Headache Questionnaire

The following questions will help you:

ARE YOU STILL SUFFERING WITH HEADACHE OR MIGRAINE AND REQUIRE TREATMENT?

• Is your Headache/Migraine the Worst headache in your life or a New Headache? Please Contact ED ASAP or your GP?
• Do You experience Headache/Migraine with Neck or Jaw Pain?
• Do you experience Headache/Migraine while sleeping or awakening?
• Do you experience Headache/Migraine with movement (neck bending, looking up, turning the neck, exertion, coughing, sexual activity, chewing food or opening your mouth)?
• Are your Headache/Migraine triggered by certain foods, your menstrual cycle, bright lights, barometric changes, stress, lack of food trigger your headaches?
• Do you have irritable bowel syndrome, gluten intolerance, fructose intolerance or altered bowel movements?
• Are your Headache/Migraine relieved by movement or rest?
• Do other family members have similar Headache/Migraine?
• Are your Headache/Migraine often preceded by warning symptoms such as visual disturbances, nausea, vomiting, hunger or fatigue?
• Are your Headache/Migraine associated with unusual sensations of the arm or leg, hot or cold hands and feet, weakness or unsteady gait, seizures, slurred speech, or fever?
• Are your Headache/Migraine following a recent head trauma or a fall?
• Have you had treatment to the neck, low back or jaw (TMJ)?
• Have you had a biomechanical analysis from head to toes or the atlas to talus?
• In the last 3 months has your headache improved by 20%?
• Have you consulted an Integrative Medical Specialist?