Need for care and perceptions of MIDAS among headache sufferers study

Walter Stewart, Richard Lipton
CNS Drugs 2002, 16 Suppl 1: 5-11

INTRODUCTION: Patients with migraine have varying medical care needs. To effectively stratify patients to appropriate care, physicians should consider the frequency and intensity of attacks, and their overall impact on ability to function. The Migraine Disability Assessment Scale (MIDAS) measures headache-related disability. The MIDAS Perceptions Study investigated whether MIDAS scores reflect headache severity and the need for medical care, and assessed whether the MIDAS questionnaire is meaningful and relevant to patients, and easy to use.

DESIGN: The Perceptions Study was conducted as a follow-up to a baseline telephone interview. Upon completion of the baseline survey, 471 individuals were invited to participate in the Perceptions Study and 420 participated: 168 patients with migraine headaches and 253 with non-migraine headaches. Patients with migraine or non-migraine headaches completed the MIDAS questionnaire and the Center of Epidemiologic Studies of Depression (CES-D) questionnaire, and were then interviewed by telephone within 48 hours of receiving the questionnaires.

RESULTS: Headache frequency and pain intensity increased significantly with increasing MIDAS grade (p < 0.0001). A pattern of decreasing quality-of-life scores on the physical and mental subscales of the Short Form-12 was also seen with increasing MIDAS grade. Scores on the CES-D scale increased significantly with increasing MIDAS grade (p < 0.0001), indicating a greater likelihood of depression and more severe depression with higher grades. There were significant associations between increasing MIDAS grade and an increasing proportion of individuals who had consulted a doctor within the past year, lower use of over-the-counter medication, and greater use of prescription medications (p < 0.0001 for all three variables). Satisfaction with current therapy decreased significantly with increasing MIDAS grade, mirroring the frequency with which individuals achieved complete relief from headache. The MIDAS questionnaire was rated as easy to use by the vast majority of respondents, and ratings of its perceived value increased significantly as MIDAS grade increased.

CONCLUSIONS: A low MIDAS score generally seems to indicate a low need for care, while individuals in MIDAS grades III and IV appear to have significant unmet medical care needs. The MIDAS questionnaire had increasingly perceived relevance as MIDAS grade increased, helped the majority of those in MIDAS grades III and IV to understand the impact of their headaches, and encouraged those with the greatest disability to seek medical care. The MIDAS questionnaire may facilitate communication between doctors and patients, and help physicians to identify those receiving inadequate medical care.

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