How severe is the pain? Measuring migraine with the MIDAS score

How do migraine headaches feel? Are they the same for everyone affected by them? How severe is my pain and how much does it limit me?

People who want to measure pain are faced with a significant challenge. Subjective bodily sensations must be ‘translated’ so that other people can understand them, and so that they become objectifiable and comparable. How can this be done? This question is almost as old as human interest in medicine, and to this day we do not have the ability to actually share another person’s sensations in such a way that we can truly understand how their pain feels. However, if we consider how we can relieve pain and prevent it, we need a device with which we can comprehend pain. In migraine therapy, the question also arises of how to find out how severely people with migraine are adversely affected by their pain, how the pain develops, and how it can be put in perspective through comparison. This is the only way to see how patients’ headache occurrences progress and what will help them the most.

Making the unmeasurable measurable: quantifying pain

At the turn of the last millennium, between 1999 and 2001, doctors Walter Stewart (USA) and Richard Lipton (GB) took on the challenge of developing a data collection device which would make migraine pain measurable. Although feelings of pain are highly subjective, they wanted to be able to make comparisons between the sensations of those affected. The purpose of developing this was also to optimise the treatment of individual cases of migraine by improving the exchange of information between patients and doctors: they wanted to create a reliable foundation, which could be used as a basis for making better decisions regarding treatment.

In order to overcome the problem that it is impossible, in practice, to measure feelings of pain, the developers did not ask any questions about individual feelings of pain, but instead asked about the level of impairment that affected people experience in their everyday life (job, school, studies, leisure time, family). This resulted in the so-called MIDAS Score (Migraine Disability Assessment), which is now the standard tool for measuring the adverse effects with which people with migraine must contend due to their pain. Shortly after its introduction, the questionnaire was already translated into numerous languages and validated for the relevant countries.

What do you ask a someone in pain?

In order to develop an appropriate set of questions, the developers decided on criteria which are considered particularly illness-related among people with migraine between 20 and 50 years old (prevalence, effects of the illness, stressful situations). From this, they derived five core questions and two additional questions, which address the adverse effects caused by headaches for those impacted by them. The time period from which data on migraine occurrences is collected is three months.

The MIDAS questionnaire asks the following questions:

1. 1. On how many days in the last three months did you not go to work or to school (or university) due to headaches?

    

2. 2. On how many days in the last three months was your productivity at work or at school reduced by half or more?
3.  
4. 3. On how many days in the last three months could you not do any housework due to your headaches?
5.  
6. 4. On how many days in the last three months was your productivity at home reduced by half or more?
7.  
8. 5. On how many days in the last three months could you not take part in family, social, or leisure activities due to your headaches? 
9.  

Further questions:

1.  
2. 1. On how many days in the last three months did you have headaches?
3.  
4. 2. How severe were these headaches? Please rate the intensity of the pain on a scale from 0 – 10 (0 = no pain, 10 = unbearable pain). 
5.  

The numbers given as answers to questions 1 – 5 are added together to create a total. In the evaluation, this is assigned a degree of disability between I and IV, with IV indicating a severe disability. The additional questions A and B document the frequency and severity of the attacks. They are not included in the score but are intended to assist the treating doctor when deciding on appropriate treatment. The survey period of three months is, on the one hand, short enough that the affected people can remember their headache attacks well. On the other hand, 90 days are long enough for the collected data to adequately reflect the occurrence of headaches.

Why the MIDAS has been successful

Comprehensive studies were able to show that the MIDAS score reliably shows how severely people with migraine are negatively impacted by headaches in their lives. Studies in the USA and Great Britain were able to show: if the total which has been calculated is compared to headache diaries which participants fill out over 90 days, there is good overall consistency. In a further study with doctors from 14 countries, it was shown that the MIDAS results correspond to doctor’s assessments with regard to severity of pain, adverse effects, and the patients’ need for medical treatment. In addition, the doctors attested that the device had very good usability. The worldwide success of the MIDAS score has ultimately led in some work groups to it now being used not only for migraine but also for assessing disability as a result of tension headaches.

Prevention requires documentation

The MIDAS score is particularly good for facilitating the kinds of treatment which take a preventative approach in the mid- to long term. Successful treatments can be measured directly in the form of reduction of disability and therefore also as an improvement in quality of life. Where we cannot feel another person’s pain, the MIDAS score helps to give us an idea of what this pain means for their everyday life – a relevant measure of personal suffering and a decisive factor for headache prevention.