Wicked Headache


using Headache Helper©
by ABIS


To view Headache Helper© Questionnaire video click here>

The purpose of this questionnaire is to help determine the types of chronic headache you have. If you are concerned that you have a serious medical condition such as stroke, tumor or trauma you should immediately contact your physician or go directly to a hospital emergency room.

Have you watched the video describing how best to take this questionnaire? If not, we suggest you do! It will help you improve the accuracy of test results.

Many of the questions in the Headache Helper© questionnaire identify comorbidities...other medical problems that feed into chronic headaches, such as family history, mood disorders, stress, sleep apnea or neurologic conditions. They need to be concurrently treated for the best results even though the treatment may not be directly aimed at migraine. So now, think about the pains you experience, follow the instructions and proceed with the test. And good luck.

The following questions are directed at identifying the headache type(s) you are suffering from. Please be sure to answer all questions that apply to your headache condition. Some questions may appear to be repetitive. They are not. They pertain to different headache types. And some apply to females only. When answering questions please keep the section heading in mind and answer the question as it pertains to that section.


* = Required information




first name :  *
middle initial :  *
mother's first name :  *
your email  * (please make sure email address is accurate)



This first part of the questionnaire concerns background information.


Sex Male Female
Present Age
Age when you first started getting headaches
As a child or adolescent did you have severe occasional headache? Yes No
If yes, were they:
As a child or adolescent did you experience car sickness or motion sickness? Yes No
As a child or adolescent did you experience recurrent attacks of vertigo or stomach pain? Yes No
Medical History: The following questions relate to your past medical history
Has a physician ever diagnosed you with any of the following conditions? (check all that apply) high blood pressure diabetes
asthma or lung disease heart disease
arthritis hay fever or environmental allergies
epilepsy or seizures cancer
stroke or TIA (transient ischemic attack) glaucoma
obstructive sleep apnea sinusitis
TMJ (temporomandibular joint disorder) giant cell/arteritis
cluster headache migraine headache
tension-muscle contraction headache trigeminal neuralgia
occipital neuralgia a neurologic condition resulting in a brain or skull operation
Have you had any of the following conditions. If yes, which ones? anxiety obsessive compulsive disorder
panic attacks bipolar
attention deficit disorder alcohol dependency
post traumatic stress disorder mood disorder
The following questions relate to any previous headache evaluation
Have you been previously examined by a medical doctor or neurologist specifically for headache? Yes No/don't know
had a CT scan of the brain had a MRI scan of the brain
had a EEG (electroencephologram)
Have you visited a medical doctor for treatment of your headache?
Family History - Has anyone in your family (blood relatives) had ...
Headaches? Yes No
If yes, which type?(check all that apply) migraine-type unknown common migraine
classical migraine (aura) cluster headache
tension muscle contraction headache
A stroke or TIA (transient ischemic attack) Yes No
epilepsy Yes No
glaucoma Yes No
Emotional or psychological problems (check all that apply) anxiety obsessive compulsive disorder
panic attacks bipolar
attention deficit disorder alcohol dependency
mood disorder post traumatic stress disorder
Medication History
Are you presently taking or have you taken?
hormonal contraceptives hormonal replacement therapy
depakote(valproate) tegretol(carbamazepine)
dilantin(phenytoin) topamax(topiramate)
neurontin(gabapentin)
Have you ever used a preventative treatment where you took medication on a daily basis so as to prevent headache in the first place? Yes No
If yes to the above, how many different kinds of medicine have you tried?
Have you taken a prescription medicine that you took only at the time of a headache? Yes No
If yes to the above, how many different prescription medications have you taken?
What would be the most pain killers you would use to treat a single headache attack?
On average, how many painkillers do you take each day?
Over the course of a month how many painkillers might you use?
Social History
Marital status
What type of work do you do?
Does your work involve lifting or repetitive activity? Yes No
Does your work involve prolonged sitting? Yes No
Does your work involve using a computer or similar machine? Yes No
What is your level of education?
Do you smoke? Yes No
caffeine use (check all that apply) 0-3 cups coffee or tea per day 4 or more cups of coffee or tea per day
4 or more caffeinated sodas per day 3 or more caffeine containing pain relievers per day
Medical Review of Systems
The following questions relate to symptoms of medical conditions that you experience
trouble sleeping Frequently Sometimes Never
muscle pains Frequently Sometimes Never
pain in sinuses Frequently Sometimes Never
pain localized to one area of the face Frequently Sometimes Never
nightime urination,two times or more Frequently Sometimes Never
nightime leg cramps Frequently Sometimes Never
pain on opening your mouth widely Frequently Sometimes Never
ringing in your ears Frequently Sometimes Never
jaw locks in open position when opening mouth widely Frequently Sometimes Never
sloshing feeling in your sinuses when you change position from lying to sitting or standing Frequently Sometimes Never
green or yellow discharge when blowing your nose Frequently Sometimes Never
treated for sinusitus Frequently Sometimes Never
nasal congestion/stuffy nose Frequently Sometimes Never
post nasal drip Frequently Sometimes Never
temporary vision loss in one eye Frequently Sometimes Never
temporary hearing loss Frequently Sometimes Never
chills or night sweats Frequently Sometimes Never
jaw fatigue/or pain with prolonged chewing or talking Frequently Sometimes Never
periods of confusion Frequently Sometimes Never
temporary facial numbness Frequently Sometimes Never
epileptic seizure Frequently Sometimes Never
severe pain in your temple-sensitive to pressure Frequently Sometimes Never
temporary numbness in your face and arm at the same time Frequently Sometimes Never
temporary weakness on one side of your body Frequently Sometimes Never
temporary lack of coordination in an arm or leg Frequently Sometimes Never
temporary staggering or disequilbrium when walking Frequently Sometimes Never
temporary double vision Frequently Sometimes Never
temporary slurred speech Frequently Sometimes Never
temporary drooping of one side of your face Frequently Sometimes Never
black outs or syncope(fainting) Frequently Sometimes Never
have others seen you have periods of "glassy eyed" staring or "spaceouts" Frequently Sometimes Never
eye pain Frequently Sometimes Never
see halos around bright lights Frequently Sometimes Never
squinting to see well Frequently Sometimes Never
eye fatigue after reading fine print Frequently Sometimes Never
need glasses or magnifying lens to see fine print Frequently Sometimes Never
smoke cigarettes Frequently Sometimes Never
drink alcohol Frequently Sometimes Never
morning stiff neck Frequently Sometimes Never
The following questions are for FEMALES only ...
Are you, or do you experience the following
pregnant? Yes No
postmenopausal? Yes No
headaches occur only at the time of your menstrual period? Yes No
headaches occur at any time but are usually worse at the time of your menstrual period? Yes No
were you ever pregnant?(skip next question if 'no') Yes No
if yes; was your pregnancy associated with :
poor posture? Yes No
heavy breasts? Yes No
neck pain or stiffness? Yes No
pain between the shoulder blades? Yes No
aching shoulders? Yes No
headaches improve by lying down? Yes No
worsening of pain when bending forward? Yes No
Stress and Sleep Factors - Do you experience any of the following
(check all that apply) extreme stress dislike your job
health problems money problems
a lot on your mind excessive worry
excessive anxiety or apprehension mind goes blank
tense(feeling keyed up,on edge) sad or blue
thoughts of death or suicide increased muscle tension
feeling overwhelmed, helpless moody or irritable
poor self image or bad feelings about yourself low energy level
easily fatigued loss of interest in things you used to enjoy
change in appetite change in sex drive
intrusive,unwanted thought or worries restless-toss and turn
mind runs continuously when trying to sleep irritability if things are out of place,not right
repetitive activities-handwashing, ordering, checking,etc
Are you in a difficult situation-moving,job change, divorce? Yes No
Do you have any of the following symptoms of disturbed sleep?
insomnia
sleepy during the day
trouble with memory or concentration
drowsy while reading or driving
forget what you read
other people tell you that you snore
wake up choking or gasping
restless, uncomfortable legs when trying to sleep
other people tell you that you stop breathing while sleeping
frequent muscle aches and pains
do you ever have a strong urge to move your legs (like the need to scratch an itch)? Yes No
do you have intermittent, uncomfortable sensations in your legs, creepy-crawiling, itchy, pulling etc., relieved by movement ? Yes No
do you have the urge to move or stretch if inactive or sitting too long (bus, desk, or airplane)? Yes No
do your symptoms get worse in the evening, espcesially when you are lying down? Yes No
are your symptoms relieved, at least for a while, after moving? Yes No
constant tapping of feet or squirming when sitting? Yes No
The following is the start of a new headache type.
Vascular Headaches (Throbbing or Pulsatile Headaches) ...Migraine, Cluster or Transformed Migraine Type
If you experience throbbing or pulsatile headaches, please complete the following section.
At least 5 separate attacks of throbbing or pulsating headache severe enough to require that you stop or decrease your activities or take a medication Yes No
On average how long can your throbbing headache last if not treated?
How often do you get throbbing headaches?
If daily or almost daily, has the headache been present one month or more? Yes No
If yes to the above, over the last three months or more have you had increasingly frequent pulsating headaches that are less severe? Yes No
How many times per month does throbbing headache interfere with family activites or daily routine?
How many times per month does throbbing headache reduce work productivity by half or more?
How many times per month does throbbing headache cause you to miss work?
How many times per month does throbbing headache cause you to miss family, social or leisure activities?
On a scale of 1-10,rate how severe your worst throbbing headaches are (4=bothersome, but you can still do daily activities;7=so severe you have to stop what you are doing;10=the worst you can imagine, have to go to ER for help)?
How many times in the last three months have you called your doctor and/or gone to the ER because of throbbing headache?
Throbbing/Pulsatile Headache Questions Continued.
Does your headache pain have the following characteristics?
Triggered by a specific substance.
msg Yes No
nitrites(preservatives) Yes No
chocolate Yes No
alcohol(red wine especially) Yes No
estrogen(birth contol pills) Yes No
hormone replacement therapy Yes No
Usually moderate or severe in intensity? Yes No
During the headache do you experience:
Nausea and/or vomiting? Yes No
Sensitivity to bright light(bright light hurts your eyes)? Yes No
Loud noises are intolerable. Yes No
Hypersensitivity to smells(smells seem bad or bothersome). Yes No
Do your throbbing/pulsatile headaches have any of the following characteristics?
Unilateral(one sided)? Yes No
Aggravated by routine physical activity? Yes No
Worse at time of menstrual cycle (females only)? Yes No
Occur during sleep or upon awakening? Yes No
Relieved by sleep? Yes No
Cause a sick feeling all over (malaise)? Yes No
Cause a a desire to lie down in a dark,quiet place? Yes No
Feeling foggy, difficulty with crisp thinking? Yes No
Occur with dizziness or vertigo? Yes No
Headache pain can change from one side of the head to the other side with different attacks? Yes No
Are your throbbing/pulsatile headaches triggered or aggravated by?
sexual intercourse Yes No
by strenuous physical exertion Yes No
missing a meal Yes No
lack of sleep,too much sleep,excessive fatigue, post stress(weekends,vacations) Yes No
glare,flashing lights,fluorescent lighting,or odors Yes No
weather changes, especially low barometric pressure Yes No
alcohol Yes No
red wine Yes No
Before throbbing/pulsatile headaches come on do you experience:
irritability Yes No
elation Yes No
physical hyperactivity Yes No
yawning Yes No
food craving Yes No
increased bowel or bladder activity Yes No
mental or physical slowing Yes No
poor concentration Yes No
word finding difficulty Yes No
weakness or fatigue Yes No
poor appetite,bloating,constipation Yes No
Migraine Aura Questions
Do you have warning symptoms before your headache starts, e.g., seeing zig zag lines, feeling pins and needles or clumsiness (aura). Yes No
If yes, which ones? (check all that apply) blurring or loss of vision numbness or tingling in face,arm or one side of the body
double vision, clumsiness,staggering gait,slurred words trouble talking or finding words
weakness on one side of your body more than one aura occurring in succession
Cluster Headache
do you have severe throbbing/pulsatile headaches that occur at the same time every day or every night for days or weeks at a time? Yes No
Check all that apply do they usually go away after 3 hours or less? are they unilateral(one sided)?
can they awaken you from sleep? do they occur in the eye, behing the eye or in the temple?
Are they associated with (check all that apply): red bloodshot eyes swelling of half the face or eyelid
nasal stuffiness or runny nose cause you to pace around/restless
tearing(watering) of the eye
Vascular Headaches (Pulsatile/Throbbing) ... Transformed Migraine
do you have daily or almost daily throbbing headaches greater than 15 times per month that have been present for a month or longer? Yes No
over the last three months or more, have you had increasingly frequent pulsating headaches that are less severe or briefer? Yes No
Vascular Headache questions are concluded.
Tension Muscle Contraction Headache (Pressing/Tightening Pain) Chronic Tension, Tension Headache with Chronic Muscle Strain
If you experience pressing or tightening headaches(nonpulsatile), please complete the following section.
At least 10 attacks of pressing or tightening pain (non-pulsatile), usually affecting both sides of the head, as brief as 30 minutes or that can last 7 days or more Yes No
On average how long can your pressing or tightening headache last if not treated?
How often do you get pressing or tightening headache pain?
If daily or almost daily, has the headache been present for 6 months or more? Yes No
If "yes" to the above, have your headaches gradually increased in severity and duration over a period of 3 months or more? Yes No
How many times per month does pressing or tightening headache interfere with family activities or daily routine?
How many times per month does pressing or tightening headache reduce work productivity by half or more?
How many times per month does pressing or tightening headache cause you to miss work?
How many times per month does pressing or tightening headache cause you to miss social or leisure activity?
On a scale of 1-10,rate how severe your worst pressing or tightening headaches are (4=bothersome, but you can still do daily activities;7=so severe you have to stop what you are doing;10=the worst you can imagine, have to go to ER for help)?
How many times in the last three months have you called your doctor and/or gone to the ER because of pressing or tightening headache?
Please answer the following questions about your Muscle Contraction Headaches.
Does your headache pain have the following characteristics?
constant Yes No
dull,achy,pressing,tightening Yes No
bilateral-hurts all over Yes No
significantly aggravated by routine physical acitivity Yes No
significantly associated with nausea and vomiting Yes No
sensitivity to noise Yes No
sensitivity to light Yes No
can last 30 minutes to 7 days Yes No
mild to moderate severity Yes No
spreads out and tightens like a band Yes No
hurts worse in the morning on awakening Yes No
lessens in the afternoon or evening Yes No
Is your pressing or tightening headache pain associated with(check all that apply): musculoskeletal pain pain or tenderness to touch at the base of your skull
morning stiff neck shoulder pain and/or pain between your shoulder blades
aggravated by coughing,sneezing,straining aggravated by bending or twisting your neck and shoulders
aggravated by using a high pillow aggravated by carrying a heavy handbag,luggage or picking up a child
certain points on the scalp,face or neck are tender to the touch
These questions apply to Sleep Habits that may affect your Muscle Contraction Headaches
How many pillows do you use under your head when sleeping?
Do you ever fall asleep on a couch or a recliner? Yes No
Do you get up from sleep to urinate more than once? Yes No
Do you get cramps in your legs when sleeping? Yes No
Tension Headache questions are concluded.
If you have sharp, jabbing pain originating from nerves, please complete the following section. If not, you have completed the questionaire. Go to instructions at the end of this qustionnaire on printing and submitting your responses.
Headache Pain originating from Nerves (Sharp, Jabbing Pain) Trigeminal Neuralgia, Occipital Neuralgia, Scalp Neuroma.
Repetitive, sharp, jabbing pain in the head or face. Pains may be brief but always strike in the same place Yes No
Is the headache triggered by any kind of physical activity? Yes No
How long have you had sharp, jabbing pain?
How long does it take the sharp, jabbing pain to reach a maximum?
How many sharp, jabbing pains can occur in a day?
How often do sharp,jabbing pains occur?
How many times per month does sharp, jabbing pain interfere with family activities or daily routine?
How many times per month does sharp, jabbing pain reduce work productivity by half or more?
How many times per month does sharp, jabbing pain cause you to miss work?
How many times per month does sharp, jabbing pain cause you to miss family social or leisure activities?
On a scale of 1 - 10, rate how severe your worst headaches are: (4 = bothersome, but you can still do daily activities; 7 = so severe you have to stop what you are doing; 10 = the worst you can imagine.. go to the ER for help)
How many times in the last three months have you gone to the ER or called your doctor because of sharp,jabbing headaches?
Sharp, jabbing pains continued.
Does your face or head pain have the following characteristics?
Is the pain sudden and without warning? Yes No
Are there places or points you touch that trigger the pain? Yes No
if yes to the above question,check all that apply: face scalp
base of skull when chewing or swallowing
combing or brushing hair
If you have face pain (Trigeminal Neuralgia)
Do you ever have a sudden brief pain in the same spot in your face or mouth with a machine gun-like repetition? Yes No
Can people see you wince or jump with attacks? Yes No
Are pain jabs identical in sensation and intensity(stereotypic)? Yes No
No pain symptoms except during attacks? Yes No
If you have scalp pain (Scalp Neuroma)
Does combining or brushing your hair trigger the pain? Yes No
Have you ever hit your head or scalp at the place you now feel the pain? Yes No
If you have pain at the base of your skull (Occipital Neuralgia)
Does pressure on the back of your skull (i.e., resting your head on a pillow) trigger sharp pain or hurt the spot? Yes No
Does sudden twisting or bending of your neck trigger sharp pain or aggravate local soreness at the back of your head? Yes No
Can the pain spread from the back of your head over your scalp, ending above or behind the eye? Yes No
does the pain cause your eye to water or tear? Yes No

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