What does MIDAS measure?
A visit can miss the difference between having pain and losing parts of your life to it. MIDAS can show that you kept attending work but functioned at half capacity, stopped household tasks, or cancelled ordinary plans. The score combines missed or reduced days into one disability total that you can compare with standard grades. It still can't identify the headache type, count medicine use, explain brain fog, or decide which treatment is right.
Function
How many days did headaches stop or reduce activity?
The score brings together missed and heavily reduced days across work or education, household responsibilities, and family, social, or leisure activity.
Grade
Which disability grade fits the three-month total?
The four grades give the total a shared meaning and make it easier to describe burden without relying only on a pain rating.
Conversation
Which lost activity should treatment try to restore?
The five item counts can show whether the largest cost was paid work, education, household activity, caring, relationships, or ordinary plans.
MIDAS measures lost activity. It does not diagnose migraine or show whether a headache is an emergency. Use the symptoms, examination, headache days, medicine use, treatment history, and insurance rules for those decisions.
Save this test
Save the MIDAS score with headache days and the exact three-month period it covers
Store the total with the item counts, dates, form type, headache days, medicine days, and the activity you lost. A later score is easier to trust when it answers the same question across another complete window.
My Fog keeps your notes. Use the authorized questionnaire for the score. Your symptoms, not the grade, show if you need urgent care.
How age, pregnancy, and daily duties change the score
MIDAS is an adult disability measure. Women and men use the same grades. Age, pregnancy, periods, work, school, and daily duties can still change what the total means.
Children and teenagers
Use PedMIDAS when the pediatric service considers it appropriate. It has six child-specific items and different grades: 0 to 10, 11 to 30, 31 to 50, and above 50. School attendance, home instruction, age, parent input, and developmental stage belong beside the score.
Adult women and men
Use the same adult scoring and grade cutoffs. There is no separate male or female MIDAS threshold. Check which duties and opportunities you actually had in the three-month window. Paid work, unpaid work, caring, and social demands affect where you count lost or reduced-productivity days.
Menstrual timing
MIDAS does not show whether attacks cluster around menstruation. If that's the question, keep a headache and menstrual diary across at least two cycles. Record headache days, disability, medicine use, aura, and cycle day rather than trying to infer the pattern from the total.
Pregnancy and the weeks after birth
The score can summarize past disability, but pregnancy needs its own safety check. Get prompt obstetric care for a severe or lasting headache. Also get help for vision changes, face or hand swelling, upper-belly or shoulder pain, trouble breathing, high blood pressure, or a sudden new pattern.
Older adults and a new headache
Get medical care for a new headache after age 50 or a major change in your usual headaches. Other warning signs include pain while chewing, vision change, fever, weight loss, cancer, or a weakened immune system. Do not wait three months to finish the score.
How to complete MIDAS without counting a day twice
Use the authorized MIDAS form in a language you understand. The questionnaire is under copyright, so we explain how it works and link to the form without copying the full wording.
Set the three-month period before answering. Save its start and end dates. Use a calendar, attendance records, messages, or a headache diary to remember what happened.
Count all headaches, including ones you're not sure were migraine. For work or education and for household activity, do not count the same missed day again as a reduced-productivity day in that same domain.
Reduced productivity means that your output fell by at least half. If you cannot judge that exactly, use the same practical rule across the whole recall window and save a note about how you counted.
Add questions 1 to 5 for the MIDAS total. Keep the extra headache-day and average-pain answers beside the score, but do not add them to it.
Also count the days you used each acute headache medicine. MIDAS does not ask for this, and medicine-use days can change the safety and treatment conversation.
Open the authorized form
Use one complete adult MIDAS version and language. For a child or teenager, ask whether the separate six-item PedMIDAS is the right tool instead.
Rebuild the three-month window
Use a diary or calendar to count missed days and days at half productivity across work or education, household activity, and family, social, or leisure activity.
Add the five scored answers
The MIDAS total is the sum of questions 1 to 5. The two supplementary answers about headache days and average pain stay beside the score and are not part of the total.
Read the grade with the missing context
Place the total in Grade I, II, III, or IV, then add headache days, acute-medicine days, unusual symptoms, treatment changes, and the main activity you lost.
What do the four MIDAS grades mean?
Add questions 1 to 5, find the adult grade, then read the item counts and the diary. The grade describes disability during one three-month period.
Grade I: little or no disability
Grade I, 0 to 5: little or no disability
Few activity days were lost in this three-month window. Check the headache-day and pain answers anyway. Severe or unusual attacks, frequent medicine use, or a new pattern can still need care even when the disability total is low.
Grade II: mild disability
Grade II, 6 to 10: mild disability
Headaches cost some work, education, household, family, social, or leisure time. Find which area contributed most and add headache and medicine-use days before discussing what's next.
Grade III: moderate disability
Grade III, 11 to 20: moderate disability
The three-month effect was moderate. This supports a fuller review of headache diagnosis, acute and preventive care, medicine use, goals, and barriers, but the grade does not choose a treatment.
Grade IV: severe disability
Grade IV, 21 or more: severe disability
Many activity days were lost or heavily reduced. Bring the item-level counts and diary because two people with the same total may have very different headache frequency, work circumstances, safety concerns, and treatment needs.
A Grade IV score is not a treatment order or emergency threshold
It shows severe disability during the recall window. A person in Grade I can still have a dangerous new headache, and two people in Grade IV may need different care. Use symptoms for urgency and use the full clinical and insurance record for treatment access.
See research details
These checks cover scoring, diary validity, repeat change, the 2026 US evidence, insurance, children, and headache red flags.
In the original international reliability study, 97 US and 100 UK participants completed it twice about three weeks apart. Total-score test-retest correlations were 0.80 and 0.83, and internal-consistency values were 0.76 and 0.73.
Among 144 people with clinically diagnosed migraine, the MIDAS total correlated 0.63 with the diary score. The average totals were similar, but the two reduced-productivity items overestimated their diary equivalents. Save the dates and use a calendar or diary, because memory isn't exact.
Keep both answers because they add frequency and intensity, but do not add them to the five-item MIDAS total. Also record acute-medicine days separately because the form does not capture them.
A 2024 German specialist-center registry of 1,218 adults estimated about a 30 percent fall for starting scores above 20. For starting scores of 6 to 20, it estimated about a 4-point fall. Those are group estimates, not personal pass marks. Compare the score with headache days, function, treatment, and the exact window.
The study ran online, and several authors were affiliated with Eli Lilly. Its main point is still useful. Read disability, headache frequency, and quality of life together. MIDAS is one measure of recovery, not the only one.
A 2025 to 2026 US analysis covered 6,898,995 people with migraine, 929,793 with chronic migraine, and 149 plans. 142 plans covered at least one CGRP-targeted medicine. Coverage varied by drug, and many still required other drugs first. Save the score, diagnosis, headache days, medicine history, and the plan's current criteria.
PedMIDAS Grade I is 0 to 10, Grade II 11 to 30, Grade III 31 to 50, and Grade IV above 50. A 2026 Turkish study in 60 children and adolescents reported internal consistency of 0.74 and test-retest correlation of 0.92 for that translation. Do not apply adult MIDAS cutoffs to a child.
A sudden explosive headache, new weakness or speech trouble, confusion, seizure, major vision loss, fever with a stiff neck, severe headache after injury, a new severe pregnancy or postpartum headache, or a new headache after age 50 needs a medical exam, whatever the score.
Keep a clear three-month headache record
Use a calendar or diary to make the three-month score easier to trust. Keep the record short. Also protect the sleep, meals, fluids, and routines that help you spot headache changes.
Build the score from a calendar, not one bad day
Keep the five item counts so a clinician can see whether the total came mostly from work, household, or social loss.
Count the things MIDAS leaves out
Count headache days, migraine-like days, average pain, aura or other neurological symptoms, days each acute medicine was used, and what helped. This separates frequency, intensity, medicine exposure, and disability instead of forcing all four into one number.
Keep sleep, meals, caffeine, and activity consistent while counting headaches
Aim for regular meals, ordinary hydration, a consistent sleep and wake time, and movement that is safe for you. Record skipped meals, sleep loss, caffeine changes, alcohol, illness, menstruation, and unusual exertion. Change one manageable thing at a time. Your score is no reason for a severe elimination diet.
Prepare one concrete request
Bring the total, each item count, your diary, medicine list, and the activity you most want back. Ask whether the diagnosis and medicine plan need review. Also ask about the treatment goal, insurance rules, and when to repeat MIDAS.
Call 911 for a sudden worst-ever headache with new weakness, numbness, trouble speaking, confusion, seizure, fainting, or major vision loss. Get urgent care for fever with a stiff neck, a severe headache after injury, or fast-changing new headaches. During pregnancy or after birth, contact obstetric care for a severe or lasting headache. Vision change, swelling, upper-belly pain, trouble breathing, or high blood pressure make this more urgent. Do not wait to finish MIDAS.
What should you keep with a MIDAS result?
Keep these together
- Adult MIDAS or PedMIDAS, authorized version, and language
- Start and end dates of the three-month recall window
- Every scored item, total, and grade
- Supplementary headache days and average pain
- Headache or migraine-like days and days each acute medicine was used
- The work, education, household, family, social, or leisure activity most affected
- Acute and preventive medicines, supplements, start or stop dates, and treatment response
- New neurological symptoms, injury, illness, menstrual timing, pregnancy, or recent birth
- Clinician interpretation, diagnosis question, insurance criteria if relevant, treatment goal, and repeat plan
Question for the visit
“Could we review my MIDAS answers, total, headache calendar, medicines, unusual symptoms, and relevant menstrual or obstetric context, then choose the activity that treatment should aim to restore?”
Sources for MIDAS Migraine Score: Disability Grades and Meaning
Authorized MIDAS access, three disability domains, and patient use context
Five scored items, supplementary headache-day and pain questions, four grades, and copyright notice
Plain-language scoring, four adult grades, and supplementary questions
US and UK reliability, three disability domains, sample size, and consistency estimates
Ninety-day diary validity, 144-person sample, correlation, and reduced-productivity recall limits
MIDAS development, validation, reliability, and clinician communication
Important-change estimate and limited responsiveness in a 103-person non-drug treatment cohort
Starting-score-specific change estimates in 1,218 adults in German tertiary headache care
Current US longitudinal evidence using headache days, MIDAS, and quality of life together, with funding context
US CGRP coverage variation, step therapy, plan counts, and authorization limits
American Headache Society position on CGRP-targeted preventive treatment
PedMIDAS development as a separate child-specific questionnaire
PedMIDAS four-grade pediatric scale and 329-child grading study
Current Turkish PedMIDAS translation study in 60 children and adolescents
Medicine-use days and duration criteria that MIDAS does not collect
Sudden-onset and neurological warning signs, injury, pregnancy, and new-headache urgency
Diary fields and practical headache tracking
Regular meals, hydration, sleep, movement, and manageable behavior changes
Pregnancy and postpartum warning signs and medicine-review context
Evaluation and management of primary and secondary headache in pregnancy and postpartum, reaffirmed 2024
Headache diary fields, menstrual timing, medicine-use thresholds, and red flags for people aged 12 and over
US patient education on migraine symptoms, diagnosis, treatment, and daily management
See each claim's sources
procedure
The authorized adult MIDAS form scores five three-month disability items and keeps headache-day and average-pain questions outside the total.range
Adult MIDAS grades are 0 to 5, 6 to 10, 11 to 20, and 21 or more.interpretation
In 97 US and 100 UK participants, MIDAS total-score test-retest correlations were 0.80 and 0.83 and internal-consistency values were 0.76 and 0.73.limitation
In a 144-person 90-day diary study, MIDAS correlated 0.63 with the diary score and overestimated reduced-productivity days while mean total scores were similar.limitation
MIDAS measures headache-related disability and supports communication but does not diagnose migraine, identify the headache cause, or triage an emergency.interpretation
Published MIDAS important-change estimates differ by starting score, population, treatment, and method and are not universal personal thresholds.interpretation
A 2026 US longitudinal study of 11,634 adults used monthly headache days, MIDAS, and migraine-specific quality of life together to characterize one-year change.limitation
A disability score may document burden, but CGRP medicine coverage and step-therapy rules vary by US insurance plan and drug.context
PedMIDAS is a separate six-item pediatric tool with grades 0 to 10, 11 to 30, 31 to 50, and above 50.context
A 2026 Turkish PedMIDAS validation in 60 children and adolescents reported internal consistency of 0.74 and test-retest correlation of 0.92.limitation
MIDAS does not count acute-medicine days, which should be recorded separately when assessing medication-overuse headache risk.safety
A severe or persistent headache with warning signs during pregnancy or after birth needs prompt obstetric assessment regardless of MIDAS grade.context
A headache diary plus regular meals, ordinary hydration, consistent sleep, and recorded triggers can add context that a three-month disability total cannot show.