Migraine: Diagnosis and assessment of disability

Migraine is a heterogeneous disorder characterized by attacks that vary in frequency, duration, severity and symptomatology. Migraine sufferers experience reduced health-related quality of life in comparison with the general population. Almost half of all sufferers have moderate to severe disability, with one-third having severe disability or needing bed rest. However, migraine is underdiagnosed and undertreated. A clinical tool that grades migraine sufferers according to their illness severity has the potential to improve migraine care by aiding communication between patients and healthcare professionals, and by providing a means to match level of medical care with disease severity. The Migraine Disability Assessment (MIDAS) Questionnaire is such a clinical tool. MIDAS is scored by summing five items that cover days of missed activities and reduced productivity in defined roles. MIDAS exhibits high internal consistency, test-retest reliability, accuracy, and face validity, and corresponds to physicians' judgements of illness severity and medical need. These features support the use of MIDAS in research and clinical practice. To improve healthcare delivery for migraine, disabled migraine sufferers should be encouraged to seek medical care and effectively communicate about their illness. In turn, physicians should be encouraged to make specific diagnoses, assess disability and select treatments appropriate to diagnosis and disability. The MIDAS Questionnaire can play an important role in public health initiatives for migraine.