Reliability of the migraine disability assessment score in a population-based sample of headache sufferers

Background. The Migraine Disability Assessment (MIDAS) score is used to quantify headache-related disability. In a previous study, we showed that the MIDAS score was highly reliable in population-based samples of both migraine headache sufferers in two countries. Objectives. To examine the test–retest reliability and internal consistency of the five items comprising the MIDAS score and the overall MIDAS score in a population-based sample of migraine and nonmigraine headache sufferers. Methods. Using a clinically validated telephone interview, a population-based sample of migraine and nonmigraine headache sufferers was identified in Baltimore, Maryland, USA. A total of 97 migraine cases and 80 nonmigraine subjects completed the MIDAS questionnaire on two occasions an average of 3 weeks apart. The MIDAS score is derived from five questions about missed time from work (or school) and household work (one question each about missed days and days with at least 50% reduced productivity) and missed days of nonwork activities. Results. Among all headache sufferers the test–retest Spearman's correlations of individual MIDAS questions ranged from 0.67 to 0.73. The Spearman's correlation for the MIDAS score (i.e., sum of lost days and reduced effectiveness days in each domain) was 0.84. Cronbach's alpha, a measure of internal consistency, was 0.83. Mean and median item values and the overall MIDAS scores differed between migraine and nonmigraine cases. Even after adjusting for differences in headache frequency, the mean MIDAS scores differed substantially (i.e., 10.3 points) between migraine cases and nonmigraine cases. Conclusions. The reliability and internal consistency of the MIDAS score are high, as tested in a population-based sample of headache sufferers. MIDAS scores are substantially higher in migraine cases than in non-migraine cases, supporting the validity of the measure.     

Clinical Utility of an Instrument Assessing Migraine Disability: The Migraine Disability Assessment (MIDAS) Questionnaire

OBJECTIVE: We evaluated the agreement between Migraine Disability Assessment (MIDAS) scores and independent physician judgments about pain, disability, and treatment needs based on patient medical histories. BACKGROUND: The MIDAS questionnaire measures headache-related disability as lost time due to headache from paid work or school, household work, and nonwork activities. METHODS: Twelve histories from patients with migraine were presented to 49 primary and specialty care physicians unaware of the MIDAS scores. Physicians graded each patient for pain level (mild, moderate, or severe), level of disability (none, mild, moderate, or severe), and need for medical care (from 0 [lowest] to 100 [highest]). Physicians also identified MIDAS scores they associated with different degrees of disability and with the urgency to prescribe an effective treatment during the first consultation. RESULTS: The physicians' perceptions of the need for medical care based on medical histories correlated with the MIDAS score (r =.69). Estimates of pain and disability by physicians were directly correlated with increasing MIDAS scores. Using the physicians' clinical judgments, the overall MIDAS score was categorized into four grades of increasing severity. CONCLUSIONS: Scores on the MIDAS are highly correlated with physician judgments regarding patients' pain, disability, and need for medical care. These findings support the potential utility of the MIDAS questionnaire in clinical practice.     

Use of the Migraine Disability Assessment Questionnaire in children and adolescents with headache: an Italian pilot study

OBJECTIVES: To determine the suitability of the Migraine Disability Assessment (MIDAS) Questionnaire for assessing disability in children and adolescents with headache and to obtain preliminary information about disability in different primary headaches. BACKGROUND: During the last decade, researchers have begun to employ standardized methodologies to investigate the global impact of primary headaches. Disease-specific instruments have been developed to measure headache-related disability. The MIDAS Questionnaire, which is the most extensively studied of these instruments, was designed to assess the overall impact of headaches over the 3 months before compilation. The MIDAS Questionnaire is an optimal tool to assess headache-related disability in adults. METHODS: Ninety-five patients aged 7 to 17 years with tension-type headache, migraine, or both completed the validated Italian form of the MIDAS questionnaire on 2 occasions. Test-retest reliability was assessed by the Spearman rank correlation test. The Cronbach alpha assessed internal consistency. The patients answered questions about the adequacy of the questionnaire. RESULTS: The Cronbach alpha was.8. Correlation coefficients were generally high for the overall MIDAS score and for the items investigating disability in school and in family/leisure activities; they were lower for the items about housework. Most patients thought that the MIDAS Questionnaire was useful (98.9%) and that it captured the impact of their headaches (58.9%); 41% thought that questions about disability in housework were useless, 44.2% suggested adding questions regarding inability to do homework. All primary headaches had a considerable impact on daily activities, but patients with migraine tended to have lower headache frequencies and lower total disability time; those with tension-type headache suffered more days in which activities, although performed, were substantially impaired. CONCLUSIONS: The MIDAS Questionnaire is useful for assessing disability in children and adolescents with different primary headaches. Minimal changes in the phrasing and content of the items would be sufficient to render the MIDAS specific for the younger population with headache.     

Impact of the COVID-19 pandemic on migraine in Japan: a multicentre cross-sectional study

ObjectivesTo assess the impacts of social situation changes due to the coronavirus disease 2019 (COVID-19) pandemic on headache-related disability and other symptoms in patients with migraine in Japan.MethodsWe conducted a multicentre, cross-sectional study including 659 outpatients with migraine diagnosed by headache specialists. The participants were asked about the impacts of the first wave of the COVID-19 pandemic on headache-related disability, headache days, headache intensity, stress, physical activity, hospital access and their work and home lives. For headache-related disability, the total Migraine Disability Assessment (MIDAS) score and part A and B scores were analysed. Multivariate stepwise linear regression analysis was performed to identify the clinical predictors of changes in the total MIDAS score before and during the COVID-19 pandemic. Logistic regression analysis was performed to determine the factors related to new-onset headache during the COVID-19 pandemic.ResultsFinally, 606 migraine patients (73 M/533 F; age, 45.2 ± 12.0 years) were included in the study, excluding those with incomplete data. Increased stress, substantial concern about COVID-19 and negative impacts of the first wave of the COVID-19 pandemic on daily life were reported in 56.8 %, 55.1 and 45.0 % of the participants, respectively. The total MIDAS and A and B scores did not significantly change after the first wave of the COVID-19 pandemic. New-onset headache, which was observed in 95 patients (15.7 %), was associated with younger age and worsened mood and sleep in the logistic regression analysis. The multivariate stepwise linear regression analysis of changes in the total MIDAS score before and during the first wave of COVID-19 pandemic identified worsened sleep, increased acute medication use, increased stress, medication shortages, comorbidities, the absence of an aura and new-onset headache were determinants of an increased total MIDAS score during the first wave of the COVID-19 pandemic.ConclusionsIn this multicentre study, clinical factors relevant to headache-related disability, such as new-onset headache, stress and sleep disturbances, were identified, highlighting the importance of symptom management in migraine patients during the first wave of the COVID-19 pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01263-1.     

Migraine frequency and intensity: relationship with disability and psychological factors

BACKGROUND: Migraine can be disabling, but it varies greatly in frequency and intensity between individuals. It is not clear which clinical features have the greatest impact on a migraineur's quality of life. OBJECTIVE: To determine the influence of headache intensity and frequency on headache-related disability. METHODS: Patients who were referred to a headache clinic and given a diagnosis of migraine with or without aura or transformed migraine (n = 115) were divided into different groups based on headache frequency and mean headache intensity. Headache frequency was determined from patient diaries. Headache intensity also was assessed from patient diaries and from scores on the pain severity scale of the Multidimensional Pain Inventory (MPI). Headache-related disability was assessed with the Headache Disability Inventory and by scores on the activity interference scale of the MPI. The degree of depression present was assessed with the Beck Depression Inventory, and emotional distress was measured by scores on the affective distress scale of the MPI. RESULTS: In our patient population, higher mean headache intensity levels were associated with higher levels of headache-related disability. Our results also suggested that increased headache intensity is associated with higher levels of depression and emotional distress, although this correlation was statistically significant in only 1 of 4 comparisons. Headache frequency did not correlate with disability, depression, or emotional distress. CONCLUSIONS: For a headache referral population, headache intensity appears to be a major determinant of headache-related disability, and it also correlates, to some extent, with the degree of depression and emotional distress present. Headache frequency was not clearly related to disability or psychological factors.     

Disability is the major determinant of the severity of depressive symptoms in primary headaches but not in low back pain

Pain syndromes are often associated with depression. In a prospective study we analysed if determinants of depression differ among patients with different primary headaches and between headaches and non-headache pain. During a 2-year period between 1 February 2002 and 31 January 2004, 635 subjects (migraine n = 231; tension-type headache n = 176; cluster headache n = 11; patients with low back pain n = 103; and healthy subjects n = 114) seen by two neurologists filled in a questionnaire on pain characteristics, the MIDAS questionnaire and the Beck Depression Inventory. A multivariate general regression model was used to identify independent predictors of the severity of depressive symptoms. Pain was most frequent in chronic tension-type headache and most intense in the cluster subgroup (P < 0.001, Kruskal-Wallis ANOVA). In univariate tests gender, age, pain frequency, pain intensity and disability were all significantly associated with the severity of depressive symptoms. In the multivariate model disability was the most important independent determinant of the severity of depressive symptoms in the pooled headache group as well as in the migraine and tension-type headache subgroups. In contrast to patients with headache, pain frequency and pain intensity were the significant independent predictors of the severity of depressive symptoms in patients with low back pain. In a multivariate model, after controlling for other factors, determinants of the severity of depressive symptoms were different in headache and non-headache pain subjects, suggesting a different mechanism for developing depression in primary headaches and in other pain syndromes.     

Post-reversible cerebral vasoconstriction syndrome headache

BackgroundChronic headache may persist after the remission of reversible cerebral vasoconstriction syndrome (RCVS) in some patients. We aimed to investigate the prevalence, characteristics, risk factors, and the impact of post-RCVS headache.MethodsWe prospectively recruited patients with RCVS and collected their baseline demographics, including psychological distress measured by Hospital Anxiety and Depression scale. We evaluated whether the patients developed post-RCVS headache 3 months after RCVS onset. The manifestations of post-RCVS headache and headache-related disability measured by Migraine Disability Assessment (MIDAS) scores were recorded.ResultsFrom 2017 to 2019, 134 patients with RCVS were recruited, of whom, 123 finished follow-up interviews (response rate 91.8%). Sixty (48.8%) patients had post-RCVS headache. Migrainous features were common in post-RCVS headache. Post-RCVS headache caused moderate-to-severe headache-related disability (MIDAS score > 10) in seven (11.7%) patients. Higher anxiety level (odds ratio 1.21, p = 0.009) and a history of migraine (odds ratio 2.59, p = 0.049) are associated with post-RCVS headache. Survival analysis estimated that 50% post-RCVS headache would recover in 389 days (95% confidence interval: 198.5–579) after disease onset.ConclusionsPost-RCVS headache is common, affecting half of patients and being disabling in one-tenth. Higher anxiety level and migraine history are risk factors. Half of the patients with post-RCVS headache would recover in about a year.     

The impact of resilience on headache disability as measured by the Migraine Disability Assessment (MIDAS)

Objective

Our objectives were to examine cross-sectional correlations of headache disability with measures of resilience, anxiety, and depression, and to determine if resilience modified the association between headache severity/frequency and disability.

Background

Resilience is associated with quality of life and functioning among patients with chronic conditions. We investigated whether resilience strongly mitigates headache-related disability as measured by the Migraine Disability Assessment (MIDAS).

Methods

We prospectively recruited 160 patients with primary headache disorders seen in a tertiary headache medicine program between February 20, 2018 and August 2, 2019. Each participant completed the MIDAS, Conner Davidson Resilience Scale (CDRS-25), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and WHO-5 Well-Being Index.

Results

The CDRS-25 score was negatively correlated with the total MIDAS (r = −0.21, p = 0.009), GAD-7 (r = −0.56, p < 0.001), and PHQ-9 scores (r = −0.34, p < 0.001). Well-being inversely correlated with disability (r = −0.37, p < 0.001). Increases in anxiety and depression increased the odds of disability. A 1 point increase in the CDRS-25 score decreased the odds of being severely disabled by 4% (OR = 0.96, 95% CI: 0.94 to 0.99, p = 0.001). However, the CDRS-25 score did not significantly moderate the association between headache days and disability.

Conclusion

Traits associated with resilience decreased the odds of severe disability from headaches, whereas anxiety, depression, and headache frequency were strongly associated with higher disability from headache.     

Reliability and validity of the Japanese Migraine Disability Assessment (MIDAS) Questionnaire

OBJECTIVE: This study was designed to assess the test-retest reliability, internal consistency, and validity of a Japanese translation of the Migraine Disability Assessment (MIDAS) Questionnaire in a sample of Japanese patients with headache. BACKGROUND: Previous studies have demonstrated that the English-language version of the MIDAS Questionnaire is a reliable and valid instrument for the assessment of migraine-related disability. Any translations of the MIDAS Questionnaire must also be assessed for reliability and validity. METHODS: Study participants were recruited from the patient population attending either the Neurology Department of Kitasato University or an affiliated clinic. Participants were eligible for study entry if they had 6 or more primary headaches per year. For reliability testing, participants completed the MIDAS Questionnaire on 2 occasions, exactly 2 weeks apart. To assess validity, patients were also invited to participate in a 90-day daily diary study. Composite measures from the 90-day diaries were compared to equivalent MIDAS measures (ie, 5 questions on headache-related disability and 1 question each on average pain intensity and headache frequency in the last 3 months) and to the total MIDAS score obtained from a third MIDAS Questionnaire completed at the end of this 90-day period. RESULTS: One hundred one patients between the ages of 21 and 77 years were recruited (81 women and 20 men). Ninety-nine patients (80 women and 19 men) participated in the diary study. At baseline, 46.5% of patients were MIDAS grade I or II (minimal, mild, or infrequent disability), 22.2% were MIDAS grade III (moderate disability), and 31.3% were MIDAS grade IV (severe disability). Test-retest Spearman correlations for the 5 disability questions and the questions on average pain intensity and headache frequency ranged from 0.59 to 0.80 (P<.0001). The test-retest Spearman correlation coefficient for the total MIDAS score was 0.83 (P<.0001). The degree to which individual MIDAS questions correlated with the diary-based measures ranged from 0.36 to 0.88. The correlation between the total MIDAS score and the equivalent diary-based measure was 0.66. In general, the mean and median values for the MIDAS items and total MIDAS score were similar to the means and medians for the diary-based measures. However, the mean MIDAS scores for the number of days on which headache was experienced and the number of missed workdays were significantly different compared to the diary-based estimates for these items (P<.05). In addition, the mean MIDAS score for the number of days of missed housework was significantly higher than the corresponding diary-based estimate (P<.01). CONCLUSIONS: The results from this study show that the Japanese translation of the MIDAS Questionnaire is comparable with the English-language version in terms of reliability and validity.     

Disability and migraine: recent outcomes using an Italian version of MIDAS

Migraine is associated with functional impairment. The migraine disability assessment (MIDAS) questionnaire is a scientific instrument which captures headache-related disability. The Italian version of MIDAS was developed through a multistep standardized methodology. Studies on Italian clinical samples confirmed that migraine patients are disabled in all activity domains. Migraine exhibits a peculiar disability pattern: non-work activities are more affected than work activities; among patients in paid work, most continue working with a headache attack. We also found that MIDAS disability grades correlate with health-related quality of life scores at the SF-36 survey, namely with the extent to which physical health, emotional state and pain interfere with functioning in different roles. We conclude that MIDAS (also in its Italian version) is a reliable and useful instrument for assessing the impact of migraine on patients' daily activities, and that it can used not only in clinical practice but also in clinical research.     

HIT‐6 and MIDAS as Measures of Headache Disability in a Headache Referral Population

(Headache 2010;50:383‐395) Objective.— The objective of this study was to compare the headache impact test (HIT‐6) and the migraine disability assessment scale (MIDAS) as clinical measures of headache‐related disability. Background.— The degree of headache‐related disability is an important factor in treatment planning. Many quality of life and headache disability measures exist but it is unclear which of the available disability measures is the most helpful in planning and measuring headache management. Methods.— We compared HIT‐6 and MIDAS scores from 798 patients from the Canadian Headache Outpatient Registry and Database (CHORD). Correlation and regression analyses were used to examine the relationships between the HIT‐6 and MIDAS total scores, headache frequency and intensity, and Beck Depression Inventory (BDI‐II) scores. Results.— A positive correlation was found between HIT‐6 and MIDAS scores (r = 0.52). The BDI‐II scores correlated equally with the HIT‐6 and the MIDAS (r = 0.42). There was a non‐monotonic relationship between headache frequency and the MIDAS, and a non‐linear monotonic relationship between headache frequency and the HIT‐6 (r = 0.24). The correlation was higher between the intensity and the HIT‐6 scores (r = 0.46), than MIDAS (r = 0.26) scores. Seventy‐nine percent of patients fell into the most severe HIT‐6 disability category, compared with the 57% of patients that fell into the most severe MIDAS disability category. Significantly more patients were placed in a more severe category with the HIT‐6 than with the MIDAS (McNemar chi‐square = 191 on 6 d.f., P < .0001). Conclusions.— The HIT‐6 and MIDAS appear to measure headache‐related disability in a similar fashion. However, some important differences may exist. Headache intensity appears to influence HIT‐6 score more than the MIDAS, whereas the MIDAS was influenced more by headache frequency. Using the HIT‐6 and MIDAS together may give a more accurate assessment of a patient's headache‐related disability.     

Epidemiology of headache in an English district

Headache prevalence, characteristics and impact in adults were measured using a cross-sectional general population survey in North Staffordshire, UK. A postal survey was mailed out to 4885 adults (aged > or = 18 years) with an adjusted response rate of 56% (n = 2662). Of respondents 93% reported headache ever and 70% in the last 3 months. Women and younger people reported higher headache prevalences. Of those reporting headache in the last 3 months, 23% experienced headache at least weekly and 16% experienced severe headache pain. Headaches affected work, home or social activities in 43% of sufferers and 20% reported at least moderate headache-related disability. Higher levels of disability were associated with higher levels of pain, 61% with severe disability reporting severe pain compared with 13% who had mild or moderate disability. In the total adult population sample headache affected more than two-thirds in the last 3 months and 14% of all adults reported headache-related disability of at least moderate level, which translates to a large burden in the general population.     

Impact of headache on quality of life in a general population survey in France (GRIM2000 Study)

OBJECTIVES: The objectives of this study were to determine the impact of headache on health-related quality of life in a nationwide sample of the French general population using a disease-specific measure, the Qualité de Vie et Migraine (QVM), to compare quality of life in subjects reporting different headache to types, and to evaluate the relationship between quality of life and severity, frequency, associated disability, and treatment responsiveness of headaches. METHODS: The QVM questionnaire was included within a large epidemiological survey of 1486 headache sufferers. Diagnosis was assigned retrospectively using an algorithm based on the International Headache Society classification. Headache severity was assessed with the MIGSEV scale and disability with the MIDAS scale. RESULTS: The mean global QVM score in the sample was 80.2. Quality of life was poorer in subjects with chronic daily headache (QVM score: 66.2) than in those with migraine (QVM score: 76.7), while those with other forms of episodic headache had the best quality of life (QVM score: 91.7). Quality-of-life scores were correlated with frequency, severity, disability, and treatment resistance of headaches (P <.001). CONCLUSION: The QVM scale is a sensitive tool to measure health-related quality of life in headache sufferers in the general population.     

Validity and reliability of Turkish translation of Migraine Disability Assessment (MIDAS) questionnaire in patients with migraine

The Migraine Disability Assessment (MIDAS) questionnaire is a brief, self-administered questionnaire which is designed to quantify headache-related disability in a 3-month period. We have tested a Turkish version of the MIDAS questionnaire in 60 migraine patients. Sixty of the clinically diagnosed migraine headache sufferers were enrolled in a 90-day diary study and completed the MIDAS questionnaire in the first, 21st and the last day of the 90-day study. The scores taken from the diary and the scores of the MIDAS taken at different times were evaluated by the correlation tests of both Pearson and Spearman for each question and total scores. Cronbach's scores taken from the diary and taken from the test of the MIDAS which was applied at different times were evaluated. Pearson's correlation on the responses in the initial MIDAS questions was between 0.44 (reduced productivity in household chores) and 0.78 (missed work or school days). The correlation of the Spearman was similar to the Pearson values. As a result, we found that the overall score of the MIDAS has a good reliability and its internal consistency is also good (Cronbach's alpha 0.87). These findings support the use of the MIDAS questionnaire as a clinical and research tool on Turkish patients.     

Factors associated with burden of primary headache in a specialty clinic

OBJECTIVE: To examine factors associated with social, occupational, and psychological burden of common primary headache (migraine and tension-type headache). BACKGROUND: The personal and social burden of primary headache is high. Health, occupational, social, and psychological factors contributing to burden in people with disabling headache have not been fully unravelled. METHODS: One hundred eighty consecutive patients with either migraine or tension-type headache attending a specialty headache outpatient clinic for the first time were evaluated over a 9-month period. Headache subtype was operationally defined according to International Headache Society criteria. Headache frequency, duration, and severity were recorded. Occupational and social disability were quantified using the Migraine Disability Assessment questionnaire. Psychological burden was quantified using the 28-item General Health Questionnaire, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Premorbid vulnerability to life stress was quantified using the neuroticism subscale of the Eysenck Personality Inventory. RESULTS: Patients with frequent (chronic) headache scored higher on the Migraine Disability Assessment questionnaire and had higher Beck Depression Inventory and General Health Questionnaire depression scores than those with less frequent (episodic) headache. Frequency of headache, but not pain severity, duration, or diagnosis, predicted both Migraine Disability Assessment total disability and General Health Questionnaire/Beck Depression Inventory depression. Neuroticism was predictive of depression but not disability. Patients with chronic migraine had the highest depression and disability scores. CONCLUSION: The number of days per month with headache is a key determinant of headache-related burden in those attending specialty clinics. Frequent (chronic) headache is associated with significantly higher psychopathology scores and general social impairment, but the direction of this relationship is not clear. Those with migraine and chronicity are the most impaired.     

Headache disability in orofacial pain patients is related to traumatic life events

Background.— Headache is commonly reported in patients presenting with orofacial pain. It has only recently been demonstrated that headache-related disability is high in orofacial pain patients. Traumatic life events (TLEs) such as sexual abuse, physical abuse, and post-traumatic stress disorder (PTSD) are also common in orofacial pain patients and in the same patients reporting headache. In association with a previously reported study of headache disability in orofacial pain patients, it was noted that Migraine Disability Assessment (MIDAS) scores appeared to be significantly higher in patients with TLEs.
Objectives.— To investigate the relationship between TLEs and headache disability in a clinic population of orofacial pain patients.
Design.— Retrospective study.
Methods.— Four hundred and twenty-six consecutive orofacial pain patient records were reviewed, composed of new patients seen at the Orofacial Pain Center, National Naval Medical Center, Bethesda, MD, from November 2003 through December 2004.
Results.— Of 426 orofacial pain patients reporting headache, 109 or 41.7% reported TLEs. In patients with TLEs, the mean MIDAS score was 28.81 ± 37.2 compared with 13.5 ± 17.9 for patients not reporting TLEs P  < .000. MIDAS scores were significantly correlated with TLEs, Spearman correlation coefficient 0.272, P  < .010.
Conclusions.— This is the first study to demonstrate that headache disability is significantly higher in a group of orofacial pain patients with TLEs and is correlated with that report of traumatic events. These findings clearly demonstrate the necessity for providers to consider a history of TLEs in orofacial pain patients presenting with headache.     

Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire

OBJECTIVES: The aim of this study is to assess the comprehensibility, internal consistency, patient-physician reliability, test-retest reliability, and validity of Turkish version of Migraine Disability Assessment (MIDAS) questionnaire in patients with headache. BACKGROUND: MIDAS questionnaire has been developed by Stewart et al and shown to be reliable and valid to determine the degree of disability caused by migraine. DESIGN AND METHODS: This study was designed as a national multicenter study to demonstrate the reliability and validity of Turkish version of MIDAS questionnaire. Patients applying to 17 Neurology Clinics in Turkey were evaluated at the baseline (visit 1), week 4 (visit 2), and week 12 (visit 3) visits in terms of disease severity and comprehensibility, internal consistency, test-retest reliability, and validity of MIDAS. Since the severity of the disease has been found to change significantly at visit 2 compared to visit 1, test-retest reliability was assessed using the MIDAS scores of a subgroup of patients whose disease severity remained unchanged (up to +/-3 days difference in the number of days with headache between visits 1 and 2). RESULTS: A total of 306 patients (86.2% female, mean age: 35.0 +/- 9.8 years) were enrolled into the study. A total of 65.7%, 77.5%, 82.0% of patients reported that "they had fully understood the MIDAS questionnaire" in visits 1, 2, and 3, respectively. A highly positive correlation was found between physician and patient and the applied total MIDAS scores in all three visits (Spearman correlation coefficients were R= 0.87, 0.83, and 0.90, respectively, P <.001). Internal consistency of MIDAS was assessed using Cronbach's alpha and was found at acceptable (>0.7) or excellent (>0.8) levels in both patient and physician applied MIDAS scores, respectively. Total MIDAS score showed good test-retest reliability (R= 0.68). Both the number of days with headache and the total MIDAS scores were positively correlated at all visits with correlation coefficients between 0.47 and 0.63. There was also a moderate degree of correlation (R= 0.54) between the total MIDAS score at week 12 and the number of days with headache at visit 2 + visit 3, which quantify headache-related disability over a 3-month period similar to MIDAS questionnaire. CONCLUSION: These findings demonstrated that the Turkish translation is equivalent to the English version of MIDAS in terms of internal consistency, test-retest reliability, and validity. Physicians can reliably use the Turkish translation of the MIDAS questionnaire in defining the severity of illness and its treatment strategy when applied as a self-administered report by migraine patients themselves.     

Outcome measurement in behavioral headache research: headache parameters and psychosocial outcomes

The experience of pain is complex and includes multiple dimensions or aspects, such as sensory and affective (among others). Headache includes not only pain, but also associated symptoms that can further diversify the relevant dimensions. Subjective ratings of head pain, sampled daily, have come to be regarded as the "gold standard" in behavioral headache research. Primary measures of headache include the attack frequency or headache days per month. Secondary measures of headache may include headache activity/index, headache duration, peak headache severity, and/or frequency of severe headaches per month. Secondary measures of disability and quality of life include Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT), Headache Disability Inventory (HDI). Secondary nonheadache measures include medication consumption, psychiatric symptoms, stress and coping, treatment satisfaction and preference, side effects, and others. Researchers should include not only primary measures of headache, but also secondary measures, disability and quality of life, and nonheadache measures. All measures should be clearly defined and reported. A baseline period that is adequate for each measure needs inclusion and a minimum of 4 weeks is recommended for primary headache measures. Specific suggestions for future research directions are provided.     

Duration of migraine is a predictor for response to botulinum toxin type A

OBJECTIVE: To identify the clinical characteristics and/or injection parameters that predict a favorable response to botulinum toxin type A in patients with episodic and chronic migraine. BACKGROUND: There is emerging scientific and clinical evidence to support the utility of botulinum toxin type A (BoNT-A) in the prophylaxis of episodic and chronic migraine headache. However, the patient characteristics and injection strategies that predict a favorable treatment response are unknown. METHODS: We conducted a prospective, open-label study on 74 patients from our clinic receiving BoNT-A for episodic or chronic migraine. For all patients, migraine-related disability (Migraine Disability Assesment [MIDAS]), headache frequency, and average headache intensity were obtained at baseline and at 3 months post-BoNT-A. Information regarding demographic characteristics and injection parameters was also collected. RESULTS: Sixty-one patients met the study criteria and were available for 3-month follow-up. At the 3-month follow-up visit, the mean MIDAS scores of the 61 qualified study patients had decreased from 102 at baseline to 49 (52% decrease, P<.001). The mean number of headache days was reduced from 60 to 39 (P<.001), and the mean headache intensity decreased from 7.6 at baseline to 5.9 (P<.001). Frequency of migraine attacks, presence of analgesic overuse, total BoNT-A dose, and presence of underlying muscle tenderness were not predictive of treatment response. Age and duration of migraine were the only clinical factors significantly predictive of treatment response. Age likely was a predictor only as a consequence of duration of illness as subjects with migraine duration greater than 30 years were significantly less likely to respond to treatment with BoNT-A. CONCLUSION: BoNT-A may be effective in decreasing headache frequency, headache intensity, and headache-related disability in episodic and chronic migraine patients. Duration of illness emerged as a predictor of treatment response. Randomized controlled studies should evaluate headache-related disability as a primary endpoint in patients with episodic and chronic headache.