Identifying Hidden Disability in Migraine Patients Using the Migraine Interictal Burden Scale-4

Q: What does MIBS-4 measure in migraine patients?

MIBS-4 measures interictal burden, capturing disability between migraine attacks. It helps quantify hidden effects that may be overlooked in routine clinical assessment.

Q: Which factors were associated with higher MIBS-4 scores?

Higher HIT-6 scores and longer disease duration were significantly associated with clinically high interictal burden. Female sex showed an association with lower MIBS-4 scores, while monthly migraine days, migraine subtype, and age were not significant predictors.

Q: How did the study evaluate interictal and ictal disability?

Interictal burden was assessed using the Migraine Interictal Burden Scale-4 (MIBS-4). Ictal disability was evaluated with the Headache Impact Test-6 (HIT-6), alongside other clinical variables and regression analyses.

Sep 28, 2026

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Migraine affects not only attacks but also the interictal period, creating hidden disability that routine practice often under-assesses. The Migraine Interictal Burden Scale-4 (MIBS-4) offers a concise way to measure this burden, yet its Japanese outpatient relevance and predictors were not well established. This cross-sectional study evaluated MIBS-4 utility in 81 Japanese migraine patients and examined associations with ictal disability (HIT-6) and clinical variables.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

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Abstract

Background

Methods

Results

Conclusion

Introduction

Materials And Methods

Review began 11/04/2025 Review ended 11/28/2025 Published 11/30/2025 © Copyright 2025 Hashimoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98195 Open Access Original Article Identifying Hidden Disability in Migraine Patients Using the Migraine Interictal Burden Scale-4 Norichika Hashimoto 1, 2, Hatsuji Uno 2, Tetsurou Tsuji 2 , Makoto Isozaki 1 1. Department of Neurosurgery, University of Fukui, Fukui, JPN 2. Department of Neurosurgery, Fukui General Hospital, Fukui, JPN Corresponding author: Norichika Hashimoto, [hashi1972@eagle.ocn.ne.jp](hashi1972@eagle.ocn.ne.jp) Abstract Background Migraine is increasingly recognized as a disorder with a substantial burden, not only during attacks but also during interictal periods. However, this dimension of disability remains under-assessed in routine clinical practice, partly because clinical attention has traditionally focused on acute attack symptoms, while patients themselves may perceive interictal periods as “normal” and therefore underreport the psychosocial impact. The Migraine Interictal Burden Scale-4 (MIBS-4) provides a concise measure of this hidden burden; however, its clinical relevance in Japanese outpatient populations has not been thoroughly investigated. This study aimed to evaluate the clinical utility of the MIBS-4 and identify its predictors in Japanese patients with migraine by examining its association with ictal disability (HIT-6) and other clinical variables. Methods We conducted a cross-sectional study involving 81 patients diagnosed with migraine at the neurosurgical outpatient clinic. Interictal burden was assessed using the MIBS-4, and ictal disability was evaluated using the Headache Impact Test-6 (HIT-6) . Emotional distress was measured using validated screening tools. Multiple regression analyses were performed to identify predictors of MIBS-4 scores. The independent variables entered into the regression model were migraine subtype, monthly migraine days (MMD), disease duration, sex, age, and headache-related disability (HIT-6) . Results Among 81 Japanese migraine patients, higher MIBS-4 scores were significantly associated with increased HIT-6 scores (β = 0 .26, p < 0 .001), indicating that greater headache-related disability contributes to an elevated interictal burden. Female sex was also associated with lower MIBS-4 scores (β = -1.49, p = 0 .057), and longer disease duration showed a trend toward significance (p = 0 .096) . MMD, migraine subtype, and age were not significant predictors. Logistic regression revealed that higher HIT-6 scores (odds ratio (OR) = 1.33, p = 0 .001) and longer disease duration (OR = 1.01, p = 0 .016) were significantly associated with a clinically high interictal burden (MIBS-4 ≥5) . Conclusion In this study, MIBS-4 scores were shown to be associated with HIT-6 scores and disease duration, but not with monthly migraine days. These findings support the utility of MIBS-4 in capturing interictal disability independently of attack frequency. Routine use of MIBS-4 in outpatient practice may help uncover hidden disease burden and guide preventive treatment strategies, particularly for patients with a long disease duration or elevated headache-related disability. Categories: Neurology, Pain Management, Public Health Keywords: cgrp antibody therapy, hit-6, interictal burden, mibs-4, patient-reported outcomes Introduction Migraine imposes a persistent burden not only during attacks but also between them. This interictal disability, including difficulties in maintaining work productivity, social participation, or family responsibilities, remains under-recognized in clinical practice [1,2] . Such a hidden burden contributes to reduced quality of life and m

FAQs

What does MIBS-4 measure in migraine patients?

MIBS-4 measures interictal burden, capturing disability between migraine attacks. It helps quantify hidden effects that may be overlooked in routine clinical assessment.

Which factors were associated with higher MIBS-4 scores?

Higher HIT-6 scores and longer disease duration were significantly associated with clinically high interictal burden. Female sex showed an association with lower MIBS-4 scores, while monthly migraine days, migraine subtype, and age were not significant predictors.

How did the study evaluate interictal and ictal disability?

Interictal burden was assessed using the Migraine Interictal Burden Scale-4 (MIBS-4). Ictal disability was evaluated with the Headache Impact Test-6 (HIT-6), alongside other clinical variables and regression analyses.

Sep 28, 2026

Uploaded by moss~