The objective of this study was to develop a questionnaire to assess the short-term quality of life decrements associated with an acute migraine headache attack. A total of 101 potential quality of life items were generated by interviewing migraineurs and migraine specialists and reviewing the literature. To reduce the items, 76 migraineurs (18 years and older) were asked to identify which of the 101 items affected their quality of life in the 24 hours following onset of a migraine and to rate them on a five-point scale from "not very important" to "extremely important." Reduction of the 101 items to a 15-item questionnaire was performed by evaluating the results of subject-perceived importance (number of times an item was chosen x mean importance score) in combination with principal components analysis. Five domains were identified: (1) work functioning, (2) social functioning, (3) energy/vitality, (4) migraine headache symptoms, and (5) feelings and concerns. Each domain has three items and the correlation between the five domains, as measured by the Spearman correlation coefficient, ranged from 0.08 to 0.38 suggesting minimal overlap. The brief migraine quality of life questionnaire was pilot-tested in two groups of 10 migraineurs and revised to improve clarity.