Consider the impact of the headache disorder on the patient’s life. Patients who have severe disability may require a program of care to improve their lives. Ask patients how headaches affect their lives and what they were hoping for in seeking care. We recommend assessing headache disability using the Migraine Disability Assessment (MIDAS) questionnaire.

This questionnaire measures the effect of headache on work or school, house-hold work, and family, social, and leisure activities over the past three months. The 4-point grading system for the MIDAS questionnaire is as follows: Grade 1 (0-5 days) = little or no disability; Grade 2 (6-10 days) = mild disability; Grade 3 (11-20 days) = moderate disability; Grade 4 (21+ days) = severe disability. Grades 3 and 4 define a more disabled group of headache sufferers (Fig. 2-1).

Headache Physical Examination
The physical examination can rule out systemic causes of headache. Include vital signs; examine the heart and lungs; auscultate the eyes, the carotids, and the vertebral arteries for bruits; perform funduscopy; and palpate the structures in and about the face and head (examine the temporomandibular joint for tenderness, decreased motility, asymmetry or clicking).

Figure 2-1 Migraine Disability Assessment (MIDAS) questionnaire

A neurologic examination should be conducted, but the results may be normal even in the presence of intracranial disease, Include mental status (speak to a family member about changes in behavior), cranial nerves (including pupils and eye movements), reflexes, Babinski’s sign, motor strength, and any evidence of meningeal irritation, such as neck stiffness or Kernig’s or Brudzinskis sign (Edmeads, 1988).

Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.