The Migraine Disability Assessment Test (MIDAS)

The MIDAS (Migraine Disability Assessment) questionnaire was put together to help you measure the impact your headaches have on your life. The information on this questionnaire is also helpful for your primary care provider to determine the level of pain and disability caused by your headaches and to find the best treatment for you.


INSTRUTIONS
Please answer the following questions about ALL of the headaches you have had over the last 3 months. Select your answer in the box next to each question. Select zero if you did not have the activity in the last 3 months. Please take the completed form to your healthcare professional.

"*" indicates required fields

Name
This is optional. If you put your name, it will be shown in the PDF report.
This is optional. If you enter a valid email, we will email you your MIDAS Score in a PDF attachment.
Enter a number between 0 and 92
Enter a number between 0 and 92
Enter a number between 0 and 92
Enter a number between 0 and 92
Enter a number between 0 and 92
What your Physician will need to know about your headache:
Enter a number between 0 and 92
Enter a number between 0 and 10
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Scoring: After you have filled out this questionnaire, add the total number of days from questions 1-5 (ignore A and B).

MIDAS Grade Definition MIDAS Score
I
Little or No Disability
0-5
II
Mild Disability
6-10
III
Moderate Disability
11-20
IV
Severe Disability
21+

If Your MIDAS Score is 6 or more, please discuss this with your doctor.

© Innovative Medical Research, 1997

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