Get Disability Test

The Migraine Disability Assessment Test The MIDAS Migraine Disability Assessment questionnaire was put together to help you measure the impact your headaches have on your life. The information on this questionnaire is also helpful for your primary care provider to determine the level of pain and disability caused by your headaches and to find the best treatment for you. INSTRUCTIONS Please answer the following questions about ALL of the headaches you have had over the last 3 months. Select your answer in the box next to each question* Select zero if you did not have the activity in the last 3 months. Please take the completed form to your healthcare professional* 1. On how many days in the last 3 months did you miss work or school because of your headaches 2. How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches Do not include days you counted in question 1 where you missed work or school* repairs and maintenance shopping caring for children and relatives because of your headaches household work. headaches Total Questions 1-5 What your Physician will need to know about your headache day count each day. B. On a scale of 0 - 10 on average how painful were these headaches where 0 no pain at all and 10 pain as bad as it can be. Scoring After you have filled out this questionnaire add the total number of days from questions 1-5 ignore A and B. MIDAS Grade Definition MIDAS Score I Little or No Disability 0-5 II Mild Disability 6-10 III Moderate Disability 11-20 IV Severe Disability If Your MIDAS Score is 6 or more please discuss this with your doctor. The information on this questionnaire is also helpful for your primary care provider to determine the level of pain and disability caused by your headaches and to find the best treatment for you. INSTRUCTIONS Please answer the following questions about ALL of the headaches you have had over the last 3 months. INSTRUCTIONS Please answer the following questions about ALL of the headaches you have had over the last 3 months. Select your answer in the box next to each question* Select zero if you did not have the activity in the last 3 months. Select your answer in the box next to each question* Select zero if you did not have the activity in the last 3 months. Please take the completed form to your healthcare professional* 1. On how many days in the last 3 months did you miss work or school because of your headaches 2. Please take the completed form to your healthcare professional* 1. On how many days in the last 3 months did you miss work or school because of your headaches 2. How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches Do not include days you counted in question 1 where you missed work or school* repairs and maintenance shopping caring for children and relatives because of your headaches household work. How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches Do not include days you counted in question 1 where you missed work or school* repairs and maintenance shopping caring for children and relatives because of your headaches household work. headaches Total Questions 1-5 What your Physician will need to know about your headache day count each day.