James Sawyer

Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers

&NA; The Migraine Disability Assessment (MIDAS) questionnaire is a brief, self‐administered questionnaire designed to quantify headache‐related disability over a 3 month period. The MIDAS score has been shown to have moderately high test–retest reliability in headache sufferers and is correlated with clinical judgment regarding the need for medical care. The aim of the study was to examine the validity of the MIDAS score, and the five items comprising the score, compared to data from a 90 day daily diary used, in part, to record acute disability from headache. In a population‐based sample, 144 clinically diagnosed migraine headache sufferers were enrolled in a 90 day diary study and completed the MIDAS questionnaire at the end of the study. The daily diary was used to record detailed information on headache features as well as activity limitations in work, household chores, and non‐work activities (social, family and leisure activities). The MIDAS score was the sum of missed work or school days, missed household chores days, missed non‐work activity days, and days at work or school plus days of household chores where productivity was reduced by half or more in the last 3 months. Validity was assessed by comparing MIDAS items and the MIDAS score with equivalent measures derived from the diary. The MIDAS items for missed days of work or school (mean 0.96, median 0) and for missed days of household work (mean 3.64, median 2.0) were similar to the corresponding diary‐based estimates of missed work or school (mean 1.23, median 0) and of missed household work (mean 3.93, median 2.01). Values for missed days of non‐work activities (MIDAS mean 2.6 and median 1 versus diary mean 2.22 and median 0.95) were also similar. Responses to MIDAS questions about number of days where productivity was reduced by half or more in work (mean 3.77, median 2.00) and in household work (mean 3.92, median 2.00) significantly overestimated the corresponding diary‐based measures for work (mean 2.94, median 1.06) and household work (mean 2.22, median 0.98). Nonetheless, the overall MIDAS score (mean 14.53, median 9.0) was not significantly different form the reference diary‐based measure (mean 13.5, median 8.4). The correlation between the MIDAS summary score and an equivalent diary score was 0.63. The group estimate of the MIDAS score was found to be a valid estimate of a rigorous diary‐based measure of disability. The mean and median values for the MIDAS score in a population‐based sample of migraine cases were similar to equivalent diary measures. The correlation between the two measures was in the low moderate range, but expected given that two very different methods of data collection were compared.

Menstrual cycle and headache in a population sample of migraineurs.

Background: Migraine is three times more common in women than men. There is a clinical impression that migraines are more common and severe around the time of menses. Objectives: To determine 1) the distribution of headache attacks by day of the menstrual cycle in women with migraine, 2) if the excess occurrence varies by headache type, and 3) if headache features differ by time in the menstrual cycle. Methods: In a population-based sample, 81 menstruating women with clinically diagnosed migraine were enrolled in a 98-day diary study and completed a total of 7219 diary days. The daily diary was used to record the occurrence of menses, headache days, and, on days with headache, associated headache features (i.e., symptoms, quality-of-pain, attack duration, pain intensity, and disability at work, household work, and nonwork activities). Results: An excess risk of headache occurred perimenstrually and was highest on days 0 and 1 of the cycle (day 0 being the first day of menses). A significantly elevated risk of headache on days 0 and 1 was observed for migraine without aura (OR 2.04; 95% CI 1.49, 2.81) and for tension-type headache (OR 1.67; 95% CI 1.24, 2.25). Elevated risks were also observed in the 2 days before onset of menses for migraine without aura (OR 1.80; 95% CI 1.40, 2.30). A significantly lower risk was observed around the time of ovulation for all headaches (OR 0.44; 95% CI 0.27, 0.72). Few significant differences were observed in headache features (i.e., pain intensity, disability score, symptom score, headache duration) by day of the cycle overall or by headache type. Pain intensity was slightly greater for migraine headaches during the first 2 days of menses. Conclusions: Attacks of migraine without aura, but not migraine with aura, were more likely to occur 2 days before onset of menses and on the first 2 days of menses. This study does not support the clinical notion that headaches, regardless of type, are more severe during the perimenstrual period compared to other times in the cycle. Although migraine headaches are significantly more painful during the first 2 days of menses, differences are small.–1523

Clinical utility of an instrument assessing Migraine disability: The Migraine Disability Assessment (MIDAS) questionnaire

Objective.—We evaluated the agreement between Migraine Disability Assessment (MIDAS) scores and independent physician judgments about pain, disability, and treatment needs based on patient medical histories.

The Cost Effectiveness of Stratified Care in the Management of Migraine

AbstractObjective: To examine the cost effectivess of a stratified-care regimen for patients with migraine — in which patients are stratified by severity of illness, and then prescribed differing treatments according to level of severity — compared with a conventional stepped-care approach. Design and methods: A decision analytic model was constructed to simulate a controlled clinical trial in which patients with migraine receiving primary medical care were randomly assigned to treatment under a stepped-care or a stratified-care regimen. A health service payer perspective was adopted and the time horizon was 1 year. Data inputs were: (i) the frequency and disability of migraine, derived from population-based studies; (ii) disability level-specific treatment response rates for over-the-counter analgesics, aspirin/metoclopramide and zolmitriptan as the representative of high-end therapy obtained from an international consensus opinion enquiry; and (iii) unit costs of healthcare obtained from UK health service sources. Main outcome measures and results: The estimated 1-year direct healthcare costs per primary care patient with migraine were pound sterling (£) 156.82 for stepped care and £151.57 for stratified care. Estimates of treatment response rates were 40 and 71% for stepped and stratified care, respectively. The cost per successfully treated attack was £23.43 for stepped care and £12.60 for stratified care.Stratified care remained cost effective when tested in a wide range of one-way sensitivity analyses, and probabilistic sensitivity analysis showed the cost effectiveness of stratified care to be significant at the 3%level.Conditional confidence analysis showed that the level of confidence in the cost effectiveness of stratified care varied positively with the case mix, i.e. in populations where the proportion of moderate and severely disabled patients with migraine was greater than 25%, the cost effectiveness of stratified care remained statistically significant. Conclusion: A stratified-care treatment strategy (including zolmitriptan as the representative of high-end therapy) is a highly cost-effective method of managing migraine in the primary care setting compared with stepped care, delivering improved clinical outcomes at no additional cost.