What Is the MIDAS Score? Calculation, Grades and When to Use It

MIDAS stands for Migraine Disability Assessment. Its score summarizes how many days headaches caused you to miss activities or work at half your usual productivity or less during the past three months. You calculate it by adding the answers to five questions about work or school, household tasks, and family, social or leisure activities.

It helps describe something a pain rating can miss: the effect headaches have on your everyday life. The standard score has four grades, from little or no disability to severe disability. It is a discussion tool for you and your clinician, not a test that diagnoses migraine or tells you which medicine to take.

What is the MIDAS score used for?

A headache diary might show when pain occurred and what medication you took. MIDAS adds a different question: how much did headaches prevent you from doing?

That might mean missing a shift, attending class but getting very little done, being unable to care for household responsibilities, or missing time with family. These effects matter even if you usually push through an attack.

The questionnaire was developed to assess headache-related disability and improve communication about migraine care. Its reliability and validity were examined in studies described by Stewart and colleagues in Neurology. Clinicians can consider the result alongside headache frequency, symptoms, treatments, side effects and your own priorities.

How is the MIDAS score calculated?

Use the past three months, not the past week or month. The standard questionnaire hosted by Oregon Health & Science University (OHSU) asks you to consider all headaches during that period.

The five scored questions cover these areas. The descriptions below explain the form rather than replace its exact wording:

Question	Days to count
1. Missed work or school	Days headaches kept you from work or school
2. Reduced productivity at work or school	Days you attended but headaches reduced your productivity by at least half; exclude days already counted in question 1
3. Missed household work	Days headaches prevented household tasks, including responsibilities such as shopping or caring for relatives
4. Reduced productivity in household work	Days headaches reduced your household productivity by at least half; exclude days already counted in question 3
5. Missed family, social or leisure activities	Days headaches caused you to miss these activities

MIDAS total = Q1 + Q2 + Q3 + Q4 + Q5. Each answer is a number of days. Do not multiply by your pain rating, convert the total to a percentage, or divide it by three.

If an activity did not apply to you during the period, the form instructs you to enter zero for that activity. If you cannot remember what happened, discuss that uncertainty with your clinician rather than automatically treating missing information as zero.

Which answers do not count toward the total?

The standard form also asks:

• A: The number of headache days during the past three months. If a headache continued across several days, count each day.
• B: Average headache pain on a scale from 0 to 10.

These answers provide useful context, but neither A nor B is added to the MIDAS score. The questionnaire has seven items in total, with only the first five contributing to its disability score.

Can the same date count more than once?

Yes, across different activity areas. If headaches made you miss work and household tasks on the same date, that date may contribute to both question 1 and question 3. It may also count toward question 5 if you missed a social activity.

Within each paired area, avoid counting the same day twice. A day counted as missed work in question 1 must not also count as reduced work productivity in question 2. The same rule applies to missed household work in question 3 and reduced household productivity in question 4.

This is why your total can exceed your number of headache days. It is a sum of activity impacts, not a count of unique calendar dates.

A worked MIDAS score example

Imagine these answers for the same three-month period:

Activity impact	Days
Missed work or school	3
Work or school productivity reduced by at least half, excluding missed days	5
Missed household work	4
Household productivity reduced by at least half, excluding missed days	6
Missed family, social or leisure activities	4
MIDAS total	22

The calculation is 3 + 5 + 4 + 6 + 4 = 22. That falls in grade IV, severe disability.

If the same person reported 12 headache days and an average pain rating of 7 out of 10, their MIDAS total would still be 22. The 12 and the 7 are separate answers, not extra points.

This example does not establish a diagnosis or a treatment plan. It shows how the scoring rules work.

How do you interpret your MIDAS score?

The standard form uses these bands:

MIDAS grade	Total score	Meaning on the questionnaire
I	0–5	Little or no disability
II	6–10	Mild disability
III	11–20	Moderate disability
IV	21 or more	Severe disability

Higher scores mean more days of activity disruption were reported. Here, “disability” refers to the activity limitations measured by the questionnaire. It is not a judgment about your effort or a determination of eligibility for disability benefits.

A low score does not mean your pain is unimportant. You might have fewer activities scheduled, have adapted your routine, or experience significant symptoms without reaching the questionnaire’s 50% productivity threshold. A high score is a reason to describe that burden to your clinician; it does not select a treatment automatically.

MIDAS is not a percentage or a 0–100 pain scale. A score of 22 does not mean you are “22% disabled,” and 100 is not its upper limit.

When should you use MIDAS?

It can be useful:

• Before a headache appointment, to describe the impact of the previous three months.
• When discussing your current care, alongside your diary and treatment history.
• At follow-up, to compare activity disruption over time using the same questionnaire and recall period.

Agree on a schedule with your clinician. Completing the standard form about every three months gives you successive periods to compare. If you repeat it sooner, the periods overlap; a recent change may be diluted by earlier weeks in the same three-month window.

You do not need to wait for three months of diary entries before asking for help. Answer the form using what you can recall, note uncertainty, and bring any records you already have.

How can a migraine diary help you answer accurately?

When possible, record what an attack prevented you from doing, as well as pain and medication. A short note such as “missed work” or “worked, but completed less than half my usual tasks” can be easier to interpret later than a pain number alone.

Record the date and activity area. If symptoms continued into another day, note the effect on that day too. Keep headache-free days separate from days you did not record anything. Our migraine diary checklist explains how to keep that distinction clear.

Cephala can help you keep attack records and add notes later. Those notes can support your recall when completing MIDAS, but an attack count or pain chart is not a MIDAS score. Use the standard questionnaire for the calculation; do not assume an app summary contains every answer it needs.

For an appointment, bring the completed form, your diary, and questions you want to discuss. See our guide to what to bring to a headache appointment.

What can MIDAS not tell you?

It cannot diagnose migraine, identify its cause, establish that a medication is safe, or determine the right treatment for you. It does not capture every aspect of living with migraine, including anxiety about future attacks or activity reductions below its productivity threshold.

The result also depends on recall and circumstances. Changes in work, school, household support or planned activities can affect the score. If your score changes, discuss both your symptoms and what was happening in your life during each period.

MIDAS is intended to support a fuller conversation. Your experience still matters when it does not fit neatly into a score.

Common questions

Is a score of 21 severe?

Yes. In the standard MIDAS grading system, 21 and above is grade IV, severe disability. A score of 20 is grade III, moderate disability.

Is MIDAS the same as headache frequency?

No. Headache days are recorded separately in question A. MIDAS adds days of lost or substantially reduced activity across five questions. Read about headache days versus attacks if you are unsure which count your diary shows.

Should I complete MIDAS during an attack?

You do not need to. It looks back over three months, so you can complete it when you feel able to review that period. Keep brief notes during or after individual attacks if that makes recall easier.

References

1. Oregon Health & Science University: Migraine Disability Assessment Test (PDF). Standard questions, three-month instructions, exclusions, supplementary items and grading bands.
2. Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56(6 Suppl 1):S20–S28. DOI: 10.1212/WNL.56.suppl_1.S20. Research background, reliability, validity and clinical communication.