Date Data collected
Item
Data collected date (m m/dd/yyyy):
date
C0011008 (UMLS CUI [1,1])
C4019276 (UMLS CUI [1,2])
Item
Does the participant/subject suffer from headaches?
integer
C0018681 (UMLS CUI [1])
Code List
Does the participant/subject suffer from headaches?
Item
If the participant/subject suffers from headaches, describe the typical pain severity:
integer
C0018681 (UMLS CUI [1])
Code List
If the participant/subject suffers from headaches, describe the typical pain severity:
CL Item
Mild (Most of the time I can ignore my headache and continue what I am doing) (1)
CL Item
Moderate (My headache makes concentration difficult, but I can perform undemanding tasks) (2)
CL Item
Severe (I cannot concentrate nor do much of anything) (3)
Item
If the participant/subject suffers from severe headaches, which of the following best describes how the participant/subject is usually affected?
integer
C0018681 (UMLS CUI [1])
Code List
If the participant/subject suffers from severe headaches, which of the following best describes how the participant/subject is usually affected?
CL Item
Able to work/function normally (1)
CL Item
Working ability or activity impaired to some degree (2)
CL Item
Working ability or activity severely impaired (3)
CL Item
Bed rest required (4)
VAS Headache
Item
Rate your typical pain on a scale of 0 - 10 (“0” = no pain & “10” = the worst pain):
integer
C2732809 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
Item
When the participant/subject has a headache, does he/she experience Nausea?
integer
C0018681 (UMLS CUI [1])
C0027497 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience Nausea?
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience Vomiting
integer
C0018681 (UMLS CUI [1])
C0042963 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience Vomiting
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience Dizziness
integer
C0018681 (UMLS CUI [1])
C0042571 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience Dizziness
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience Vertigo
integer
C0018681 (UMLS CUI [1])
C0012833 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience Vertigo
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience Nonvertigo
integer
C0018681 (UMLS CUI [1])
C0012833 (UMLS CUI [2,1])
C0026603 (UMLS CUI [2,2])
Code List
When the participant/subject has a headache, does he/she experience Nonvertigo
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience Increased neck pain or stiffness
integer
C0018681 (UMLS CUI [1])
C0007859 (UMLS CUI [2,1])
C0151315 (UMLS CUI [2,2])
Code List
When the participant/subject has a headache, does he/she experience Increased neck pain or stiffness
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience Increased sensitivity to light
integer
C0018681 (UMLS CUI [1])
C0085636 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience Increased sensitivity to light
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience Increased sensitivity to noise
integer
C0018681 (UMLS CUI [1])
C3843207 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience Increased sensitivity to noise
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience Increased sensitivity to smell
integer
C0018681 (UMLS CUI [1])
C0234259 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience Increased sensitivity to smell
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience pain made worse by routine physical activity
integer
C0018681 (UMLS CUI [1])
C4054844 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience pain made worse by routine physical activity
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience pain on one side of head only
integer
C0018681 (UMLS CUI [1])
C0877781 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience pain on one side of head only
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience pulsating/throbbing headaches
integer
C0018681 (UMLS CUI [1])
C3843209 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience pulsating/throbbing headaches
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience weakness on one side
integer
C0018681 (UMLS CUI [1])
C2203001 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience weakness on one side
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience seeing shimmering lights, lines, dark spots, other shapes or colors before the eyes, before or during the headache and lasts more than a few minutes but less than an hour
integer
C0018681 (UMLS CUI [1])
C0422943 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience seeing shimmering lights, lines, dark spots, other shapes or colors before the eyes, before or during the headache and lasts more than a few minutes but less than an hour
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
When the participant/subject has a headache, does he/she experience one-sided numbness of lips, tongue, fingers, or legs that migrates or moves and starts before the headache becomes severe and lasts less than an hour
integer
C0018681 (UMLS CUI [1])
C3843205 (UMLS CUI [2])
Code List
When the participant/subject has a headache, does he/she experience one-sided numbness of lips, tongue, fingers, or legs that migrates or moves and starts before the headache becomes severe and lasts less than an hour
CL Item
2 Less than half the time (3)
CL Item
3 Half the time or more (4)
Item
On average, how many days per month has the participant/subject had headaches in the past 3 months (based on a 30 day month)?
integer
C0018681 (UMLS CUI [1,1])
C0556971 (UMLS CUI [1,2])
Code List
On average, how many days per month has the participant/subject had headaches in the past 3 months (based on a 30 day month)?
CL Item
0-4 days per month (1)
CL Item
5-9 days per month (2)
CL Item
10-14 days per month (3)
CL Item
15-19 days per month (4)
CL Item
>24 days per month (5)
CL Item
Continuous/nearly continuous (essentially no headache-free time) (6)
Headache days per month
Item
Actual average number of days per month the participant/subject had headaches in the past 3 months (numeric value between 0 and 30)
integer
C0018681 (UMLS CUI [1,1])
C0556971 (UMLS CUI [1,2])
Headache days per month
Item
Does this recent 3 month frequency represent a change compared to the prior 3 months?
boolean
C0018681 (UMLS CUI [1,1])
C0556971 (UMLS CUI [1,2])
Item
Does this recent 3 month frequency represent a change compared to the prior 3 months? If yes, specify change:
integer
C0018681 (UMLS CUI [1,1])
C0556971 (UMLS CUI [1,2])
Code List
Does this recent 3 month frequency represent a change compared to the prior 3 months? If yes, specify change: