MIDAS questionnaire: what it asks, how the score adds up and what grades I to IV mean
What the MIDAS migraine questionnaire asks, how five day counts add up to a score and grades I to IV, and how to bring the trend to your doctor.
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When your doctor asks how much migraine affects your life, "a lot" is hard to work with. The MIDAS questionnaire turns it into one number: the days migraine cost you at work, at home and in your free time over the last three months. You can fill it in on paper or answer it in the migraine diary in Sam, which brings it to you once a month as a short check-in. This guide explains what MIDAS asks, how the score adds up and what the four grades mean.
What does the MIDAS questionnaire ask?
MIDAS stands for Migraine Disability Assessment. William Stewart, Richard Lipton and colleagues developed it. It looks back over the last three months. Five questions count days, and each answer is a number of days.
Two questions are about paid work or school. One counts the days you missed completely. The other counts days you got half or less of your usual work done. Two questions do the same for housework. The fifth counts days you missed family, social or leisure activities. A day already counted as missed is not counted again as a reduced day.
Two more questions follow. Question A asks on how many days you had a headache at all. Question B asks how strong the pain was on average, from 0 to 10. Both give your doctor context, but neither is part of the score.
We describe the questions in our own words here. You can fill in the form with our MIDAS migraine score tool and bring the result.
How do you calculate the MIDAS score?
Add up the five day counts. Questions A and B stay out. The result is your MIDAS score. A lower score means less disability.
Here is an example with invented numbers. You missed work on 2 days and got half done on 3 more. At home you skipped housework on 1 day and did half on 2 days. You cancelled 2 evenings with friends. That makes 2 + 3 + 1 + 2 + 2 = 10 days, which is grade II.
The score has no low ceiling. With frequent attacks it can lie well above 21, because each area counts on its own.
What do MIDAS grades I to IV mean?
The score falls into one of four grades.
| Grade | Score | Label |
|---|---|---|
| I | 0-5 | Little or no disability |
| II | 6-10 | Mild disability |
| III | 11-20 | Moderate disability |
| IV | 21 or more | Severe disability |
The grades come from the developers' own work. In a 2001 study, doctors read patient histories without seeing the scores. They rated how much medical care each person needed. Their ratings went along with the MIDAS scores (r = 0.69), and the four grades were set from those judgments.
A grade describes how much migraine got in the way of your days. It does not describe how bad a single attack feels, and it is not a diagnosis. What a grade means for your care is something to discuss with your doctor.
What MIDAS leaves out
MIDAS counts lost days, not pain. Average pain is asked in question B, but it never enters the score. MIDAS also does not say whether your headaches are migraine. That question belongs to your doctor.
The count depends on what your days demanded. An attack on a deadline day costs a work day. The same attack on a quiet Sunday may cost none. So two people with the same number of headache days can end up with different scores.
Three months is also a long time to remember. If you write attacks down as they happen, you count instead of guessing. Our headache calendar guide lists what an entry needs.
How much does a change in MIDAS matter?
Every check-in looks back three months, so the score moves slowly. Two answers a month apart share about two months of history.
A study from the headache registry of the German Migraine and Headache Society (DMKG) gives an idea of size. Ruscheweyh and colleagues followed 1,218 adults with migraine seen at specialised headache centres. For people starting in grade II or III, about 4 points was the smallest change that went along with feeling better. For grade IV, it was about 30 percent of the starting score.
These are group figures from headache centres. Whether your own change matters is a question for your doctor.
Is there a German version of MIDAS?
There are two. Agosti and colleagues published a German version in 2008. A later study reports that its wording was checked, but its reliability and validity were not tested. Sam uses this version when the app is set to German.
In 2018, Benz and colleagues in Switzerland translated MIDAS again, following international guidelines. In their test, 36 headache patients filled it in twice, about two days apart. The total scores agreed very closely (ICC 0.991). The authors still asked for validity testing before wide clinical use.
How MIDAS works in Sam
When you start the migraine diary in Sam, you confirm that a doctor has found migraine. Then you answer MIDAS for the first time. After that, it comes back 30 days after your last check-in, with a reminder when it is due.
The questions appear in the original wording of the form, in English or in the German version from 2008. Each day count starts at 0. You tap plus or minus, or drag the slider. Questions A and B are asked too, with the note that they do not change your score.
After each check-in, Sam shows your score and grade on the grade scale. The history keeps every past check-in with your answers. The doctor report as a PDF has a section called "MIDAS over time". It shows your latest score and grade and, from two check-ins on, a trend line for the period you choose. Your logged migraine days and days with acute medication appear in the same report, in their own section.
What to bring to the appointment
- your latest MIDAS score and grade, and the trend if you have several check-ins
- your migraine days per month and the days you took an acute medication
- your questions about what the numbers mean for you
How headache days are counted for chronic migraine is explained in chronic migraine: how many days count. If you are still waiting for a specialist, you can use the waiting time to collect three months of entries.
Answer MIDAS in Sam each month and bring the trend as a PDF
You see your MIDAS grade change over months instead of counting back three months in the waiting room.
- Instead of a paper form at the appointment: Sam brings you MIDAS once a month as a short check-in and reminds you when it is due.
- Instead of loose sheets: every past check-in stays in the history with your score, grade and answers.
- Instead of memory: the doctor report as a PDF shows MIDAS over time for the period you choose, in the same report as your migraine days.
The program for migraine, your own diary with a doctor report and a monthly questionnaire, starts once a doctor has found migraine. Sam records your answers, and your doctor interprets them.
Try Sam for freeSam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.
Related reading
Sources
Updated: October 2026
- 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. PubMed 11294956
- Lipton RB, Stewart WF, Sawyer J, Edmeads JG: Clinical utility of an instrument assessing migraine disability: the Migraine Disability Assessment (MIDAS) questionnaire. Headache 2001;41(9):854-861. PubMed 11703471
- Benz T, Lehmann S, Gantenbein AR et al.: Translation, cross-cultural adaptation and reliability of the German version of the migraine disability assessment (MIDAS) questionnaire. Health and Quality of Life Outcomes 2018;16:42. PMC5845367
- Ruscheweyh R et al.: Minimal important difference of the Migraine Disability Assessment (MIDAS): longitudinal data from the DMKG Headache Registry. Cephalalgia 2024;44(7). PubMed 39033424
- Scripps Health: Migraine Disability Assessment (score and grade table)
- MIDAS questionnaire: Stewart WF and Lipton RB, copyright Innovative Medical Research 1997. The questions are described in our own words, not reproduced.
More on Migraine
- See the program for Migraine
- For family members: Migraine
- With a second condition: Migraine and Epilepsy
- With a second condition: Migraine and Panic Disorder
- See the doctor report
- Keep your medication and reminders in one list
- Keep a diary of your symptoms and complaints
- Share what you record with family
- Calculate your MIDAS migraine score (free tool)
Frequently Asked Questions
What does the MIDAS questionnaire measure?+
MIDAS counts the days in the last three months on which headaches kept you from work or school, housework, or family, social and leisure time, or cut what you got done there by half or more. It measures how much headaches got in the way of your days. It does not measure pain, and it does not say which headache you have.
How is the MIDAS score calculated?+
You add up the day counts from the five main questions. The two extra questions, headache days (A) and average pain (B), are not part of the score. A lower score means less disability.
What do the MIDAS grades mean?+
Grade I (0 to 5 days) is little or no disability, grade II (6 to 10) mild, grade III (11 to 20) moderate and grade IV (21 or more) severe disability. The developers set the grades from doctors' judgments of the need for medical care. What a grade means for you is for your doctor to say.
Can a MIDAS score tell me whether I have migraine?+
No. MIDAS does not diagnose any headache disorder. It counts lost days. Whether your headaches are migraine is for a doctor to assess.
How often should I fill in MIDAS?+
MIDAS looks back three months. In Sam you answer it every 30 days, so check-ins overlap and the score moves slowly. Shortening the three months to one would no longer be MIDAS. How often you use it outside Sam is up to you and your doctor.
How big a change in the MIDAS score matters?+
In a study of 1,218 adults from German headache centres, about 4 points was the smallest change linked with improvement for people starting in grade II or III. For grade IV it was about 30 percent. These are group figures. Whether a change matters for you is for your doctor to judge.
Is there a German version of MIDAS?+
Yes. Agosti and colleagues published one in 2008. It was checked for language, but its reliability and validity were not tested, and Sam uses it for German. A Swiss team (Benz et al., 2018) made a new translation with very high test-retest agreement in 36 patients.