Headache Questionnaire

  1. How often do you get severe headaches (that make it difficult or impossible to continue normal function)? daily or almost daily
  2. 3-4 times a week
  3. every 2 weeks or so
  4. once a month or less
  5. almost never
  • How often do you get mild or less severe headaches? daily or almost daily
  • 3-4 times a week
  • every 2 weeks or so
  • once a month or less
  • almost never
  • How often do you take pain relievers or any medication to relieve headache symptoms? daily or almost daily
  • 3-4 times a week
  • every 2 weeks or so
  • once a month or less
  • almost never
  • How often do you miss some work or leisure time because of headaches? daily or almost daily
  • 3-4 times a week
  • every 2 weeks or so
  • once a month or less
  • almost never
  • Are you satisfied with the current medication you use to relieve your headaches?
    1. yes
    2. no
  • Are you taking daily prescription medication to prevent headaches?
    1. yes
    2. no
  • If no, do your headaches trouble you enough to take daily preventive medication?
    1. yes
    2. no