PedMIDAS: Pediatric Migraine Disability Assessment Scale
Also known as: Pediatric Migraine Disability Assessment, MIDAS, MIDAS Pediatric
The PedMIDAS is a brief 6-item parent-report (with child input for older youth) instrument developed by Hershey et al. in 2001 to quantify migraine-related functional disability in children and adolescents. Rather than measuring pain intensity or headache frequency, the PedMIDAS focuses on the ultimate impact of migraine on daily life: how many days of school, sports/play, and family activities does the child miss or participate in only with significant limitation? This outcome-focused approach makes it particularly useful for assessing the real-world burden of migraine in children and evaluating treatment effectiveness.
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When to use it
The PedMIDAS is indicated for children and adolescents aged 6–17 years with a diagnosis of migraine (episodic or chronic). It is particularly valuable in pediatric neurology or headache specialty clinics for rapid assessment of migraine disability, in longitudinal monitoring to track functional improvement with treatment, in clinical trials of migraine preventive medications or behavioral interventions, and in school-based screening to identify children with disabling migraine who may benefit from medical referral. The PedMIDAS is not appropriate for non-migraine headache types (tension-type headache, medication overuse headache without migraine) or for children without headache disorders.
Strengths & limitations
- Exceptionally brief (6 items, 2–5 minute administration) while capturing functionally relevant outcomes; practical for busy clinical settings.
- Outcomes-focused rather than symptom-focused: directly measures what matters most to families and society—can the child attend school and participate in age-appropriate activities?
- Intuitive disability grades (A/B/C/D) enable rapid communication of migraine burden to families and clinicians; no complex interpretation needed.
- Highly responsive to treatment effects; improvements in migraine frequency or severity directly translate to reduced days missed and improved grades.
- Extensively validated in pediatric migraine populations; extensively used in clinical practice and research.
- Simple scoring requires no calculators or complex algorithms; can be administered and scored by anyone in a clinical setting.
- Relies on parent (or parent + child) recall of days missed or limited in the past 3 months; subject to recall bias and difficulty quantifying 'partial' days.
- Does not measure pain intensity, headache frequency, or duration; a child with infrequent but severe migraines that cause profound functional loss may score lower than a child with frequent migraines that only mildly limit activity.
- Limited age range (6–17 years); not validated for younger children or adults with migraine.
- Binary classification into disability grades (0–10, 11–30, 31–50, >50) may mask important changes near cutoff boundaries; a child improving from 35 to 25 days moves from grade C to grade B, but from a functional standpoint, the change is continuous.
- Does not directly measure quality of life in non-functional domains (emotional impact, school performance beyond attendance, peer relationships); these require supplementary measures.
Frequently asked
Can the PedMIDAS be used for children with tension-type headache or other non-migraine headaches?
The PedMIDAS is validated specifically for migraine. While you could theoretically use the item format (days of missed activity due to headache) for other headache types, the diagnostic specificity and psychometric properties apply only to migraine populations. For non-migraine headaches, consider using generic disability measures or headache-specific scales designed for those conditions.
What is a meaningful change in PedMIDAS score?
A change of one full disability grade (e.g., from Grade B to Grade A, or Grade C to Grade B) is generally considered clinically meaningful. In numerical terms, improvements of 10–20 days in the past 3 months correspond to grade changes and are typically considered meaningful. However, the clinical meaningfulness depends on the child's baseline; reducing a Grade D child to Grade C is meaningful, but the absolute number of days reduced may be large.
Should I use the absolute days lost (items 1, 3, 5) or the full 6-item score?
Check the specific protocol and literature you are following. The original PedMIDAS by Hershey et al. uses all 6 items. Some researchers focus on absolute lost days (items 1, 3, 5) as more objective. Be consistent and clear about which scoring approach you use so that comparisons are valid.
Can I use the PedMIDAS for adults with migraine?
No. The PedMIDAS is validated only for ages 6–17 years. Adults should use the adult MIDAS scale. Child and adult migraines have different impacts (school vs. work), different typical frequencies, and different risk factors; separate instruments are necessary.
Sources
- Hershey, A. D., Powers, S. W., Vockell, A. L., LeCates, S., & Ellinwood, E. H. (2001). PedMIDAS: Development of a questionnaire to assess disabilities in migrainous children. Headache, 41(6), 556-563. DOI: 10.1212/wnl.57.11.2034 ↗
- Powers, S. W., Patton, S. R., Hommel, K. A., & Hershey, A. D. (2004). Quality of life in pediatric migraine: clinical impact and comparison of generic and headache-specific instruments. Headache, 43(5), 499-508. link ↗
How to cite this page
ScholarGate. (2026, June 3). PedMIDAS: Pediatric Migraine Disability Assessment Scale. ScholarGate. https://scholargate.app/en/pediatric-medicine/pediatric-migraine-qol
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