ID

32672

Descripción

This ODM file contains the form for the subject diary. To be filled out throughout the study. Study ID: 101999 Clinical Study ID: 101999 Study Title: A randomized, double-blind, parallel group, placebo-controlled, single-attack evaluation of the efficacy and tolerability of TREXIMA™ (sumatriptan 85mg/naproxen sodium 500mg)* tablets vs placebo when administered during the mild pain phase of a migraine Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: sumatriptan Trade Name: Imitrex ,Imiject ,Imigran Study Indication: Migraine Disorders

Palabras clave

Versiones (3)
  1. 11/11/18 11/11/18 -
  2. 14/11/18 14/11/18 -
  3. 15/1/19 15/1/19 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

11 de noviembre de 2018

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0
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Efficacy and Tolerability of TREXIMA™ (sumatriptan 85mg/naproxen sodium 500mg) ID 101999

Inglés

Subject Diary

1 formularios  
  1. StudyEvent: ODM
    1. Subject Diary
Administrative Data
Descripción

Administrative Data

Alias
UMLS CUI-1
C1320722
Subject Identifier
Descripción

Subject Identifier

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Subject Diary Instructions
Descripción

Subject Diary Instructions

Alias
UMLS CUI-1
C3890583
UMLS CUI-2
C1442085
Reminder to Site Personnel
Descripción

Reminder to Site Personnel

Alias
UMLS CUI-1
C1709896
UMLS CUI-2
C2985654
Migraine Symptoms
Descripción

Migraine Symptoms

Alias
UMLS CUI-1
C0149931
UMLS CUI-2
C1457887
Enter the date your migraine headache pain started
Descripción

Enter the date your migraine headache pain started.

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C0018681
UMLS CUI [1,3]
C0332189
UMLS CUI [1,4]
C0808070
Enter the time your migraine headache pain started
Descripción

Enter the time your migraine headache pain started.

Tipo de datos

time

Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C0018681
UMLS CUI [1,3]
C0332189
UMLS CUI [1,4]
C1301880
Did you wake up with your migraine headache pain?
Descripción

Did you wake up with your migraine headache pain?

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0442696
UMLS CUI [1,2]
C0149931
UMLS CUI [1,3]
C0018681
From the time your migraine started until you took study drug, did you have any of the following symptoms? Aura
Descripción

Aura during migraine

Tipo de datos

text

Alias
UMLS CUI [1]
C0154723
From the time your migraine started until you took study drug, did you have any of the following symptoms? Pain worsened by routine physical activity
Descripción

Migraine pain worsened by routine physical activity

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C4054844
UMLS CUI [1,3]
C0149931
Which best describes the quality of your migraine headache pain? Tick only one:
Descripción

Quality of migraine headache pain

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C0018681
UMLS CUI [1,3]
C1148406
Which best describes the location of your migraine headache pain? Tick only one:
Descripción

Llocation of your migraine headache pain

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C0018681
UMLS CUI [1,3]
C0030193
UMLS CUI [1,4]
C0450429
Subject Reminder
Descripción

Subject Reminder

Alias
UMLS CUI-1
C0681850
UMLS CUI-2
C1709896
Date and Time Study Medication Taken
Descripción

Date and Time Study Medication Taken

Alias
UMLS CUI-1
C0011008
UMLS CUI-2
C0013227
UMLS CUI-3
C0040223
UMLS CUI-4
C0013227
Date study medication taken
Descripción

Date study medication taken

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0013227
Time study medication taken :
Descripción

Time study medication taken :

Tipo de datos

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0013227
Details of Migraine Headache Pain and Symptoms
Descripción

Details of Migraine Headache Pain and Symptoms

Alias
UMLS CUI-1
C0149931
UMLS CUI-2
C0018681
UMLS CUI-3
C0030193
UMLS CUI-4
C1457887
Planned Timepoint
Descripción

Planned Timepoint of Medication

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2348792
UMLS CUI [1,3]
C1301732
How severe is your migraine headache pain? Tick one at each timepoint:
Descripción

Severity of migraine headache pain

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C0018681
UMLS CUI [1,3]
C0439793
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Nausea
Descripción

Tick Yes or No for each symptom at each timepoint:

Tipo de datos

text

Alias
UMLS CUI [1]
C0027497
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Vomiting
Descripción

Tick Yes or No for each symptom at each timepoint:

Tipo de datos

text

Alias
UMLS CUI [1]
C0042963
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Light Sensitivity
Descripción

Tick Yes or No for each symptom at each timepoint:

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C0085636
Do you have any of the following symptoms? Sound Sensitivity
Descripción

Tick Yes or No for each symptom at each timepoint:

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2938899
UMLS CUI [1,2]
C0149931
Do you have any of the following symptoms? Neck Pain/Discomfort
Descripción

Tick Yes or No for each symptom at each timepoint:

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0863104
UMLS CUI [1,2]
C0149931
UMLS CUI [2,1]
C0007859
UMLS CUI [2,2]
C0149931
Do you have any of the following symptoms? Sinus (facial) Pain/Pressure
Descripción

Tick Yes or No for each symptom at each timepoint:

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0015468
UMLS CUI [1,2]
C0149931
UMLS CUI [2,1]
C0522251
UMLS CUI [2,2]
C0149931
ALLODYNIA QUESTIONNAIRE (Complete at time of dosing)
Descripción

ALLODYNIA QUESTIONNAIRE (Complete at time of dosing)

Alias
UMLS CUI-1
C0034394
UMLS CUI-2
C0458247
UMLS CUI-3
C0149931
UMLS CUI-4
C0439564
UMLS CUI-5
C3469597
Details of Work Ability
Descripción

Details of Work Ability

Alias
UMLS CUI-1
C4274891
Planned Relative Time
Descripción

Planned Relative Time

Tipo de datos

text

Alias
UMLS CUI [1]
C0439564
How do you rate your ability to work or perform your normal/usual activities?
Descripción

Tick one appropriate response at each timepoint:

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0441655
UMLS CUI [1,2]
C0085732
UMLS CUI [1,3]
C0149931
UMLS CUI [2,1]
C4274891
UMLS CUI [2,2]
C0149931
ALLODYNIA QUESTIONNAIRE (Complete 2 hours after dosing)
Descripción

ALLODYNIA QUESTIONNAIRE (Complete 2 hours after dosing)

Alias
UMLS CUI-1
C0034394
UMLS CUI-2
C0458247
UMLS CUI-3
C0149931
UMLS CUI-4
C0439564
UMLS CUI-5
C1548614
UMLS CUI-6
C3469597
Recurrence
Descripción

Recurrence

Alias
UMLS CUI-1
C0034897
If your migraine headache pain was NONE at 2 hours, did any pain return between 2 and 24 hours after first treating?
Descripción

Return of Pain after Treatment

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0034897
UMLS CUI [1,3]
C1882428
UMLS CUI [1,4]
C0149931
If Yes was ticked (any pain returned after migraine headache pain had been none at 2 hours), complete the following: Date your pain first returned
Descripción

Date of Migraine Headache Pain Recurrence

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0807712
UMLS CUI [1,2]
C0030193
UMLS CUI [1,3]
C0149931
If Yes was ticked (any pain returned after migraine headache pain had been none at 2 hours), complete the following: Time your pain first returned
Descripción

Time of Migraine Headache pain recurrence

Tipo de datos

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0034897
UMLS CUI [1,3]
C0030193
UMLS CUI [1,4]
C0149931
If Yes was ticked (any pain returned after migraine headache pain had been none at 2 hours), complete the following: How severe was your migraine headache pain at the time your pain first returned?
Descripción

Tick one:

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0034897
UMLS CUI [1,2]
C0030193
UMLS CUI [1,3]
C1507013
UMLS CUI [1,4]
C0149931
If your migraine headache pain was MILD or NONE at 2 hours, did MODERATE or SEVERE pain return up to 24 hours after treating?
Descripción

Recurrence of Moderate or Severe Migraine Headache Pain

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2957106
UMLS CUI [1,2]
C0034897
UMLS CUI [1,3]
C1882428
UMLS CUI [1,4]
C0149931
UMLS CUI [2,1]
C0278139
UMLS CUI [2,2]
C0018681
UMLS CUI [2,3]
C0034897
UMLS CUI [2,4]
C1882428
UMLS CUI [2,5]
C0149931
If Yes was ticked (moderate or severe headache pain returned after the migraine headache pain had been none or mild 2 hours), complete the following: Date your pain became MODERATE or SEVERE
Descripción

Date of Moderate or Severe Migraine Headache Pain Recurrence

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0807712
UMLS CUI [1,2]
C2957106
UMLS CUI [1,3]
C0149931
UMLS CUI [2,1]
C0807712
UMLS CUI [2,2]
C0278139
UMLS CUI [2,3]
C0018681
UMLS CUI [2,4]
C0149931
If Yes was ticked (moderate or severe headache pain returned after the migraine headache pain had been none or mild 2 hours), complete the following: How severe was your migraine headache pain at the time it became moderate or severe?
Descripción

Tick one:

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0034897
UMLS CUI [1,2]
C0030193
UMLS CUI [1,3]
C1507013
UMLS CUI [1,4]
C0149931
Medications Taken
Descripción

Medications Taken

Alias
UMLS CUI-1
C0013227
UMLS CUI-2
C0087111
Drug Name Record one medication per row:
Descripción

Drug Name

Tipo de datos

text

Alias
UMLS CUI [1]
C2360065
Date Taken
Descripción

Date Medication Taken

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0013227
Time Taken
Descripción

(24 hour clock)

Tipo de datos

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0013227
Primary Reason Medication Taken: Migraine Headache Pain
Descripción

Tick one to indicate migraine headache pain severity ONLY if you took this medication for migraine headache pain:

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C0018681
UMLS CUI [1,3]
C1507013
Primary Reason Medication Taken: Other Reason
Descripción

specify reason

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C3840932
Productivity
Descripción

Productivity

Alias
UMLS CUI-1
C0033269
Were you scheduled to do paid work during this migraine attack?
Descripción

Were you scheduled to do paid work during this migraine attack?

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C3846711
UMLS CUI [1,3]
C1571999
If you were scheduled to do paid work during this migraine attack, record the number of hours (to the nearest one-half hour) you were scheduled to do paid work during this migraine attack:
Descripción

Number of Hours Subject was Scheduled to Do Paid Work

Tipo de datos

float

Unidades de medida
  • Hours
Alias
UMLS CUI [1,1]
C1265611
UMLS CUI [1,2]
C0043227
UMLS CUI [1,3]
C1571999
Hours
Productivity: Affect of Migraine Attack on work and non-work related activities
Descripción

Productivity: Affect of Migraine Attack on work and non-work related activities

Alias
UMLS CUI-1
C0149931
UMLS CUI-2
C0026516
UMLS CUI-3
C0441655
Activity
Descripción

Activity

Tipo de datos

integer

Alias
UMLS CUI [1]
C0441655
Number of hours missed from doing activity due to migraine symptoms
Descripción

Zero = 00.0

Tipo de datos

float

Alias
UMLS CUI [1,1]
C0441655
UMLS CUI [1,2]
C0443288
UMLS CUI [1,3]
C1265611
UMLS CUI [1,4]
C0149931
Number of hours continued to do activity with migraine symptoms
Descripción

Number of hours continued to do activity with migraine symptoms

Tipo de datos

float

Alias
UMLS CUI [1,1]
C0441655
UMLS CUI [1,2]
C1314677
UMLS CUI [1,3]
C1265611
UMLS CUI [1,4]
C0149931
Estimate how effective you were, compared to your usual performance, while you continued to do activity with migraine symptoms
Descripción

If number of hours doing activity is 00.0, DO NOT COMPLETE. 100% = effective as usual

Tipo de datos

integer

Unidades de medida
  • %
Alias
UMLS CUI [1,1]
C0149931
UMLS CUI [1,2]
C1280519
%
PATIENT PERCEPTION OF MIGRAINE QUESTIONNAIRE - REVISED (PPMQ-R)
Descripción

PATIENT PERCEPTION OF MIGRAINE QUESTIONNAIRE - REVISED (PPMQ-R)

Alias
UMLS CUI-1
C0149931
UMLS CUI-2
C0030971
UMLS CUI-3
C0034394
Date of completion
Descripción

Date of Completion

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0850287
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Similar models

Subject Diary

1 formularios
  1. StudyEvent: ODM
    1. Subject Diary
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Subject Identifier
Item
Subject Identifier
text
C2348585 (UMLS CUI [1])
Item Group
Subject Diary Instructions
C3890583 (UMLS CUI-1)
C1442085 (UMLS CUI-2)
Item Group
Reminder to Site Personnel
C1709896 (UMLS CUI-1)
C2985654 (UMLS CUI-2)
Item Group
Migraine Symptoms
C0149931 (UMLS CUI-1)
C1457887 (UMLS CUI-2)
Date of migraine headache pain start
Item
Enter the date your migraine headache pain started
date
C0149931 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
C0332189 (UMLS CUI [1,3])
C0808070 (UMLS CUI [1,4])
Time of migraine headache pain start
Item
Enter the time your migraine headache pain started
time
C0149931 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
C0332189 (UMLS CUI [1,3])
C1301880 (UMLS CUI [1,4])
Item
Did you wake up with your migraine headache pain?
text
C0442696 (UMLS CUI [1,1])
C0149931 (UMLS CUI [1,2])
C0018681 (UMLS CUI [1,3])
Did you wake up with your migraine headache pain?
Code List
Did you wake up with your migraine headache pain?
CL Item
Yes (Y)
CL Item
No (N)
Item
From the time your migraine started until you took study drug, did you have any of the following symptoms? Aura
text
C0154723 (UMLS CUI [1])
Aura during migraine
Code List
From the time your migraine started until you took study drug, did you have any of the following symptoms? Aura
CL Item
Yes (Y)
CL Item
No (N)
Item
From the time your migraine started until you took study drug, did you have any of the following symptoms? Pain worsened by routine physical activity
text
C0018681 (UMLS CUI [1,1])
C4054844 (UMLS CUI [1,2])
C0149931 (UMLS CUI [1,3])
Migraine pain worsened by routine physical activity
Code List
From the time your migraine started until you took study drug, did you have any of the following symptoms? Pain worsened by routine physical activity
CL Item
Yes (Y)
CL Item
No (N)
Item
Which best describes the quality of your migraine headache pain? Tick only one:
integer
C0149931 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
C1148406 (UMLS CUI [1,3])
Quality of migraine headache pain
Code List
Which best describes the quality of your migraine headache pain? Tick only one:
CL Item
Pulsating, throbbing, or pounding headache pain (1)
CL Item
Pressure/tightening (2)
Item
Which best describes the location of your migraine headache pain? Tick only one:
text
C0149931 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
C0030193 (UMLS CUI [1,3])
C0450429 (UMLS CUI [1,4])
Llocation of your migraine headache pain
Code List
Which best describes the location of your migraine headache pain? Tick only one:
CL Item
Only on one side of head (1)
CL Item
On both sides of head (2)
Item Group
Subject Reminder
C0681850 (UMLS CUI-1)
C1709896 (UMLS CUI-2)
Item Group
Date and Time Study Medication Taken
C0011008 (UMLS CUI-1)
C0013227 (UMLS CUI-2)
C0040223 (UMLS CUI-3)
C0013227 (UMLS CUI-4)
Date study medication taken
Item
Date study medication taken
date
C0011008 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Time study medication taken :
Item
Time study medication taken :
time
C0040223 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Item Group
Details of Migraine Headache Pain and Symptoms
C0149931 (UMLS CUI-1)
C0018681 (UMLS CUI-2)
C0030193 (UMLS CUI-3)
C1457887 (UMLS CUI-4)
Item
Planned Timepoint
text
C0013227 (UMLS CUI [1,1])
C2348792 (UMLS CUI [1,2])
C1301732 (UMLS CUI [1,3])
Planned Timepoint
Code List
Planned Timepoint
CL Item
At time of dosing (At time of dosing)
CL Item
30 minutes after dose (30 minutes after dose)
CL Item
1 hour after dose (1 hour after dose)
CL Item
2 hours after dose (2 hours after dose)
CL Item
4 hours after dose (4 hours after dose)
Item
How severe is your migraine headache pain? Tick one at each timepoint:
integer
C0149931 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
C0439793 (UMLS CUI [1,3])
Severity of migraine headache pain
Code List
How severe is your migraine headache pain? Tick one at each timepoint:
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Nausea
text
C0027497 (UMLS CUI [1])
Nausea
Code List
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Nausea
CL Item
Yes (Y)
CL Item
No (N)
Item
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Vomiting
text
C0042963 (UMLS CUI [1])
Migraine Vomiting
Code List
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Vomiting
CL Item
Yes (Y)
CL Item
No (N)
Item
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Light Sensitivity
text
C0149931 (UMLS CUI [1,1])
C0085636 (UMLS CUI [1,2])
Light Sensitivity during Migraine
Code List
Do you have any of the following symptoms? Tick Yes or No for each symptom at each timepoint: Light Sensitivity
CL Item
Yes (Y)
CL Item
No (N)
Item
Do you have any of the following symptoms? Sound Sensitivity
text
C2938899 (UMLS CUI [1,1])
C0149931 (UMLS CUI [1,2])
Sound Sensitivity during Migraine
Code List
Do you have any of the following symptoms? Sound Sensitivity
CL Item
Yes (Y)
CL Item
No (N)
Item
Do you have any of the following symptoms? Neck Pain/Discomfort
text
C0863104 (UMLS CUI [1,1])
C0149931 (UMLS CUI [1,2])
C0007859 (UMLS CUI [2,1])
C0149931 (UMLS CUI [2,2])
Neck Pain/ Discomfort during Migraine
Code List
Do you have any of the following symptoms? Neck Pain/Discomfort
CL Item
Yes (Y)
CL Item
No (N)
Item
Do you have any of the following symptoms? Sinus (facial) Pain/Pressure
text
C0015468 (UMLS CUI [1,1])
C0149931 (UMLS CUI [1,2])
C0522251 (UMLS CUI [2,1])
C0149931 (UMLS CUI [2,2])
Sinus (facial) Pain/Pressure during Migraine
Code List
Do you have any of the following symptoms? Sinus (facial) Pain/Pressure
CL Item
Yes (Y)
CL Item
No (N)
Item Group
ALLODYNIA QUESTIONNAIRE (Complete at time of dosing)
C0034394 (UMLS CUI-1)
C0458247 (UMLS CUI-2)
C0149931 (UMLS CUI-3)
C0439564 (UMLS CUI-4)
C3469597 (UMLS CUI-5)
Item Group
Details of Work Ability
C4274891 (UMLS CUI-1)
Item
Planned Relative Time
text
C0439564 (UMLS CUI [1])
Planned Relative Time
Code List
Planned Relative Time
CL Item
At time of dosing (At time of dosing)
CL Item
2 hours after dose (2 hours after dose)
CL Item
4 hours after dose (4 hours after dose)
Item
How do you rate your ability to work or perform your normal/usual activities?
integer
C0441655 (UMLS CUI [1,1])
C0085732 (UMLS CUI [1,2])
C0149931 (UMLS CUI [1,3])
C4274891 (UMLS CUI [2,1])
C0149931 (UMLS CUI [2,2])
Ability to work or perform usual activities
Code List
How do you rate your ability to work or perform your normal/usual activities?
CL Item
Normal (0)
CL Item
Mildly Impaired (1)
CL Item
Moderately Impaired (2)
CL Item
Severely Impaired (3)
CL Item
Required Bedrest (4)
Item Group
ALLODYNIA QUESTIONNAIRE (Complete 2 hours after dosing)
C0034394 (UMLS CUI-1)
C0458247 (UMLS CUI-2)
C0149931 (UMLS CUI-3)
C0439564 (UMLS CUI-4)
C1548614 (UMLS CUI-5)
C3469597 (UMLS CUI-6)
Item Group
Recurrence
C0034897 (UMLS CUI-1)
Item
If your migraine headache pain was NONE at 2 hours, did any pain return between 2 and 24 hours after first treating?
text
C0030193 (UMLS CUI [1,1])
C0034897 (UMLS CUI [1,2])
C1882428 (UMLS CUI [1,3])
C0149931 (UMLS CUI [1,4])
Return of Pain after Treatment
Code List
If your migraine headache pain was NONE at 2 hours, did any pain return between 2 and 24 hours after first treating?
CL Item
Yes (Y)
CL Item
No (N)
Date of Migraine Headache Pain Recurrence
Item
If Yes was ticked (any pain returned after migraine headache pain had been none at 2 hours), complete the following: Date your pain first returned
date
C0807712 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
C0149931 (UMLS CUI [1,3])
Time of Migraine Headache pain recurrence
Item
If Yes was ticked (any pain returned after migraine headache pain had been none at 2 hours), complete the following: Time your pain first returned
time
C0040223 (UMLS CUI [1,1])
C0034897 (UMLS CUI [1,2])
C0030193 (UMLS CUI [1,3])
C0149931 (UMLS CUI [1,4])
Item
If Yes was ticked (any pain returned after migraine headache pain had been none at 2 hours), complete the following: How severe was your migraine headache pain at the time your pain first returned?
integer
C0034897 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
C1507013 (UMLS CUI [1,3])
C0149931 (UMLS CUI [1,4])
undefined item
Code List
If Yes was ticked (any pain returned after migraine headache pain had been none at 2 hours), complete the following: How severe was your migraine headache pain at the time your pain first returned?
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
If your migraine headache pain was MILD or NONE at 2 hours, did MODERATE or SEVERE pain return up to 24 hours after treating?
text
C2957106 (UMLS CUI [1,1])
C0034897 (UMLS CUI [1,2])
C1882428 (UMLS CUI [1,3])
C0149931 (UMLS CUI [1,4])
C0278139 (UMLS CUI [2,1])
C0018681 (UMLS CUI [2,2])
C0034897 (UMLS CUI [2,3])
C1882428 (UMLS CUI [2,4])
C0149931 (UMLS CUI [2,5])
Recurrence of Moderate or Severe Migraine Headache Pain
Code List
If your migraine headache pain was MILD or NONE at 2 hours, did MODERATE or SEVERE pain return up to 24 hours after treating?
CL Item
Yes (Y)
CL Item
No (N)
Date of Moderate or Severe Migraine Headache Pain Recurrence
Item
If Yes was ticked (moderate or severe headache pain returned after the migraine headache pain had been none or mild 2 hours), complete the following: Date your pain became MODERATE or SEVERE
date
C0807712 (UMLS CUI [1,1])
C2957106 (UMLS CUI [1,2])
C0149931 (UMLS CUI [1,3])
C0807712 (UMLS CUI [2,1])
C0278139 (UMLS CUI [2,2])
C0018681 (UMLS CUI [2,3])
C0149931 (UMLS CUI [2,4])
Item
If Yes was ticked (moderate or severe headache pain returned after the migraine headache pain had been none or mild 2 hours), complete the following: How severe was your migraine headache pain at the time it became moderate or severe?
integer
C0034897 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
C1507013 (UMLS CUI [1,3])
C0149931 (UMLS CUI [1,4])
undefined item
Code List
If Yes was ticked (moderate or severe headache pain returned after the migraine headache pain had been none or mild 2 hours), complete the following: How severe was your migraine headache pain at the time it became moderate or severe?
CL Item
Moderate (1)
CL Item
Severe (2)
Item Group
Medications Taken
C0013227 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
Drug Name
Item
Drug Name Record one medication per row:
text
C2360065 (UMLS CUI [1])
Date Medication Taken
Item
Date Taken
date
C0011008 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Time Medication Taken
Item
Time Taken
time
C0040223 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Item
Primary Reason Medication Taken: Migraine Headache Pain
text
C0149931 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
C1507013 (UMLS CUI [1,3])
Migraine Headache Pain Severity
Code List
Primary Reason Medication Taken: Migraine Headache Pain
CL Item
Mild Migraine Headache Pain (1)
CL Item
Moderate Migraine Headache Pain (2)
CL Item
Severe Migraine Headache Pain (3)
Other Reason for Medication
Item
Primary Reason Medication Taken: Other Reason
text
C0013227 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
Item Group
Productivity
C0033269 (UMLS CUI-1)
Item
Were you scheduled to do paid work during this migraine attack?
text
C0149931 (UMLS CUI [1,1])
C3846711 (UMLS CUI [1,2])
C1571999 (UMLS CUI [1,3])
Were you scheduled to do paid work during this migraine attack?
Code List
Were you scheduled to do paid work during this migraine attack?
CL Item
Yes (Y)
CL Item
No (N)
Number of Hours Subject was Scheduled to Do Paid Work
Item
If you were scheduled to do paid work during this migraine attack, record the number of hours (to the nearest one-half hour) you were scheduled to do paid work during this migraine attack:
float
C1265611 (UMLS CUI [1,1])
C0043227 (UMLS CUI [1,2])
C1571999 (UMLS CUI [1,3])
Item Group
Productivity: Affect of Migraine Attack on work and non-work related activities
C0149931 (UMLS CUI-1)
C0026516 (UMLS CUI-2)
C0441655 (UMLS CUI-3)
Item
Activity
integer
C0441655 (UMLS CUI [1])
Activity
Code List
Activity
CL Item
Paid work activities. (Complete this row only if you were scheduled to do paid work during this attack.) (1.)
CL Item
Activities outside your paid work. (e.g., leisure activities, household chores/tasks, family/social activities, etc.) (2.)
Number of hours missed from doing activity due to migraine symptoms
Item
Number of hours missed from doing activity due to migraine symptoms
float
C0441655 (UMLS CUI [1,1])
C0443288 (UMLS CUI [1,2])
C1265611 (UMLS CUI [1,3])
C0149931 (UMLS CUI [1,4])
Number of hours continued to do activity with migraine symptoms
Item
Number of hours continued to do activity with migraine symptoms
float
C0441655 (UMLS CUI [1,1])
C1314677 (UMLS CUI [1,2])
C1265611 (UMLS CUI [1,3])
C0149931 (UMLS CUI [1,4])
Estimation of Effectiveness with Migraine Symptoms
Item
Estimate how effective you were, compared to your usual performance, while you continued to do activity with migraine symptoms
integer
C0149931 (UMLS CUI [1,1])
C1280519 (UMLS CUI [1,2])
Item Group
PATIENT PERCEPTION OF MIGRAINE QUESTIONNAIRE - REVISED (PPMQ-R)
C0149931 (UMLS CUI-1)
C0030971 (UMLS CUI-2)
C0034394 (UMLS CUI-3)
Date of Completion
Item
Date of completion
date
C0011008 (UMLS CUI [1,1])
C0850287 (UMLS CUI [1,2])
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