Twenty years ago, researchers projected in a Neurology article the impact the Migraine Disability Assessment (MIDAS) Questionnaire would have for use in clinical practice, research, and public health.

Migraines were often underdiagnosed and undertreated, with varying symptoms in and among patients, prompting a need for standardizing their clinical description to improve communication between individuals with migraines and health care professionals – and to spur public health initiatives to improve the management of the disability they can cause.

Through reviewing studies, the researchers found that most migraine patients did not consult their physicians and many who did report their symptoms did not receive a correct diagnosis. Of those who did, “only a minority” of migraine patients took prescription medications, studies showed. In a US study, only 29% of patients with migraines said they were “very satisfied” with prescription medication treatment.


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The researchers said migraine sufferers needed to be encouraged to consult their physicians to find appropriate treatment and to continue with their care and that improved diagnosis and treatment strategies are crucial. They also noted a need for coordinating efficient migraine identification processes so primary care physicians, who provided most migraine management, could quickly identify the “more disabled patients who most need this attention.”

Patients could complete the questionnaire, placing themselves in a category (MIDAS Grade I-IV), before meeting with their physicians. A study found that 89% of a group of 49 physicians found it “easy to score and interpret” even though the majority did not speak English as their first language. Their assessments of 12 migraine case histories correlated with the MIDAS scores when the scores were blinded.

Limitations of the MIDAS Questionnaire included an inability to appropriately account for patients with “a very small number of very severe attacks” because these patients may need triptans or other intensive treatments.

“Obviously, any treatment recommendation emanating from the MIDAS score requires tempering with clinical judgment,” the authors wrote.

MIDAS scores can also assess the improvement treatments in clinical trials provide, as seen in a study of patients who were being treated for chronic daily headache (CDH). MIDAS scores dropped from a mean of 61.71 pretreatment to 21.60 post-treatment (P <.0001).

In improving communication about the impact of migraine, the questionnaire could prompt information campaigns within the medical profession and among the public.

“We believe that MIDAS is an important part of a package of educational, investigative, and therapeutic measures, and could play a major role in improving the care of migraine sufferers,” the study authors wrote. “For example, a new, simplified algorithm for migraine diagnosis based on the International Headache Society (IHS) criteria has the potential to improve the accuracy of diagnosis in clinical practice. This, used in conjunction with the MIDAS Questionnaire, could enable rapid identification of migraine patients in greatest medical need and could aid in getting the treatment right the first time.”

Disclosure: Several study authors declared receiving an honorarium from AstraZeneca for their participation in the project. Please see the original reference for a full list of authors’ disclosures.

References

1. Edmeads J, Láinez M, Brandes JL, Schoenen J, Freitag F. Potential of the Migraine Disability Assessment (MIDAS) Questionnaire as a public health initiative and in clinical practice. Neurology. 2001;56(6 Suppl 1):S29-S34. doi:10.1212/wnl.56.suppl_1.s29