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Migraine Treatment Optimization Questionnaire-4 (mTOQ-4)
Patient-reported assessment of how well acute migraine medication is working.
Migraine Treatment Optimization Questionnaire-4 (mTOQ-4)
Pain-free within 2 hours for most attacks after taking your migraine medication?
Does 1 dose usually relieve your headache and keep it away for at least 24 hours?
Comfortable enough with your migraine medication to plan your daily activities?
Do you feel in control of your migraines enough to return to normal function?
Result0 / 8 – Very poor treatment response
Very poor treatment response; consider whether acute therapy needs to be reassessed.
When to use
- Screening patients with migraine for suboptimal response to their current acute (abortive) treatment in primary care or headache clinic follow-up.
Formula
Sum of 4 items, each scored 0 (never/rarely), 1 (less than half the time), or 2 (half the time or more), for a total of 0-8. Higher scores indicate better acute-treatment optimization.
Pearls and pitfalls
- A low mTOQ-4 score should prompt review of diagnosis, medication choice/dose/timing, and overuse of acute medication before escalating therapy.
- Complements, but does not replace, a structured headache-frequency and disability history.
References
- Lipton RB, Kolodner K, Bigal ME, et al. Validity and reliability of the migraine-treatment optimization questionnaire. Cephalalgia. 2009;29(7):751-759.
- Serrano D, Buse DC, Manack Adams A, Reed ML, Lipton RB. Acute treatment optimization in episodic and chronic migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2015;55(4):502-518.