Office based Headache Questionnaires

Timothy C. Hain, MD • Page last modified: July 30, 2022Return to questionnaire index

Here we briefly review the commonly used office based tests of headaches. We use both of these in our clinical practice, which includes many patients with headache. The "MIDAS" questionnaire is unfortunate in several ways. It has very skewed (i.e. scores are not all normally distributed), and it is really a measure of "duty cycle" of headaches -- i.e. a time measure, not a severity measure. The HIT-6 has a much better looking distribution, and doesn't pretend to diagnose anything.

Questionnaire used to quantify headaches Link to questionnaire Source
Headache Impact Test HIT6 (pdf).•HIT6 description, Another online version: Comment: This is not a diagnostic test. The distribution of HIT scores in a very large number of dizzy patients is shown here.
Migraine disability assessment MIDAS (pdf). MIDAS description, Another online version: Comment: This is not a diagnostic test, it is symptom duration survey. It is unfortunate that it has "migraine" in its name. It is basically a measurement of headache distress. The distribution of MIDAS scores in a large group of patients is here.


None of the questionaires above make "diagnoses". Some have unfortunate names, as if they did make diagnoses. For example, the Migraine disability assessment. One might wrongly think that someone who scores highly on this survey has migraine. Perhaps they have something else -- like a subdural, a brain tumor, a sinus infection ...

Pursuing this idea, it is important not to confuse a symptom inventory with a diagnosis. In other words, someone who scores highly on, lets say, the "Concussion Impact Inventory", doesn't necessarily have a concussion. They have some symptoms that people with concussion have as well.

The difficulty here lies in diagnoses that are all symptoms. For example, lets take migraine. This is a diagnosis based on what a patient tells you - -symptoms. It is not based on a blood test, a genetic test, or a brain image. One should not confuse a collection of symptoms with having a pattern that a committee has sugggested is a diagnosis.

Or to put this another way, not everyone who has a headache, is having a migraine (whatever that means). Not everyone who is confused has Alzheimer's disease. Not everyone who had a ping-pong ball drop on their head (i.e an impact), and has headaches has a concussion. This tendency to make causal inferences from symptom inventories is illogical, and common.

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