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Q01: What type of headache do you have?
Q02: How long have you experienced headaches?
Regular Headache: Significant Headache Debilitating Headache
Q3: How frequently do you get headaches?
Regular Headache
Significant Headache
Debilitating Headache
Significant Headache
Debilitating Headache
Q04: Where does your head pain typically start ?

Q05: Does your headache start on one side?
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Q06: How long does your typical headache attack last?
Q07: How many headache attacks can you get in a day?
Q08: How would you describe your headache?
Q09: Do you have any of these symptom days before a significant headache (Prodroma)?
Q10: Do you get any of these warnings before imminent headache attacks (Aura)?
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Q11: Do you experience any of the following symptoms during headache attacks?
Q12: Do you notice any of the signs in your face during headache attacks?
Q13: Have you noticed any factors that may trigger headache attacks?
Q14: Does your headache get worse with these physical activities.?
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Q15: Do your headaches occur at a specific time?
Q16: Have you been diagnosed with the following conditions in the past that may cause headache?
Q17: Have you been diagnosed with the following conditions in the past that may relate to your headache?
Q18: Are your headaches related to your hormonal changes?
Q19: Do significant headaches run in your family?
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Q20: Have you been diagnosed with any of the following conditions that may complicate headaches?
Q21: What medications have you tried for your headache attacks? How effective are they?
not work: - | half work: +/- | mostly work: + | side effect: s | Effectiveness | |||
Medications To Relieve Headaches | - | +/- | + | s |
01. Ibuprofen (Advil,Motrin ) | ||||
02. Naproxen (Aleve) | ||||
03. Diclofenac (Toradol, Cambia) | ||||
04. Dihydroergotamine (DHE, Migranal) | ||||
05. Ergotamine (Cafergot) | ||||
06. Sumatriptan (Imitrex) | ||||
07. Rizatriptan (Maxalt) | ||||
08. Eletriptan (Relpax) | ||||
09. Zolmitriptan (Zomig) | ||||
10. Almotriptan (Axert) | ||||
11. Ubrogepant (Ubrelvy) | ||||
12. Rimegepant (Nurtec) | ||||
13. Lasmiditan (Reyvow) | ||||
14. Metoclopramide (Reglan) | ||||
15. Promethazine (Phenergan) | ||||
16. Methylprednisolone (Solu-Medrol) | ||||
17. Dexamethasone (Decadron) | ||||
18. Prednisone (Aleve) | ||||
19. Prochlorperazine (Compazine) | ||||
20. Ondansetron (Zofran) | ||||
21. Aspirin + Caffeine + Butalbital (Fiorinal) | ||||
22. Acetaminophen + Caffeine + Butalbital (Fioricet) | ||||
23. Isometheptene, dichloralphenazone and acetaminophen (Midrin) | ||||
24. High-flow oxygen therapy |
Q22 At what age do you start headache?
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Q23: What daily medications do you use or have used for headache prevention and how effective are they?
not work: - | half work: +/- | mostly work: + | side effect: s | Effectiveness | |||
Medications To Prevent Headaches | - | +/- | + | s |
01. Propranolol (Inderal) | ||||
02. Metoprolol | ||||
03. Lisinopril | ||||
04. Candesartan | ||||
05. Topiramate (Topamax) | ||||
06. Valproate Acid (Depakote) | ||||
07. Zonisamide (Zonegran) | ||||
08. Nortriptyline (Pamelor) | ||||
09. Amitriptyline (Elavil) | ||||
10. Pregabalin (Lyrica) | ||||
11. Gabapentin (Neurontin) | ||||
12. Venlafaxine (Effexor) | ||||
13. Duloxetine(Cymbalta) | ||||
14. Verapamil | ||||
15. Erenumab (Aimovig) | ||||
16. Fremanezumab (Ajovyl) | ||||
17. Galcanezumab (Emgality) | ||||
18. Eptinezumab (Vyepti) | ||||
19. Onabotulinumtoxin (Botox) | ||||
20. Lithium | ||||
21. Tizanidine (Zanaflex) | ||||
22. Cyproheptadine |
Q24: Have you used any alternative remedies to manage headaches and how effective are they?
not work: - | half work: +/- | mostly work: + | side effect: s | Effectiveness | |||
Supplements To Suppress Headaches | - | +/- | + | s |
01. Caffeine | ||||
02. Vitamin B2 (Riboflavin) | ||||
03. Diclofenac (Toradol, Cambia) | ||||
04. Vitamin B6 (Pyridoxine) | ||||
05. Coenzyme Q10 (CoQ10) | ||||
06. Vitamin D | ||||
07. Magnesium | ||||
08. Melatonin | ||||
09. Zinc | ||||
10. Feverfew | ||||
11. Butterbur | ||||
12. Ginger | ||||
13. Turmeric | ||||
14. Valerian Root | ||||
15. Ginkgo Biloba | ||||
16. Omega-3 Fatty Acids (Fish Oil) | ||||
17. Probiotics |
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Q25: Have you used any therapy to manage headaches and how effective are they?
not work: - | half work: +/- | mostly work: + | side effect: s | Effectiveness | |||
Therapy To Suppress Headaches | - | +/- | + | s |
01. Neuromodulation (Cefaly, gammaCore) | ||||
02. Cognitive Behavioral Therapy (CBT) | ||||
03. Trigger point injection | ||||
04. Dihydroergotamine (DHE, Migranal) | ||||
05. Occipital nerve block< | ||||
06. Acupuncture | ||||
07. Cold packs | ||||
08. Exercise | ||||
09. Sleep | ||||
10. Meditation | ||||
11. Physical therapy< | ||||
12. Massage | ||||
13. Chiropractic manipulation |
Q26: In the past 3 months, how has headache affected your life?
1 | 2 | 3 | 4 | >5 | |
01. Days missed work/schoolwork | |||||
02. Days missed from household choir. | |||||
03. Days missed from family / social activity | |||||
04. Days missed from leisure activities | |||||
05. Days only partially functioning. |
Q27: Have you undergone imaging (e.g., MRI/CT) for headaches?
Q28:Have you undergone lab tests for headaches?
01. Kidney function
02. Liver function
03. Thyroid function
02. Liver function
03. Thyroid function