a visit — or administer the formal questionnaire with most of the informational items already populated.
Adding the formal MIDAS as an in-app questionnaire (with periodic prompts to complete it) is a reasonable future feature.
What this isn’t
Not a self-diagnosis tool. MIDAS quantifies disability for treatment decisions but doesn’t diagnose migraine. The scoring bands are useful prognostic markers, not absolute treatment triggers — clinical judgment factors in comorbidities, prior treatments, and patient preferences.