InItIal HeadacHe QuestIonnaIre: (CHECK ANSWERS BELOW)
InItIal HeadacHe QuestIonnaIre: (CHECK ANSWERS BELOW) Please COMPLETE and bring with you to the first visit. Please answer all questions to the best of your ability. ... Retrieve Here
Headache Questionnaire - Pih-mpls.com
Headache Questionnaire Name of patient _____ Date _____ Date of Birth _____ Person completing questionnaire _____ Relationship _____ 1. How long have you been having headaches? _____ 2. Is the Abdominal Pain Yes No Dizziness Yes No ... View Doc
Neurological Disorder - Wikipedia, The Free Encyclopedia
Migraines and other types of Headache such as Cluster Headache and Tension Headache; Lower back and neck pain (see Back pain) or other type of structured interview or questionnaire process. At the present time, neuroimaging (brain scans) ... Read Article
HEADACHE QUESTIONNAIRE - Ollis Chiropractic
HEADACHE QUESTIONNAIRE PLEASE READ: This questionnaire is designed to enable us to understand how much your neck pain has affected your ability to ... Fetch This Document
Headache Questionnaire 2010 - ENT Of Georgia
Headache Questionnaire How do you rate the severity of your headaches on a scale of 1 to 5? 1 = the least pain ever felt 3 5 = the worst pain ever felt ... Document Retrieval
HEADACHE DISABILITY INDEX - Tranquility Chiropractic
HEADACHE DISABILITY INDEX Patient Name _____ Date _____ INSTRUCTIONS: Please CIRCLE the correct response: 1. I have headache: (1 The Henry Ford Hospital headache disability inventory (HDI). Neurology 1994;44:837-842. Title: Form.PDF Author: ... Fetch Content
Medical History - Wikipedia, The Free Encyclopedia
Nervous system (Headache, loss of consciousness, dizziness and vertigo, speech and related functions like reading and writing skills and memory). Musculoskeletal system (any bone or joint pain accompanied by joint swelling or tenderness, ... Read Article
Overcome Headaches Naturally Unknown Headache Secret - YouTube
Http://bit.ly/1hsD8DW Overcome Headaches Naturally Unknown Headache Secret headaches headache tension type cluster migrain migraine sinus migran what causes remedies treatment relief severe sinusitis types of stress cancer bad constant medicine chronic ice pick massive cervicogenic ... View Video
SWEDISH PAIN AND HEADACHE CENTER INITIAL QUESTIONNAIRE
SWEDISH PAIN AND HEADACHE CENTER INITIAL QUESTIONNAIRE Name Today’s Date Date of Birth Please list your main areas of pain, how long you have had pain in each area and how severe the pain is on average (EX: low ... Access Content
Headache Questionnaire - Djmwellness.com
Headache Questionnaire . Name: _____ Date: _____ Check the statements that apply to you: 1. I have a headache right now. 2. I have taken medication My pain gets wose when lying down and improves by being upright.r ... View Full Source
Pelvic Pain Questionnaire - Mercy
Pelvic Pain Questionnaire Chronic Headache/ Migraine TMJ (Jaw) Pain Chronic Back pain Fibromyalgia Interstitial Cystitis (Bladder Pain Syndrome) Irritable Bowel Syndrome (IBS) Chronic Fatigue Syndrome Autoimmune Disease (Lupus, Rheumatoid Arthritis, Sjogren’s Disease, etc.) ... View Document
HIT-6 Headache Impact Test - Neurohealth
Tool.This questionnaire was designed to help you describe and communicate the When you have headaches, how often is the pain severe? never rarely sometimes very often always How often do headaches limit your ability to do HIT-6™ Headache Impact Test To score, add points for answers ... Retrieve Content
Midas Headache Questionnaire - Kaiser Permanente
(where 0 = no pain at all, and 10 = pain as bad as it can be) *** Make sure you entered the date above when you completed this survey! DSA – My Doctor Online – Department of Neurology Last updated – 11/19/13 : Midas Headache Questionnaire ... Fetch Document
7 Home Remedies For headaches - YouTube
7 home remedies for headaches a headache acidity headache acupressure for headaches acupressure headache acupuncture for headaches acupuncture for migraines ... View Video
Follow-up Visit Questionnaire - UTSW Medicine
UT Southwestern Headache and Facial Pain Disorders Program Follow-up Visit Questionnaire Name Date Date of Birth Your typical headache Since initial visit c Much Better c Better c Same c Worse Comments ... Return Document
NAME DATE Headache Questionnaire
Headache Questionnaire – page 3 9. Does rest or sleep relieve or stop your headache: YES NO 10. Do any of the following physical activities trigger a headache, head ... Retrieve Document
Www.headachenetwork.ca Headache Pain Scale Interpretation
Headache Pain Scale Interpretation *Please use this information as a reference when completing your headache diaries. 10 Extreme pain; unable to function; worst pain imaginable; bed rest likely ... Read Document
Symptoms And Quality Of Life After Military Brain Injury -- Research Update From Journal Of Head Trauma Rehabilitation
( Wolters Kluwer Health ) New research shows four distinct patterns of symptoms after mild traumatic brain injury in military service members, and validates a new tool for assessing the quality-of-life impact of TBI. The studies appear in the January-February issue of The Journal of Head Trauma Rehabilitation (JHTR), an annual special issue devoted to TBI in the military. The official journal of ... Read News
Www.ferrellwhited.com
NAME: HEADACHE DISABILITY INDEX (52) DATE: AGE: SCORES TOTAL: (100) (48) INSTRUCTIONS: Please CIRCLE the correct response: I have headache: [1) I per month [2) more than but less than 4 per month [31 more than one per week. ... Read Document
HEADACHE DISABILITY INDEX - Billerica Chiropractic Office
HEADACHE DISABILITY INDEX NAME: _____ D ATE: _____ A GE: ____ S CORES TOTAL: ____; E____; F____ (100) (52) (48) INSTRUCTIONS: Please CIRCLE the correct response: 1. I have headache: [1] 1 per month [2] more than but less than 4 per month [3] more than one per week. 2. My headache is ... Document Retrieval
Headache Questionnaire - Gwdocs.com
DEPARTMENT OF NEUROLOGY – GWU. HEADACHE QUESTIONAIRE 6.15.09 2 12. Does the pain usually change with any of the following? ... Read Content
The Craniofacial Pain, Headache And Sleep Center Headache ...
The Craniofacial Pain, Headache and Sleep Center Headache Questionnaire Patient Name: _____ Date: _____ Age of onset of headache: Circumstances around the onset of headache: Recent change in headache: Present Frequency of headaches: (per ... Get Content Here
Migraine Disability Assessment (MIDAS) Questionnaire
The Migraine Disability Assessment (MIDAS) questionnaire was developed to measure the effect migraine headaches have on your daily function. It tries to determine how many days of your life were affected to the point that you were unable to function in a way to which you are accustomed. ... Read Article
MIGRAINE/HEADACHE QUESTIONNAIRE - Pain Medicine
Maia U. Chakerian, MD Board Certified Specialist in Pain Medicine 10) MEDICATIONS AND TREATMENTS: a) Please list all current medications that you take for migraine headaches. ... Read Here
No comments:
Post a Comment