1 |
Sex |
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2 |
How old were you when the headache occurred for the first time? |
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3 |
How often do you have headache attacks? |
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4 |
How long do the headache attacks last? |
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5 |
Where is the headache located? |
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6 |
How intense is the pain? |
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7 |
What is the quality of the pain you experience? |
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8 |
Do your headaches worsen after physical activities such as walking? |
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9 |
Do you avoid routine physical activities because you fear they might trigger your headache? |
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10 |
Are the headaches accompanied by? a) Nausea |
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11 |
Are the headaches accompanied by? b) Vomiting |
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12 |
Are the headaches accompanied by? c) Photophobia |
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13 |
Are the headaches accompanied by? d) Phonophobia |
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14 |
Do you have temporary visual, sensory or speech disturbance? |
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15 |
Do you, during a headache attack, have tension and/or heightened tenderness of head or neck muscles? |
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TTH |
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16 |
Do you have any body numbness or weakness? |
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17 |
Do you have any indications of oncoming headache? |
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18 |
Headache is usually triggered by: Menstrual periods |
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19 |
In the half or my visual field, lasting 5 minutes to an hour, along with the headache attack or an hour before. |
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20 |
Along with the headache attack or an hour before one I have sensory symptoms. |
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