Headache Questionnaire

Dear Visitor,

No software program can substitute for a face to face neurologic evaluation but give it a try. Answer all the questions as best you can. It will provide a rough indication of whether your headaches are vascular(migrainous), tension, cluster or atypical.

I experience the following symptoms: Choose an Option
1. Continuous headaches:
2. One sided headaches:
3. Nausea:
4. Nausea and vomiting:
5. Sensitivity to light:
6. Headaches that wake me:
7. Flickering Lights:
8. Blind Spots:
9. Neck Muscle spasm:
10. I have been unconscious (fainting, seizures, head injury, any cause):
11. I get sinus infections:
12. My eyes water with headaches:
13. My eyes get red with headaches:
14. My headaches get worse as the day goes by:
15. I have a family history of headaches.

This questionnaire is intended for the classification of your headache profile. It is intended for chronic headaches. If you are having new or unusual headaches, see your doctor or call for an appointment: 510 644 2282

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