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. 2022 Jan 19;43(6):3811–3822. doi: 10.1007/s10072-021-05831-w

Table 1.

Headache questionnaire sheet

Questions Answers
1. Age (  ) y.o
2. Sex Man or Woman
3. In these three months, how many days per month does your headache occur? (  ) days/month
4. Does your headache have the following characteristics?
  4–1. unilateral location Yes or No
  4–2. pulsating quality Yes or No
  4–3. moderate or severe pain intensity Yes or No
  4–4. aggravation by or causing avoidance of routine physical activity Yes or No
  4–5. nausea and/or vomiting OR photophobia and phonophobia Yes or No
5. How long does your headache last? (  ) hrs or days
6–1. What do you use for headaches as acute medication? (free answer)
6–2. How many days per month do you use such acute medication? (  ) days/month
7–1. Do you use prophylactic medication for headaches? Yes or No
7–2. What prophylactic medication do you use? (free answer)

Valid responses were those that filled in all the items in the questionnaire sheet. People who could not understand the questionnaire due to dementia, psychiatric disorder, and mental retardation and who indicated that they did not want to participate in this study were excluded. The questionnaire sheets with one or more blank answers were also excluded from this study