Migraines or other headaches? Work History. Highest level of education. Current occupation. Currently working? Yes. On disability.
Scoring: After you have filled out this questionnaire, add the total number of days from questions 1-5 (ignore A and B). MIDAS Grade. Definition. MIDAS Score. I.
Headache Questionnaire. Page 1 of 5. S. B. U. H. 2. 0. 1. 2. N. 0. 8. 2. At what age did you have your first headache: ______ What year did your current ...
Headache Questionnaire. Patient Name: Date: 1. Did the headaches start after an accident, illness or infection? □Yes □ No. 2. How long has the patient had ...
The MIDAS (migraine disability assessment) questionnaire can help your doctor assess the impact your headaches are causing on your life and determine the.
average. 3. How long do your migraine headaches usually last after you take your migraine medicine? (Check one). □ No more ...
the migraine screen questionnaire (MS-Q) using categorical data methods. Material ... AS, et al. Factor scoring models of the Pittsburgh sleep quality index: a .
In our evaluation of headache, your history is typically our most valuable tool for diagnosis and subsequent treatment. If you have any questions regarding this form ...
How would you describe your migraine headaches? (Check all the apply). Throbbing/Pounding. Ache/pressure. Like a tight band. Dull. Other______________.
Migraine-Specific Quality of Life Questionnaire version. 2.1 (MSQ v2.1) Role Function-Restrictive (RFR) domain, which measures the impact of migraine on work ...