Table 6.
1. Do you suffer from cold hands or feet (possibly also in the summer) or have other people ever told you that your hands are cold? | |
2. Do you feel cold when you sit down quietly for some time or when you are not moving? | |
3. Do you have or have you ever had a low blood pressure? | |
4. Do you ever feel dizzy when you suddenly stand up from a lying down (or resting) position? | |
5. Do you need a relatively long time to fall asleep (e.g., when you are cold)? | |
6. How is your feeling of thirst? | |
7. How often do you have a headache? | |
8. In case you suffer from migraines, do you have accompanying symptoms (e.g., visual disturbances, transient altered sensation [e.g., itching] in your arms or in your legs etc.?) | |
9. If you have to take medications (other than painkillers), do you have the feeling that you react strongly to them and/or that you would feel better if you would take a lower dose than that which is normally prescribed? | |
10. Do you suffer from any type of pain (for which you would have to take pain killers)? | |
11. How well can you smell? Can you smell things that other people do not smell or that others smell to a lesser extent? | |
12. Please mark the following: At 20–30 years of age, I was …(slim, normal, overweight) | |
13. If you had to judge yourself (e.g., in your work), would you say that you are particularly reliable with a tendency towards perfectionism? | |
14. Have you had phases in your life in which you had ringing in your ear (tinnitus)? | |
15. Have you noticed reversible blotches (white or red) on your skin when you were excited or angry (e.g., during stress)? |
Reprinted with the courtesy of Prof. Josef Flammer, University of Basel Eye Hospital, Switzerland