Chronic headaches- Questionnaire: Headache History
Here is a list of questions that will guide us choose the right neuromuscular treatment for you
- On a scale of 1-10 with “10” being the worst pain imaginable above the shoulders, how many mornings per week do you wake up with a “0” (zero)?
- On a scale of 1-10, what’s the average “number” you usually wake with?
- What % of your waking time do you have some degree of headache?
- What % of your waking time do you have a “0” (zero) without taking medications?
- What is your average headache pain level (1-10 scale) throughout the day?
- On a scale of 1-10, what is the worst pain level you experience?
- What time of day do you usually experience your worst headaches?
- How many times per week (or month) might you experience your worst pain?
- Where does your pain seem to originate from?
- How would you describe your pain? (Examples: throbbing, squeezing, pressure, dull, stabbing, shooting, etc.)
- Please circle the types of health care providers you’ve seen for your headaches. MD, Neurologiste, ENT, Internist, Physical Therapist, Chiropractor, Dentist, Others:
- What medical tests have been performed regarding your headaches? CT scan, MRI, Xray, Blood analysis, Other:
- What types of procedures or treatments (including dental) have you had (for headaches)?
- What medication(s) do you now take to prevent your headaches?
- What medications have you tried to prevent your headaches?
- What prescribed or over-the-counter medications do you take to relieve your headaches? (and how much)
Call us to book your consultation in order to discuss your results
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