Living with Migraine - Part 2.

The MIDAS questionnaire.

 Flourishnote: for Part 1 of Living with Migraine, click here

The Migraine Disability Assessment Questionnaire (MIDAS)

PAGE 1

INSTRUCTIONS:

• Please answer the following questions about ALL your headaches you had over the last 3 months.
• Write zero if you did not do the activity in the last 3 months.

1.  On how many days in the last 3 months did you miss work or school because of your headache? _____days

2. How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do not include days you counted in question 1 where you missed school or work) _____days

3. On how many days in the last 3 months did you not do household work because of your headache? _____days

4. How many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches? (Do not include days you counted in question 3 where you did not do housework) _____days

5. On how many days in the last 3 months did you miss family, social, or leisure activities because of your headaches? _____days

A. On how many days in the last 3 months did you have a headache? (If a headache lasted more than 1 day, count each day) _____days

B. On a scale of 0-10, on average how painful were these headaches? (Where 0 = no pain at all, and 10 = pain as bad as it can be) _____

© Innovative Medical Research 1997 Version 3.0

Once you have filled in the questionnaire, add up the total number of days in question 1-5 (ignore questions A and B)

Grading system for the MIDAS questionnaire:

Grade Definition Score

I    Little or no disability 0-5
II   Mild disability 6-10
III  Moderate disability 11-20
IV   Severe disability 21+

The Midas Disability Assessment Questionnaire (MIDAS).  The MIDAS was developed by Innovative Medical Research Inc., with sponsorship/assistance from AstraZeneca.

PAGE 2

HEADACHE TRIGGER CHECKLIST

Migraineurs - tick below Yes, No or Unsure and note relevant details for migraine triggers

Non-migraineurs - asterix below Yes, No or Unsure and note relevant details for headache triggers

PSYCHOLOGICAL

Yes No Unsure Relevant details

Emotional or mental stress including anxiety Exposure time

< 1 hour 1 hour - 1 day More than 1 day

Relaxation after stress

Depression

Crying:

• when sad

• when happy

• other, eg, peeling onions Exposure time

< 1 hour 1 hour – 1 day More than 1 day

PHYSIOLOGICAL

Yes No Unsure Relevant details

Blow to the head (eg, during sport)

Lack of food

Oral contraceptives

Other drugs including vitamin supplements (particularly Vitamin A) Specify:

Menstruation

Fatigue

Excessive exercise

Insomnia

Sleeping late

Allergic reactions (eg, asthma, hay fever, dermatitis)

Illness

High blood pressure

Head/neck pains

EXTERNAL

Yes No Unsure Relevant details

Foods:

wheat, yeast, rice Small taste/ bite/sip Average serve More than average serve

citrus fruits, apple, pineapple, grapes, coconut, tomato

sugar, corn

tea, coffee

chocolate, cocoa products

cola drinks

eggs, nuts, legumes/broad beans

fat, milk, sour cream

aged, salty or other cheese

fermented sausages, salted-processed meats (ham, salami, frankfurters, bacon, bologna), beef, pork, shellfish, pickled herring

Monosodium glutamate containing foods (some Chinese or soya sauce)

Pretzels, potato chips, other salty snacks/fast foods

Alcohol:

red wine, white wine, spirits, beer, other (specify)

Sip

1 glass

More than 1 glass

Taste aversion

Weather changes/extremes of temperature Specify : eg, seasonal (which season), very hot days, very cold days, air conditioned or heated rooms

Stuffy atmosphere

< ½ hour exposure

More than ½ hour exposure

Fumes/odours

Specify:

Travel/motion

Noise

Visual stimuli (glare, flicker, sunlight, eye strain, television, films, darkness)

Specify:

Change in routine (eg, weekend headaches)

Other triggers (detail below):

© Innovative Medical Research 1997 Version 3.0

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