Measuring the impact of migraine: a systematic review of the measurement properties of MIDAS, HIT-6, and MSQoL

Migraine is a leading cause of global disability. Valid, reliable instruments are essential for quantifying its impact. The Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6), and Migraine-Specific Quality-of-Life questionnaire (MSQoL) are widely used, yet their comparative measurement properties across populations remain insufficiently characterized. To systematically review and compare the measurement properties of MIDAS, HIT-6, and MSQoL following the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. This systematic review followed the COSMIN guidelines for systematic reviews of outcome measurement instruments and was reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-COSMIN guideline. In total, seven databases were searched from study inception to January 31, 2025, restricted to English-language full-text studies. Methodological quality was appraised with the COSMIN Risk of Bias checklist; results were rated against criteria for good measurement properties, and evidence was graded using a modified Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) approach. Of 2,674 records, 22 studies (20,455 participants) were included. All three instruments showed sufficient internal consistency and construct validity. The HIT-6 showed sufficient ratings across all properties (moderate-to-high quality evidence). Also, the MIDAS showed sufficient core properties but limited responsiveness and inconsistent reliability across cultural versions. Finally, MSQoL showed sufficient structural validity and internal consistency but insufficient test-retest reliability. Both HIT-6 and MIDAS can be recommended for measuring migraine impact (Category A), whereas MSQoL shows potential but requires further reliability and responsiveness research (Category B). A combined approach is recommended for comprehensive migraine burden evaluation.