Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dr. Andrea C. Bostrom PhD, PMH CNS-BC

Second Advisor

Dr. Karen Burritt PhD, FNP-BC, RN,

Third Advisor

Susan Price FNP, RN


Introduction: Headache is a chronic pain that is challenging to properly assess in clinical practice, as it is based almost entirely on the ability of the clinician and patient to communicate. This communication is based on pain scale tools. To assess patients’ disability and pain intensity, the selected organization uses the Migraine Disability Assessment (MIDAS) screening tool. Pain intensity is measured with a Numeric Pain Scale within the MIDAS. Measuring chronic headache pain accurately, while using a very subjective and inadequate pain scale to measure chronic pain was an issue. The literature review supported replacing the Numeric Pain Scale with the Mankoski within the MIDAS screening tool. The DNP scholarly project aimed to answer the question: Does implementation of the standardized and descriptive headache assessment tool, the Mankoski, at a Neurology Clinic in a Midwestern City improve the accuracy of the MIDAS screening tool?

Objectives: The use of an evidence-based pain assessment tool to improve the assessment of pain for all patients. To focus solely on patients with headaches who come into a Neurology Clinic in a Midwestern city and to screen all headache patients with the MIDAS screening tool.

Methods: The quality improvement project used a pre and post data comparison. The pre data from 2018 had the pain portion rated on the Numeric Pain Scale and the post –data from 2019 had the pain portion rated with the Mankoski pain scale. Collected data included age, sex, diagnosis, MIDAS score, and pain scale score. The inclusion criteria were all adults over 18 years of age, who presented with any type of headache. Exclusion criteria were headache red flags, such as: sudden acute headache that has a new onset, worsening pain, and patients under 18 years of age.

Results: A total of 107 patient encounters were included in the collected data. In 2018, 51 patients presented with a diagnosis of headache. In 2019, 56 patients presented with a diagnosis of headache. The pain and functional status were correlated using a Pearson’s correlation. The data from these ordinal level scales were treated as interval level data. The project measured the correlation of MIDAS and the Numerical pain scale and the correlation of MIDAS and the Mankoski scale. In 2018, the correlation between MIDAS and numerical pain scale was 0.11177 (p=0.4349). In 2019, the correlation between the MIDAS and Mankoski was 0.50360 (p=0.0001). The Mankoski clearly better assesses the association between function and pain.

Conclusions: According to this quality improvement project results, chronic headache pain is measured more accurately with the Mankoski pain scale. As a result patient and provider have a better mutual understanding of the condition and a better treatment plan.

Implications: Implication for practice includes standardizing screening of headache patients, by administering a revised MIDAS screening tool to all headache patients on each visit.

Available for download on Thursday, May 06, 2021