MIDAS and HIT-6 are the two standard questionnaires that quantify migraine disability. Learn what each score means and how they support treatment and insurance decisions.
If you have ever sat in a neurology waiting room and been handed a clipboard with a set of questions about lost workdays and canceled plans, you were filling out a disability questionnaire, most likely a MIDAS score form, a HIT-6, or both. These two tools are the clinical standard for converting the lived experience of migraine into numbers that doctors, insurers, and researchers can actually work with.
Counting migraine days per month is useful, but it tells an incomplete story. Two people can each have eight migraine days per month and live entirely different lives. One pushes through with over-the-counter analgesics, works full days, and manages household responsibilities with only moderate difficulty. The other is bedbound for those eight days, misses work completely, and spends the following day in a post-drome fog that further limits function. Migraine day count captures the first dimension, frequency, but misses severity, duration, and downstream disability.
That gap is exactly what structured disability questionnaires fill. They do not replace headache diaries; they sit on top of them, translating symptom data into a standardized metric that clinicians and payers can compare across patients, across time, and across treatment arms. Without this translation, conversations about whether a treatment is "working" stay subjective and anecdotal. With it, they become evidence.
MIDAS stands for Migraine Disability Assessment. The instrument consists of five core questions, each anchored to the past three months. Patients are asked to count the number of days that migraine caused them to:
Two additional questions, not scored, ask about total headache days and average pain intensity. The scored MIDAS total is simply the sum of days reported across questions one through five.
That raw number maps onto four grade tiers that carry clinical meaning:
| MIDAS Score | Grade | Disability Level | Clinical Implication |
|---|---|---|---|
| 0 to 5 | I | Little or no disability | Acute treatment usually sufficient |
| 6 to 10 | II | Mild disability | Preventive therapy may be considered |
| 11 to 20 | III | Moderate disability | Preventive therapy typically warranted |
| 21 or higher | IV | Severe disability | Strong indication for preventive treatment; supports CGRP eligibility |
Grade I patients are typically managed with acute therapy alone. By Grade III, most guidelines support initiating a preventive. Grade IV is the threshold most commonly cited when neurologists and insurers evaluate whether a CGRP monoclonal antibody or gepant is clinically necessary. A baseline MIDAS score in Grade IV, followed by a lower score after several months of treatment, is one of the clearest pieces of evidence that a therapy is doing its job.
The three-month lookback is long enough to capture meaningful patterns but short enough to remain relevant to current care. It also aligns conveniently with insurance authorization cycles, which is not an accident. MIDAS was developed in part to give clinicians data that could support treatment decisions in real-world practice, not just in research settings.
The Headache Impact Test, six items, hence HIT-6, takes a different angle. Instead of counting lost days, it asks how severely headaches affect functioning across six domains over the past four weeks:
Each item is answered on a five-point scale: never, rarely, sometimes, very often, or always. The response options carry fixed point values (6, 8, 10, 11, and 13 respectively), and the six item scores are summed to produce a total ranging from 36 to 78.
| HIT-6 Score | Impact Level |
|---|---|
| 36 to 49 | Little or no impact |
| 50 to 55 | Some impact |
| 56 to 59 | Substantial impact |
| 60 to 78 | Severe impact |
A score of 60 or above, the severe impact range, is the most clinically significant threshold. Most patients seeking specialist care for refractory migraine land here. Like MIDAS Grade IV, a baseline HIT-6 in the severe range paired with a post-treatment score in the substantial or lower range provides quantifiable evidence of meaningful improvement.
The two instruments are not redundant: they measure adjacent but distinct constructs. MIDAS is fundamentally a lost days metric. It counts absence: the work shifts missed, the chores undone, the plans canceled. A patient who powers through migraine attacks with pain and reduced efficiency may underreport on MIDAS because they technically "showed up," even though their performance was severely compromised.
HIT-6 catches what MIDAS misses. Its domains include energy, concentration, and emotional burden, things that affect a person on headache-free days as well as attack days. The anticipatory dread of the next migraine, the fatigue that lingers into the post-drome, the social withdrawal that builds over months of chronic attacks: HIT-6 picks up all of it. Together, the two scores give a clinician a more complete picture than either provides alone.
Disability questionnaires serve three distinct clinical functions.
Establishing a baseline. Before starting a new preventive, a neurologist will often record a MIDAS and HIT-6 score. This snapshot becomes the comparison point for everything that follows. Without it, "you seem to be doing better" is an impression; with it, "your MIDAS dropped from 32 to 11" is a measurable outcome.
Tracking treatment response. Repeating the questionnaires at three- to six-month intervals reveals trajectory. If scores are improving, the treatment is earning its place. If they are flat or worsening, it may be time to adjust dose, switch therapy, or layer interventions.
Supporting prescribing decisions. Many treatment guidelines, including those from the American Headache Society, incorporate disability grade as a criterion for when to initiate preventive therapy. A patient presenting with a Grade IV MIDAS score has cleared a widely recognized clinical threshold.
For CGRP preventive therapies, insurers typically require prior authorization and periodic renewal. Renewal criteria often go beyond monthly migraine day counts. A payer reviewing a renewal request may ask: has this medication meaningfully changed the patient's disability burden?
Documented improvement in MIDAS or HIT-6 between baseline and renewal, alongside a reduction in monthly migraine days, strengthens a case substantially. A MIDAS dropping from Grade IV to Grade II is the kind of concrete, standardized evidence that a reviewer can assess without interpreting clinical notes. Similarly, a HIT-6 moving out of the severe range carries weight because it reflects functional recovery across multiple domains, not just headache frequency.
Important: MIDAS and HIT-6 are clinical tools designed to support conversations with your care team and document your condition for medical purposes. They are not designed for self-diagnosis and should not be used to evaluate whether you "qualify" for any treatment on your own. Work through these scores with your neurologist or headache specialist.
Both instruments rely on patients accurately recalling the past three months (MIDAS) or four weeks (HIT-6). That is a significant cognitive load. Research on pain recall consistently shows that patients underestimate the frequency and severity of past attacks, particularly if the most recent weeks have been relatively good. A string of migraine-free days before a clinic appointment can artificially compress a patient's memory of how bad the preceding two months were.
This is not a flaw in the questionnaires: it is a flaw in human memory. The remedy is prospective tracking. When patients log their symptoms daily, including attack onset, duration, severity, and functional impact, they have a concrete record to reference when completing MIDAS or HIT-6. Instead of guessing whether they missed "about four or five" days of work, they can count exactly. Instead of estimating how often they felt drained or unable to concentrate, they have entries that capture it in real time.
Timestamped daily logs transform retrospective questionnaire answers from approximations into evidence. The difference matters, not just for clinical accuracy, but for the insurance authorizations and treatment decisions that follow from those scores.
Educational, not medical advice. Migraine Tracker: CGRP Log is a personal tracking tool, not a medical device. It does not diagnose, treat, or provide medical advice. Always talk to your clinician.
MIDAS (Migraine Disability Assessment) measures how many days in the past 3 months migraine prevented or significantly limited activity across work, household tasks, and non-work activities. The total score places patients into one of four disability grades.
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