Twenty years ago, in an article on neurology, researchers projected the impact of the Migraine Assessment Questionnaire (MIDAS) on clinical practice, research, and public health.
Migraines were often underdiagnosed and under-treated, with varying symptoms in and between patients, resulting in the need to standardize their clinical description in order to improve communication between migraineurs and health professionals – and encourage public health initiatives to do so Improve management of the disability that they can cause.
By reviewing studies, the researchers found that most migraineurs did not see their doctor, and many who reported their symptoms did not get a correct diagnosis. Studies showed that “only a minority” of migraine sufferers took prescription drugs. In a US study, only 29% of migraineurs said they were “very satisfied” with treatment with prescription drugs.
The researchers said migraine sufferers need to be encouraged to consult their doctor in order to find appropriate treatment and continue their care, and that improved diagnostic and treatment strategies are critical. They also found that efficient migraine identification processes need to be coordinated so that GPs, who provide the most migraine management, can quickly identify the “disabled patients who need this attention most”.
Patients were able to fill out the questionnaire and place themselves in a category (MIDAS grades I-IV) before meeting with their doctors. One study found that 89% of a group of 49 doctors found it “easy to evaluate and interpret” even though the majority did not speak English as their first language. Their assessments of 12 migraine case studies correlated with the MIDAS scores when the scores were blinded.
One of the limitations of the MIDAS questionnaire was the inability to adequately account for patients with “a very small number of very severe seizures” as these patients may require triptans or other intensive treatments.
“Obviously, every treatment recommendation resulting from the MIDAS score requires temperature control with clinical judgment,” the authors wrote.
MIDAS scores can also assess the improvements that treatments offer in clinical trials, as shown in a study of patients treated for chronic daily headache (CDH). The MIDAS values fell from an average of 61.71 pre-treatment to 21.60 post-treatment (P <0.0001).
By improving communication about the effects of migraines, the questionnaire could lead to information campaigns within the medical profession and among the general public.
“We believe that MIDAS is an important part of a package of educational, diagnostic and therapeutic measures and could play an important role in improving the care of migraineurs,” the authors of the study write. “For example, a new, simplified algorithm for migraine diagnosis based on the criteria of the International Headache Society (IHS) can improve the accuracy of diagnosis in clinical practice. This, in conjunction with the MIDAS questionnaire, could enable rapid identification of migraineurs with greatest unmet medical need and help get treatment right the first time. “
Disclosure: Several study authors said they received a fee from AstraZeneca for participating in the project. For a full list of the authors’ information, see the original reference.
1. Edmeads J., Láinez M., Brandes JL, Schoenen J., Freitag F. Potential of the MIDAS (Migraine Disability Assessment) questionnaire as a public health initiative and in clinical practice. Neurology. 2001; 56 (6 Suppl 1): S29-S34. doi: 10.1212 / wnl.56.suppl_1.s29