The MIDAS test, explained — and why your doctor will trust the answer

Most neurologist appointments go like this: you show up, they ask “how often do you get migraines?”, you say “a lot, I think,” and they have nothing concrete to work with.

MIDAS fixes that in 30 seconds. It’s the single most-useful thing you can fill out before a migraine appointment, and it’s free, validated, and self-administered.

Here’s the test, the scoring, and what to do with the result.

The 5 questions

For each, count the number of days in the past 3 months when migraine was the cause:

1. On how many days did migraine keep you from work or school?
2. On how many days was your work or school productivity reduced by half or more? (Don’t double-count days from #1)
3. On how many days did migraine keep you from doing housework?
4. On how many days was your housework productivity reduced by half or more? (Don’t double-count #3)
5. On how many days did migraine keep you from family, social, or leisure activities?

Sum all 5. That’s your MIDAS score.

The grading scale

Score	Grade	Meaning
0–5	I	Little or no disability
6–10	II	Mild disability
11–20	III	Moderate disability
21+	IV	Severe disability

Two extra questions are usually included for clinical context:

• A. On how many days did you have a headache at all? (Any headache, not just migraine)
• B. On a 0–10 scale, how painful were these headaches on average?

These don’t affect your MIDAS score but help your neurologist gauge frequency vs. severity.

What the number actually tells your doctor

A MIDAS score isn’t a diagnosis. It’s a functional impact measure. It answers the question “how much is this costing your life?” in concrete days.

Why neurologists like it:

• It’s quantitative. “I get migraines a lot” is unfalsifiable. “I lost 14 days of work in 3 months” is.
• It tracks treatment response. If your MIDAS goes from 32 to 8 after starting a CGRP inhibitor, the prescription is working. That’s a real outcome metric, not a vibe.
• Insurance often requires it. In the US, many CGRP inhibitor approvals (Aimovig, Emgality, Ajovy, Vyepti) require documented MIDAS or HIT-6 above a threshold. Pre-filling it speeds the process.

The honest part

MIDAS depends on your honest count. If you’ve stopped tracking your migraines, your number will be wrong — usually low, because you forget the days when you were just “kind of out of it” and don’t count them.

That’s why I built logging into Migra. You log attacks as they happen (or right after), and the app calculates your MIDAS automatically from your timeline whenever you ask. No 3-month memory required. Bring the PDF to your appointment.

If you’d rather skip the app, do it on paper:

• Keep a sticky note on your fridge.
• Mark a tick mark every day you were affected. Add a note: “missed work” / “half productivity” / “missed dinner with friends”.
• Add it up at month 3.

You’ll be shocked how many days were affected that you’d otherwise forget.

What MIDAS does not measure

• The severity of any individual attack (use HIT-6 for that — try our HIT-6 calculator)
• Pain level (use 0–10 scales, see citations)
• Trigger patterns (use a tracker)
• Medication effectiveness (use treatment-response tracking)

Don’t try to make MIDAS do everything. It’s one number that answers one question very well.

How to bring it to your doctor

1. Fill it out the morning of your appointment (so it’s fresh)
2. Write the date you completed it at the top
3. List your top 3 most-frequent triggers if you know them
4. Bring any prescription medications and how often you’ve used each in the past 3 months

That single page changes your appointment from a 5-minute symptom-listing exercise to a data conversation. It’s the difference between “I think I should try a preventive” and “my MIDAS is 28, my HIT-6 is 64, I’ve used sumatriptan 11 times in the last 90 days — I think I’m a candidate for a CGRP inhibitor.”

The latter usually gets a yes.