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(press ctrl+left mouse click when submitting more that one item)

your email address:
Please fill in your exact email address. Otherwise I cannot anwer.

your initials: 

your age: years

gender: m 

do you have only one or several types if headache (please fill in one questionnaire for every type)

Since when do you have a headache problem? 

Where does your headache start normally ? 

When does your headache start usually?

Is your headache

Symptoms that go along with your headache?

The following can trigger my headache or make it worse:

The following can make my headache better:

How long does your headache last?

How often do you suffer from your headache?

What medication do you take?

Are you otherwise in good health, besides your headache problem? yesno

Do you take oral anticonzeptives? ja no

Do you take other medication regularly ja no 

If yes, what?

Your special, personal and confidential question:



common headache | common migraine | classical migraine | cluster headache | spondylogenic headache | traumatic headache | trigeminal neuralgia | others | please ask me | Links