How do you assess the impact of migraine on daily functioning?

Assessing the Impact of Migraine on Daily Functioning

Use validated disability assessment tools—specifically the Migraine Disability Assessment (MIDAS) questionnaire or the Headache Impact Test (HIT-6)—to quantify functional impairment across work, household, and social domains, combined with a headache diary to track frequency and severity patterns. 1

Primary Assessment Tools

MIDAS Questionnaire (Preferred for Clinical Practice)

• The MIDAS is a 5-item self-administered questionnaire that measures lost time across three specific domains over the past 3 months: 2, 3

  • Days of missed work or school
  • Days with reduced effectiveness at work or school (≥50% productivity loss)
  • Days of missed household work or chores
  • Days with reduced effectiveness in household work
  • Days of missed family, social, or leisure activities

• MIDAS generates a total disability score that stratifies patients into four grades: 3, 4

  • Grade I (0-5 points): Little or no disability
  • Grade II (6-10 points): Mild disability
  • Grade III (11-20 points): Moderate disability
  • Grade IV (21+ points): Severe disability

• Patients with chronic migraine (≥15 headache days/month) demonstrate significantly higher MIDAS scores (mean 34.9) compared to episodic migraine (mean 19.3), with 64.3% falling into Grade IV severe disability. 3

Headache Impact Test (HIT-6)

• HIT-6 offers broader accessibility (available online and as paper form) and covers a wider spectrum of headache impact than MIDAS, including pain intensity, social functioning, role functioning, vitality, cognitive functioning, and psychological distress. 2

• HIT-6 has demonstrated excellent validity with sensitivity of 0.93 and specificity of 0.81 when compared to specialist diagnosis. 2

Complementary Assessment Methods

Headache Diary Documentation

• Maintain a daily headache diary recording: 1

  • Frequency of headache episodes
  • Duration of each episode (hours)
  • Pain intensity (using 0-10 scale)
  • Associated symptoms (nausea, photophobia, phonophobia, vomiting)
  • Acute medication use (type and frequency)
  • Menstrual cycle timing (for women)

• Electronic headache diaries facilitate more detailed information capture, though compliance can be challenging—only 46% of patients complete paper diaries consistently in primary care settings. 1

Screening Questionnaires for Initial Assessment

• The ID-Migraine 3-item questionnaire rapidly identifies migraine likelihood based on: 1

  • Headache-associated nausea
  • Photophobia
  • Disability from headache

• The Migraine Screen Questionnaire (MS-Q) includes 5 questions covering frequency, intensity, duration, associated symptoms, and disability, with sensitivity of 0.93 and positive predictive value of 0.83. 1

Migraine-ACT Questionnaire for Treatment Evaluation

• The 4-item Migraine Assessment of Current Therapy (Migraine-ACT) identifies patients requiring treatment changes by assessing: 5
  • Consistency of medication response across attacks
  • Complete pain resolution within 2 hours
  • Return to normal function within 2 hours
  • Ability to plan daily activities confidently

Quality of Life Assessment

• Chronic migraine patients demonstrate substantially lower health-related quality of life (HRQoL) than episodic migraine patients, with greater inability to work, attend social functions, and perform routine chores. 1

• The American College of Physicians identifies migraine-related disability, quality of life, and physical functioning as key outcome measures when evaluating treatment efficacy. 1

Clinical Application Algorithm

Step 1: Initial Screening

• Ask the simple screening question: "Do you feel like you have a headache of some type on 15 or more days per month?" to identify chronic migraine, as patients often underreport milder headache days. 1

Step 2: Quantify Disability

• Administer MIDAS questionnaire at the initial visit to establish baseline disability grade and guide treatment intensity. 3, 6, 4

Step 3: Track Patterns

• Provide headache diary or calendar for prospective tracking over at least 1 month before treatment decisions. 1

Step 4: Reassess Treatment Response

• Re-administer MIDAS at 2-3 months after treatment initiation, then every 6-12 months to monitor treatment efficacy as an objective outcome measure. 7, 6

Common Pitfalls to Avoid

• Patients typically report only "severe headache days" and fail to mention milder headaches, leading to underestimation of true headache frequency—always use structured diaries rather than relying on recall alone. 1

• Only 20% of patients who fulfill criteria for chronic migraine are correctly diagnosed, highlighting the critical need for systematic disability assessment tools rather than clinical impression alone. 1

• Disability assessment tools are underutilized in primary care despite proven validity—incorporating MIDAS or HIT-6 into routine practice improves physician-patient communication and treatment stratification. 2, 6

• Medication overuse must be documented, as 69.8% of chronic migraine patients overuse acute medications, which significantly worsens disability scores and functional impairment. 3