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your email address: Please fill in your exact email address. Otherwise I cannot anwer.
your initials:
your age: years
gender: m w
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? acute, never had such a thing in my life less than three months between three months and a year since mor than a year since when I was a teenager or earlier
Where does your headache start normally ? forehead temples neck or back of the head unilateral, side may change at one and practically ever on the same side in the face
When does your headache start usually? in the morning, gets better during the day in the second half of the day, getting worse at night so that I wake up when doing sport or physical exercise when having stress or when getting upset or angry when making sex
Is your headache boring pulsating burning like a constant compression my scalp aches so that I cannot touch it like electric current
Symptoms that go along with your headache? none Sometimes I get sick and I even have to throw up I can't stand light and noise my partner can see that I have a headache I get pale I get red in the face (eventually only on one side) I sweat (eventually only at one spot of the head) my eye becomes smaller at the side of the headache My nose is congested or runs on the side of the headache I'm getting dizzy I'm getting a numb sensation in my hands or feet or in my tongue I'm getting a cold nose or cold hands or feet I'm getting weak I cannot speak well I see white or colored lights I see bright or dark zig zag lines I see dark spots, eventually pulsating I am craving for chocolate I get moody I get tired I get agitated I faint
The following can trigger my headache or make it worse: not enough sleep too much sleep weekend menstruation physical exercise hunger or fasting small amounts of alcohol, especially red wine Special kind of food smells noise crowds
The following can make my headache better: going to sleep Running about and touching, holding or even banging my head Putting a cold pack on the neck or forehead Putting a warm or hot pack on the neck or taking a hot bath Having a drink and relax Drinking coffee
How long does your headache last? Only a few seconds, like an exploding flash Only a few seconds, like an exploding flash 10 Minutes to 2 hours, then fading away Three hours until three days Days and days
How often do you suffer from your headache? Only a few times per year About once or twice a month Every week or more Mostly at weekends Practically every day Every day or night, usually at the same hour, and lasting a period of some weeks. Such a period may occur from once in some years to some times in a year.
What medication do you take? none Aspirin or the like Combination with Ergotamines I use a constant medical treatment to prevent my headache
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:
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