ID

36222

Description

NINDS Common Data Elements (Headache Mail Questionnaire) Used from the National Institute of Neurological Disorders and Stroke Common Data Elements (https://www.commondataelements.ninds.nih.gov/) References: Grinnon ST, Miller K, Marler JR, Lu Y, Stout A, Odenkirchen J, Kunitz S. National Institute of Neurological Disorders and Stroke Common Data Element Project - approach and methods. Clin Trials. 2012;9(3):322-9.

Link

https://www.commondataelements.ninds.nih.gov/

Keywords

Versions (2)
  1. 9/27/17 9/27/17 -
  2. 4/23/19 4/23/19 - Sarah Riepenhausen
Copyright Holder

National Institute of Neurological Disorders and Stroke Common Data Element Project

Uploaded on

April 23, 2019

DOI

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License

Creative Commons BY-NC 3.0
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NINDS CDE Headache Mail Questionnaire

English

Headache Mail Questionnaire

1 forms  
Headache Mail Questionnaire
Description

Headache Mail Questionnaire

In the past year, have you had at least one headache that WAS NOT caused by a head injury, hangover or an illness such as a cold or the flu?
Description

Headache

Data type

boolean

Alias
UMLS CUI [1]
C0018681
On how many days in the last 3 months did you have a headache, if a headache lasted more than 1 day, count each day?
Description

Write In Number Of Days

Data type

integer

Measurement units
  • Days
Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0449238
Days
Because of your headaches, on how many days in the last 3 months was your productivity at work or school reduced by half or more?
Description

Productivity decrease

Data type

integer

Measurement units
  • Days
Alias
UMLS CUI [1]
C1821718
Days
Because of your headaches, on how many days in the last 3 months was your productivity in household work reduced by half or more?
Description

Productivity decrease in ADL

Data type

integer

Measurement units
  • Days
Alias
UMLS CUI [1,1]
C1821718
UMLS CUI [1,2]
C0001288
Days
On a scale of 0-10 (where 0 = no pain at all and 10 = pain as bad as it can be), on average how painful were these headaches?
Description

VAS Headache

Data type

integer

Alias
UMLS CUI [1,1]
C2732809
UMLS CUI [1,2]
C0018681
Number In Past Month of Most severe type of headache
Description

Please consider the different types of headache you may have. Please enter the number of headaches you have had in the past month, and in the past 12 months, for each type of headache listed below. If you just have one type, please enter a “0” when asked about the second type and other types of headache

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Number In Past Month of Most severe type of headache
Description

Please consider the different types of headache you may have. Please enter the number of headaches you have had in the past month, and in the past 12 months, for each type of headache listed below. If you just have one type, please enter a “0” when asked about the second type and other types of headache

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
When was the last time you had a headache? # of months ago:
Description

Headache

Data type

integer

Alias
UMLS CUI [1]
C0018681
How many different types of headache do you have? Specify number of headache types:
Description

By type of headache we mean headaches that may differ in how they begin or the location of the pain, not necessarily pain severity

Data type

integer

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C0018681
Number In Past 12 Month of Most severe type of headache
Description

Please consider the different types of headache you may have. Please enter the number of headaches you have had in the past month, and in the past 12 months, for each type of headache listed below. If you just have one type, please enter a “0” when asked about the second type and other types of headache

Data type

integer

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0750480
Number In Past 12 Month of Second Most severe type of headache
Description

Please consider the different types of headache you may have. Please enter the number of headaches you have had in the past month, and in the past 12 months, for each type of headache listed below. If you just have one type, please enter a “0” when asked about the second type and other types of headache

Data type

integer

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0750480
Number In Past 12 Month of other types of headache
Description

Please consider the different types of headache you may have. Please enter the number of headaches you have had in the past month, and in the past 12 months, for each type of headache listed below. If you just have one type, please enter a “0” when asked about the second type and other types of headache

Data type

integer

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0750480
Most Severe Type Of Headache:The pain is pounding, pulsating or throbbing
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Most Severe Type Of Headache:The pain is made worse by routine activities such as walking or climbing stairs
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Most Severe Type Of Headache:Light bothers you (more than when you do not have headaches)
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Second Most Severe Type Of Headache:The pain is worse on just one side
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Second Most Severe Type Of Headache:The pain has moderate or severe intensity
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Second Most Severe Type Of Headache:You feel nauseated or sick to your stomach
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Second Most Severe Type Of Headache:Sound bothers you (more than when you do not have headaches)
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Other Types Of Headache:The pain is pounding, pulsating or throbbing
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Other Types Of Headache:The pain is made worse by routine activities such as walking or climbing stairs
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
Other Types Of Headache:Light bothers you (more than when you do not have headaches)
Description

Considering your different types of headaches, please answer how the following statements describe your pain and other symptoms. If you have just one type of headache, answer the questions regarding the “Most Severe Type” only

Data type

integer

Alias
UMLS CUI [1,1]
C1148406
UMLS CUI [1,2]
C0475264
When I DON'T take medication, my headaches last ...minutes or ...hours or ...days
Description

For Questions 8 through 19 answer for your most severe type of headache only. Considering your most severe type of headache, how long on average does this type of headache last? Write An Answer In EITHER Minutes Or Hours Or Days Below For BOTH “A” And “B”

Data type

text

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0449238
When I DON'T take medication, my headaches last
Description

For Questions 8 through 19 answer for your most severe type of headache only. Considering your most severe type of headache, how long on average does this type of headache last? Write An Answer In EITHER Minutes Or Hours Or Days Below For BOTH “A” And “B”

Data type

integer

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0449238
Have you ever seen things like spots, stars, lines, flashing lights, zigzag lines, or "heat waves" around the time of your most severe type of headache
Description

This is different than "light bothers you" in question 7f above. (X ONE Box)

Data type

integer

Alias
UMLS CUI [1]
C0422943
How often do you have these changes in vision with your most severe type of headache?
Description

X ONE Box

Data type

integer

Alias
UMLS CUI [1]
C0422943
With your most severe type of headache, how often have you had a feeling such as numbness or tingling in any part of your body or face?
Description

X ONE Box

Data type

integer

Alias
UMLS CUI [1]
C3472693
After the headache pain ends, how long does it take until you can function normally
Description

You don't feel dull, confused, tired, out of sorts? Write In Answer In EITHER Hours OR Days

Data type

text

Alias
UMLS CUI [1]
C0598463
How often does your most severe type of headache occur near the time of menstruation (from a day before to two days after)?
Description

Females only X ONE Box

Data type

integer

Alias
UMLS CUI [1]
C0269226
On average, how long are you unable to work or undertake normal activities, when you have your most severe type of headache? Hours: OR Days:
Description

Write In Answer In Either Hours Or Days Below, Enter "0" If No Activity Restrictions Due To Headaches

Data type

text

Alias
UMLS CUI [1]
C0517480
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are pulling your hair back (for example like a ponytail)
Description

Skin sensations or pain

Data type

integer

Alias
UMLS CUI [1]
C3472693
UMLS CUI [2]
C0030193
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are wearing eyeglasses
Description

Skin sensations or pain

Data type

integer

Alias
UMLS CUI [1]
C3472693
UMLS CUI [2]
C0030193
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are wearing earrings
Description

Skin sensations or pain

Data type

integer

Alias
UMLS CUI [1]
C3472693
UMLS CUI [2]
C0030193
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are wearing tight clothing
Description

Skin sensations or pain

Data type

integer

Alias
UMLS CUI [1]
C3472693
UMLS CUI [2]
C0030193
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are resting your face or head on a pillow
Description

Skin sensations or pain

Data type

integer

Alias
UMLS CUI [1]
C3472693
UMLS CUI [2]
C0030193
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are exposed to cold (using an ice pack, washing with cold water)
Description

Skin sensations or pain

Data type

integer

Alias
UMLS CUI [1]
C3472693
UMLS CUI [2]
C0030193
Have you ever discussed your headaches with a doctor or other health professional?
Description

Physician or Health care professional

Data type

boolean

Alias
UMLS CUI [1]
C0031831
UMLS CUI [2]
C0018724
I have never talked with a doctor about my headaches (if yes, Skip to Qu. 23a)
Description

Talk to physician about headache

Data type

boolean

Alias
UMLS CUI [1]
C0018681
UMLS CUI [2]
C0031831
Have you ever been told by a doctor or other health professional that you have…?
Description

X ALL That Apply

Data type

integer

Alias
UMLS CUI [1]
C1960629
What type(s) of doctor or other health professional do you see most often for your headaches?
Description

X ALL That Apply

Data type

integer

Alias
UMLS CUI [1]
C0031831
UMLS CUI [2]
C0018724
Please specify other:
Description

Physician or health care professional

Data type

text

Alias
UMLS CUI [1]
C0031831
UMLS CUI [2]
C0018724
How many times in the past 12 months did you visit your primary care doctor's office specifically for the treatment of your headaches?
Description

Write In Number Below Under Column "A" For EACH. If You Did NOT Visit a Given Type of Healthcare Facility, Enter a "0"

Data type

integer

Alias
UMLS CUI [1]
C0018704
How many times in the past 12 months did you visit an urgent care center specifically for the treatment of your headaches?
Description

Write In Number Below Under Column "A" For EACH. If You Did NOT Visit a Given Type of Healthcare Facility, Enter a "0"

Data type

integer

Alias
UMLS CUI [1]
C0018704
How many times in the past 12 months did you visit a pain clinic specifically for the treatment of your headaches?
Description

Write In Number Below Under Column "A" For EACH. If You Did NOT Visit a Given Type of Healthcare Facility, Enter a "0"

Data type

integer

Alias
UMLS CUI [1]
C0018704
Other place for medical treatment (Specify):
Description

Health care facility

Data type

text

Alias
UMLS CUI [1]
C0018704
In total, over the past 12 months, how many nights, if any, did you stay overnight in the hospital due to your headaches or other reasons?
Description

Please include emergency room visits where you may have spent the night in the hospital emergency room or department Write in Number If None or Not Applicable, Enter "0"

Data type

integer

Alias
UMLS CUI [1]
C0019993
In total, over the past 12 months, how many nights, if any, did you stay overnight in the hospital due to your headaches
Description

Please include emergency room visits where you may have spent the night in the hospital emergency room or department Write in Number If None or Not Applicable, Enter "0"

Data type

integer

Alias
UMLS CUI [1]
C0019993
Please "X" each medication you currently use to treat your most severe type of headaches.
Description

Medication

Data type

integer

Alias
UMLS CUI [1]
C0013227
For each medication you currently use, write in the name of medication and number of days you take this medication in a typical month.
Description

Medication frequency

Data type

text

Alias
UMLS CUI [1]
C3476109
When did you last take preventive medications for headache ON A DAILY BASIS, to help prevent your most severe type of headache from happening in the first place?
Description

Preventive medication

Data type

integer

Alias
UMLS CUI [1]
C0497105
Why did you stop taking preventive medication: I got better and stopped by myself
Description

Treatment stopped

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2746065
Why did you stop taking preventive medication: I had side effects
Description

Treatment stopped

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2746065
Why did you stop taking preventive medication: It was inconvenient to take the medicine
Description

Treatment stopped

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2746065
Why did you stop taking preventive medication: I had to take the medication several times per day
Description

Treatment stopped

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2746065
Why did you stop taking preventive medication: Insurance would not cover
Description

Treatment stopped

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2746065
Why did you stop taking preventive medication: Other (Specify)
Description

Treatment stopped

Data type

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2746065
Please specify any other medication you have ever used
Description

Pharmaceutical Preparations

Data type

text

Alias
UMLS CUI [1]
C0013227
Please specify any other medication you have ever used to prevent headaches
Description

Pharmaceutical Preparations

Data type

text

Alias
UMLS CUI [1]
C0013227
Please “X” each medication that you currently use
Description

Pharmaceutical Preparations

Data type

integer

Alias
UMLS CUI [1]
C0013227
Please specify any other medication you currently use to prevent headaches
Description

Pharmaceutical Preparations

Data type

text

Alias
UMLS CUI [1]
C0013227
Overall I am satisfied with the medication I use to prevent my headaches
Description

If you are currently using medication to prevent headaches, how satisfied are you?

Data type

integer

Alias
UMLS CUI [1]
C3476649
Since I started to use my preventive medication, my headaches are not as bad as before
Description

If you are currently using medication to prevent headaches, how satisfied are you?

Data type

integer

Alias
UMLS CUI [1]
C3476649
Since I started to use my preventive medication, I miss less time at family, social and leisure activities because of my headaches
Description

If you are currently using medication to prevent headaches, how satisfied are you?

Data type

integer

Alias
UMLS CUI [1]
C3476649
The medication that I use to treat the headache attack (acute medication) works better
Description

If you are currently using medication to prevent headaches, how satisfied are you?

Data type

integer

Alias
UMLS CUI [1]
C3476649
Since I started to use my preventive medication, I have had at least a 50% decrease in headache frequency
Description

If you ever used any of these medications, please answer the following questions regarding the effect of that medication(s) on your most severe type of headache.

Data type

integer

Alias
UMLS CUI [1]
C3476649
Since I started to use my preventive medication, I miss less time at work, school or household work because of my headaches
Description

If you ever used any of these medications, please answer the following questions regarding the effect of that medication(s) on your most severe type of headache.

Data type

integer

Alias
UMLS CUI [1]
C3476649
My preventive medication does not produce very many side effects
Description

If you ever used any of these medications, please answer the following questions regarding the effect of that medication(s) on your most severe type of headache.

Data type

integer

Alias
UMLS CUI [1]
C3476649
Having a medication that prevents at least half of my headaches
Description

In deciding to take a daily medication to prevent your most severe type of headache, how important is each of the following…?

Data type

integer

Alias
UMLS CUI [1]
C0011109
Having a medication that prevents all of my headaches
Description

In deciding to take a daily medication to prevent your most severe type of headache, how important is each of the following…?

Data type

integer

Alias
UMLS CUI [1]
C0011109
Having a medication that does not increase my appetite or cause weight gains
Description

In deciding to take a daily medication to prevent your most severe type of headache, how important is each of the following…?

Data type

integer

Alias
UMLS CUI [1]
C0011109
Having a medication that does not cause sleepiness or slow down my thinking
Description

In deciding to take a daily medication to prevent your most severe type of headache, how important is each of the following…?

Data type

integer

Alias
UMLS CUI [1]
C0011109
Have you been told by a doctor or any other health professional that you have any of the following health problems?
Description

X ALL That Apply

Data type

integer

Alias
UMLS CUI [1]
C0009488
Are you currently...?
Description

X ALL That Apply

Data type

integer

Alias
UMLS CUI [1]
C0242271
How many DAYS do you usually work each WEEK? Write In DAYS per week
Description

Working conditions

Data type

integer

Alias
UMLS CUI [1]
C0681124
Did you miss a full day of work for any reason in the PAST TWO WEEKS? If no, skip to Qu 43
Description

Sick leave

Data type

boolean

Alias
UMLS CUI [1]
C0242807
What were the reason(s) you were not feeling well? (X ALL That Apply)
Description

Health problems

Data type

integer

Alias
UMLS CUI [1]
C1446390
Check the reason or reasons why you missed work
Description

X all that apply

Data type

integer

Alias
UMLS CUI [1]
C0242807
What were the reason(s) that you were not feeling well at work?
Description

X all that apply

Data type

integer

Alias
UMLS CUI [1]
C2364135
When you weren't feeling well, how long, on average, did it take you to start working after you got to work?
Description

Discomfort ; get started

Data type

integer

Alias
UMLS CUI [1]
C2364135
UMLS CUI [2]
C0439659
On average, how much of the time did you spend doing a job over because you made a mistake or your supervisor told you to do a job over?
Description

For Questions 46-50, please answer on average for the day or days you were at work in the last two weeks and were not feeling well. Think specifically about how the most important tasks you do and the tasks you do most often were affected

Data type

integer

Alias
UMLS CUI [1,1]
C4049986
UMLS CUI [1,2]
C4075610
On average, how much of the time did you work more slowly or take longer to complete tasks than usual or expected?
Description

For Questions 46-50, please answer on average for the day or days you were at work in the last two weeks and were not feeling well. Think specifically about how the most important tasks you do and the tasks you do most often were affected

Data type

integer

Alias
UMLS CUI [1,1]
C4049986
UMLS CUI [1,2]
C4075610
How much have you been bothered by little interest or pleasure in doing things
Description

During the last 2 weeks, how much have you been bothered by any of the following problems? (X ONE Box For EACH)

Data type

integer

Alias
UMLS CUI [1]
C0848067
How much have you been bothered by trouble falling or staying asleep, or sleeping too much
Description

During the last 2 weeks, how much have you been bothered by any of the following problems? (X ONE Box For EACH)

Data type

integer

Alias
UMLS CUI [1]
C0848067
How much have you been bothered by poor appetite or overeating
Description

During the last 2 weeks, how much have you been bothered by any of the following problems? (X ONE Box For EACH)

Data type

integer

Alias
UMLS CUI [1]
C0848067
How much have you been bothered by trouble concentrating on things, such as reading the newspaper or watching television
Description

During the last 2 weeks, how much have you been bothered by any of the following problems? (X ONE Box For EACH)

Data type

integer

Alias
UMLS CUI [1]
C0848067
How much have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way
Description

During the last 2 weeks, how much have you been bothered by any of the following problems? (X ONE Box For EACH)

Data type

integer

Alias
UMLS CUI [1]
C0848067
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Similar models

Headache Mail Questionnaire

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Headache Mail Questionnaire
Headache
Item
In the past year, have you had at least one headache that WAS NOT caused by a head injury, hangover or an illness such as a cold or the flu?
boolean
C0018681 (UMLS CUI [1])
Headache Duration
Item
On how many days in the last 3 months did you have a headache, if a headache lasted more than 1 day, count each day?
integer
C0018681 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Productivity decrease
Item
Because of your headaches, on how many days in the last 3 months was your productivity at work or school reduced by half or more?
integer
C1821718 (UMLS CUI [1])
Productivity decrease in ADL
Item
Because of your headaches, on how many days in the last 3 months was your productivity in household work reduced by half or more?
integer
C1821718 (UMLS CUI [1,1])
C0001288 (UMLS CUI [1,2])
Item
On a scale of 0-10 (where 0 = no pain at all and 10 = pain as bad as it can be), on average how painful were these headaches?
integer
C2732809 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
VAS Headache
Code List
On a scale of 0-10 (where 0 = no pain at all and 10 = pain as bad as it can be), on average how painful were these headaches?
CL Item
0 No Pain (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
CL Item
8 (9)
CL Item
9 (10)
CL Item
10 Pain Is As Bad As It Could Be (11)
Pain quality and localization
Item
Number In Past Month of Most severe type of headache
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Item
Number In Past Month of Most severe type of headache
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Headache
Item
When was the last time you had a headache? # of months ago:
integer
C0018681 (UMLS CUI [1])
Type of headache
Item
How many different types of headache do you have? Specify number of headache types:
integer
C0332307 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
Number of headaches
Item
Number In Past 12 Month of Most severe type of headache
integer
C0018681 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Number of headaches
Item
Number In Past 12 Month of Second Most severe type of headache
integer
C0018681 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Number of headaches
Item
Number In Past 12 Month of other types of headache
integer
C0018681 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Item
Most Severe Type Of Headache:The pain is pounding, pulsating or throbbing
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Most Severe Type Of Headache:The pain is pounding, pulsating or throbbing
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Most Severe Type Of Headache:The pain is made worse by routine activities such as walking or climbing stairs
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Most Severe Type Of Headache:The pain is made worse by routine activities such as walking or climbing stairs
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Most Severe Type Of Headache:Light bothers you (more than when you do not have headaches)
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Most Severe Type Of Headache:Light bothers you (more than when you do not have headaches)
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Second Most Severe Type Of Headache:The pain is worse on just one side
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Second Most Severe Type Of Headache:The pain is worse on just one side
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Second Most Severe Type Of Headache:The pain has moderate or severe intensity
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Second Most Severe Type Of Headache:The pain has moderate or severe intensity
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Second Most Severe Type Of Headache:You feel nauseated or sick to your stomach
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Second Most Severe Type Of Headache:You feel nauseated or sick to your stomach
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Second Most Severe Type Of Headache:Sound bothers you (more than when you do not have headaches)
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Second Most Severe Type Of Headache:Sound bothers you (more than when you do not have headaches)
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Other Types Of Headache:The pain is pounding, pulsating or throbbing
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Other Types Of Headache:The pain is pounding, pulsating or throbbing
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Other Types Of Headache:The pain is made worse by routine activities such as walking or climbing stairs
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Other Types Of Headache:The pain is made worse by routine activities such as walking or climbing stairs
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
Other Types Of Headache:Light bothers you (more than when you do not have headaches)
integer
C1148406 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Pain quality and localization
Code List
Other Types Of Headache:Light bothers you (more than when you do not have headaches)
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Headache duration
Item
When I DON'T take medication, my headaches last ...minutes or ...hours or ...days
text
C0018681 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Headache duration
Item
When I DON'T take medication, my headaches last
integer
C0018681 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Item
Have you ever seen things like spots, stars, lines, flashing lights, zigzag lines, or "heat waves" around the time of your most severe type of headache
integer
C0422943 (UMLS CUI [1])
Visual symptoms
Code List
Have you ever seen things like spots, stars, lines, flashing lights, zigzag lines, or "heat waves" around the time of your most severe type of headache
CL Item
Yes (Continue)  (1)
CL Item
No (Skip to Qu. 12)  (2)
CL Item
Don't know (Continue) (3)
Item
How often do you have these changes in vision with your most severe type of headache?
integer
C0422943 (UMLS CUI [1])
Pain quality and localization
Code List
How often do you have these changes in vision with your most severe type of headache?
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Item
With your most severe type of headache, how often have you had a feeling such as numbness or tingling in any part of your body or face?
integer
C3472693 (UMLS CUI [1])
Pain quality and localization
Code List
With your most severe type of headache, how often have you had a feeling such as numbness or tingling in any part of your body or face?
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Level of function
Item
After the headache pain ends, how long does it take until you can function normally
text
C0598463 (UMLS CUI [1])
Item
How often does your most severe type of headache occur near the time of menstruation (from a day before to two days after)?
integer
C0269226 (UMLS CUI [1])
Pain quality and localization
Code List
How often does your most severe type of headache occur near the time of menstruation (from a day before to two days after)?
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Less Than Half The Time (3)
CL Item
Half The Time Or More (4)
Perceived impact on current lifestyle
Item
On average, how long are you unable to work or undertake normal activities, when you have your most severe type of headache? Hours: OR Days:
text
C0517480 (UMLS CUI [1])
Item
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are pulling your hair back (for example like a ponytail)
integer
C3472693 (UMLS CUI [1])
C0030193 (UMLS CUI [2])
Skin sensations or pain
Code List
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are pulling your hair back (for example like a ponytail)
CL Item
Never  (1)
CL Item
Rarely  (2)
CL Item
Less Than Half The Time  (3)
CL Item
Half The Time Or More  (4)
CL Item
Does Not Apply To Me (5)
Skin sensations or pain
Item
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are wearing eyeglasses
integer
C3472693 (UMLS CUI [1])
C0030193 (UMLS CUI [2])
Skin sensations or pain
Item
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are wearing earrings
integer
C3472693 (UMLS CUI [1])
C0030193 (UMLS CUI [2])
Skin sensations or pain
Item
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are wearing tight clothing
integer
C3472693 (UMLS CUI [1])
C0030193 (UMLS CUI [2])
Skin sensations or pain
Item
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are resting your face or head on a pillow
integer
C3472693 (UMLS CUI [1])
C0030193 (UMLS CUI [2])
Skin sensations or pain
Item
How often do you experience increased pain or an unpleasant sensation on your skin during your most severe type of headache when you are exposed to cold (using an ice pack, washing with cold water)
integer
C3472693 (UMLS CUI [1])
C0030193 (UMLS CUI [2])
Physician or Health care professional
Item
Have you ever discussed your headaches with a doctor or other health professional?
boolean
C0031831 (UMLS CUI [1])
C0018724 (UMLS CUI [2])
Talk to physician about headache
Item
I have never talked with a doctor about my headaches (if yes, Skip to Qu. 23a)
boolean
C0018681 (UMLS CUI [1])
C0031831 (UMLS CUI [2])
Item
Have you ever been told by a doctor or other health professional that you have…?
integer
C1960629 (UMLS CUI [1])
History of headache
Code List
Have you ever been told by a doctor or other health professional that you have…?
CL Item
Migraine headaches (1)
CL Item
Menstrual headaches or menstrual migraines (2)
CL Item
Sinus headaches (3)
CL Item
Tension headaches (4)
CL Item
Stress headaches (5)
CL Item
Chronic migraine or transformed migraine (6)
CL Item
Chronic daily headache (7)
CL Item
Rebound headache due to medication overuse (8)
CL Item
Cluster headaches (9)
CL Item
Other (Specify) (10)
Physician or health care professional
Item
What type(s) of doctor or other health professional do you see most often for your headaches?
integer
C0031831 (UMLS CUI [1])
C0018724 (UMLS CUI [2])
Physician or health care professional
Item
Please specify other:
text
C0031831 (UMLS CUI [1])
C0018724 (UMLS CUI [2])
Health care facility
Item
How many times in the past 12 months did you visit your primary care doctor's office specifically for the treatment of your headaches?
integer
C0018704 (UMLS CUI [1])
Health care facility
Item
How many times in the past 12 months did you visit an urgent care center specifically for the treatment of your headaches?
integer
C0018704 (UMLS CUI [1])
Health care facility
Item
How many times in the past 12 months did you visit a pain clinic specifically for the treatment of your headaches?
integer
C0018704 (UMLS CUI [1])
Health care facility
Item
Other place for medical treatment (Specify):
text
C0018704 (UMLS CUI [1])
Hospitalization
Item
In total, over the past 12 months, how many nights, if any, did you stay overnight in the hospital due to your headaches or other reasons?
integer
C0019993 (UMLS CUI [1])
Hospitalization
Item
In total, over the past 12 months, how many nights, if any, did you stay overnight in the hospital due to your headaches
integer
C0019993 (UMLS CUI [1])
Item
Please "X" each medication you currently use to treat your most severe type of headaches.
integer
C0013227 (UMLS CUI [1])
Medication
Code List
Please "X" each medication you currently use to treat your most severe type of headaches.
CL Item
Tylenol (or other brand of acetaminophen) (1)
CL Item
Aleve/Naprosyn/Anaprox (or other brand of naproxen) (2)
CL Item
Aspirin (3)
CL Item
Excedrin/Excedrin Migraine/Generic "Excedrin" (acetaminophen+aspirin+caffeine) (4)
CL Item
Advil, Motrin (or other brand of ibuprofen) (5)
CL Item
Orudis/Oruvail (ketoprofen) (6)
CL Item
Other non-prescription (specify): (7)
CL Item
Other non-prescription (specify): (8)
CL Item
PRESCRIPTION MEDICATIONS (9)
CL Item
Amerge tablets (naratriptan) (10)
CL Item
Axert tablets (almotriptan) (11)
CL Item
Demerol (oral or injected meperidine) (12)
CL Item
Ergomar/Bellergal-S/Cafergot (or other brand of ergotamine) (13)
CL Item
Fiorinal/Fioricet (butalbital+caffeine+acetaminophen) with or without codeine (14)
CL Item
Frova tablets (frovatriptan) (15)
CL Item
Imitrex tablets (sumatriptan) (16)
CL Item
Imitrex nasal spray (sumatriptan) (17)
CL Item
Imitrex STAT dose (injection) (sumatriptan) (18)
CL Item
Midrin/Duradrin (Isometheptene+dichoralphenazone+acetaminophen) (19)
CL Item
Maxalt MLT (oral wafer) (rizatriptan) (20)
CL Item
Maxalt tablets (rizatriptan) (21)
CL Item
Migranal nasal spray or DHE-45 injection (dihydroergotamine) (22)
CL Item
Oral narcotics (Darvocet,Tylenol with codeine, Vicodin, Vicoprofen)  (23)
CL Item
Phrenilin (butalbital+acetaminophen) (24)
CL Item
Relpax tablets (eletriptan) (25)
CL Item
Zomig nasal spray (zolmitriptan) (26)
CL Item
Stadol NS (nasal spray) (butorphanol) (27)
CL Item
Toradol (ketorolac) other non-narcotic (28)
CL Item
Zomig tablet (zolmitriptan) (29)
CL Item
Zomig ZMT (melt) (zolmitriptan) (30)
CL Item
Any other injected pain reliever (specify): (31)
CL Item
Other prescription (specify): (32)
Medication frequency
Item
For each medication you currently use, write in the name of medication and number of days you take this medication in a typical month.
text
C3476109 (UMLS CUI [1])
Item
When did you last take preventive medications for headache ON A DAILY BASIS, to help prevent your most severe type of headache from happening in the first place?
integer
C0497105 (UMLS CUI [1])
Preventive medication
Code List
When did you last take preventive medications for headache ON A DAILY BASIS, to help prevent your most severe type of headache from happening in the first place?
CL Item
Currently taking (Skip to Qu. 30a) (1)
CL Item
Last took within the past 3 months (2)
CL Item
Last took 3-12 months ago (3)
CL Item
Last took more than 12 months ago (4)
Treatment stopped
Item
Why did you stop taking preventive medication: I got better and stopped by myself
integer
C0013227 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
Treatment stopped
Item
Why did you stop taking preventive medication: I had side effects
integer
C0013227 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
Treatment stopped
Item
Why did you stop taking preventive medication: It was inconvenient to take the medicine
integer
C0013227 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
Treatment stopped
Item
Why did you stop taking preventive medication: I had to take the medication several times per day
integer
C0013227 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
Item
Why did you stop taking preventive medication: Insurance would not cover
integer
C0013227 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
Treatment stopped
Code List
Why did you stop taking preventive medication: Insurance would not cover
CL Item
Strongly Agree  (1)
CL Item
Agree  (2)
CL Item
Neutral  (3)
CL Item
Disagree  (4)
CL Item
Strongly Disagree (5)
Item
Why did you stop taking preventive medication: Other (Specify)
text
C0013227 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
Treatment stopped
Code List
Why did you stop taking preventive medication: Other (Specify)
Pharmaceutical Preparations
Item
Please specify any other medication you have ever used
text
C0013227 (UMLS CUI [1])
Pharmaceutical Preparations
Item
Please specify any other medication you have ever used to prevent headaches
text
C0013227 (UMLS CUI [1])
Item
Please “X” each medication that you currently use
integer
C0013227 (UMLS CUI [1])
Pharmaceutical Preparations
Code List
Please “X” each medication that you currently use
CL Item
Depakote (divalproex sodium) (1)
CL Item
Neurontin (gabapentin) (2)
CL Item
Topamax (topiramate) (3)
CL Item
Other anti-seizure (specify) (4)
CL Item
Cymbalta (duloxetine) (5)
CL Item
Effexor (venlafaxine) (6)
CL Item
Elavil (amitriptylline) (7)
CL Item
Pamelor (nortriptylline) (8)
CL Item
Paxil (paroxetine) (9)
CL Item
Prozac (fluoxetine) (10)
CL Item
Zoloft (sertraline) (11)
CL Item
Other anti-depressant (specify): (12)
CL Item
Blocadren (timolol) (13)
CL Item
Calan/Covera-HS/Isoptin (verapamil) (14)
CL Item
Corgard (nadolol) (15)
CL Item
Inderal (propranolol) (16)
CL Item
Lopressor/Toprol XL (metoprolol) (17)
CL Item
Procardia (nifedipine) (18)
CL Item
Tenormin (atenolol) (19)
CL Item
Other blood pressure/heart medications (specify) (20)
CL Item
Butterbur (Petasites) (21)
CL Item
Feverfew (22)
CL Item
Magnesium (23)
CL Item
Vitamin B2 (riboflavin) (24)
CL Item
Vitamin B6 (pyridoxine) (25)
CL Item
Other vitamin, mineral or herbal combination (26)
CL Item
Botulinum Toxin (27)
CL Item
Other (Specify) (28)
Pharmaceutical Preparations
Item
Please specify any other medication you currently use to prevent headaches
text
C0013227 (UMLS CUI [1])
Treatment satisfaction
Item
Overall I am satisfied with the medication I use to prevent my headaches
integer
C3476649 (UMLS CUI [1])
Treatment satisfaction
Item
Since I started to use my preventive medication, my headaches are not as bad as before
integer
C3476649 (UMLS CUI [1])
Treatment satisfaction
Item
Since I started to use my preventive medication, I miss less time at family, social and leisure activities because of my headaches
integer
C3476649 (UMLS CUI [1])
Treatment satisfaction
Item
The medication that I use to treat the headache attack (acute medication) works better
integer
C3476649 (UMLS CUI [1])
Treatment satisfaction
Item
Since I started to use my preventive medication, I have had at least a 50% decrease in headache frequency
integer
C3476649 (UMLS CUI [1])
Item
Since I started to use my preventive medication, I miss less time at work, school or household work because of my headaches
integer
C3476649 (UMLS CUI [1])
Treatment stopped
Code List
Since I started to use my preventive medication, I miss less time at work, school or household work because of my headaches
CL Item
Strongly Agree  (1)
CL Item
Agree  (2)
CL Item
Neutral  (3)
CL Item
Disagree  (4)
CL Item
Strongly Disagree (5)
Item
My preventive medication does not produce very many side effects
integer
C3476649 (UMLS CUI [1])
Treatment stopped
Code List
My preventive medication does not produce very many side effects
CL Item
Strongly Agree  (1)
CL Item
Agree  (2)
CL Item
Neutral  (3)
CL Item
Disagree  (4)
CL Item
Strongly Disagree (5)
Item
Having a medication that prevents at least half of my headaches
integer
C0011109 (UMLS CUI [1])
Decision making
Code List
Having a medication that prevents at least half of my headaches
CL Item
Extremely Important  (1)
CL Item
Moderately Important  (2)
CL Item
Neither Important Nor Unimportant  (3)
CL Item
Moderately Unimportant  (4)
CL Item
Not At All Important (5)
Item
Having a medication that prevents all of my headaches
integer
C0011109 (UMLS CUI [1])
Decision making
Code List
Having a medication that prevents all of my headaches
CL Item
Extremely Important  (1)
CL Item
Moderately Important  (2)
CL Item
Neither Important Nor Unimportant  (3)
CL Item
Moderately Unimportant  (4)
CL Item
Not At All Important (5)
Decision making
Item
Having a medication that does not increase my appetite or cause weight gains
integer
C0011109 (UMLS CUI [1])
Decision making
Item
Having a medication that does not cause sleepiness or slow down my thinking
integer
C0011109 (UMLS CUI [1])
Item
Have you been told by a doctor or any other health professional that you have any of the following health problems?
integer
C0009488 (UMLS CUI [1])
Comorbidities
Code List
Have you been told by a doctor or any other health professional that you have any of the following health problems?
CL Item
Allergies/Hay fever (1)
CL Item
Rheumatoid Arthritis / Osteoarthritis (2)
CL Item
Asthma (3)
CL Item
Bronchitis (4)
CL Item
Bipolar disorder/Mania (5)
CL Item
Cancer (of any type) (6)
CL Item
Chronic bronchitis (7)
CL Item
Chronic pain (Specify location) (8)
CL Item
Circulation problems (cold hands or feet) (9)
CL Item
Depression (10)
CL Item
Dermatitis/Eczema (11)
CL Item
Diabetes (12)
CL Item
Emphysema/COPD (13)
CL Item
Heart disease/Angina (chest pain) (14)
CL Item
High blood pressure (15)
CL Item
High cholesterol (16)
CL Item
Low blood pressure (17)
CL Item
Nervousness or anxiety (18)
CL Item
Obesity (19)
CL Item
PMS/Menstrual problems (20)
CL Item
Seizures, epilepsy, fits or convulsions (21)
CL Item
Sinusitis or sinus infection (22)
CL Item
Stroke (23)
CL Item
Ulcers of the stomach or intestines (24)
CL Item
Other (Specify) (25)
Item
Are you currently...?
integer
C0242271 (UMLS CUI [1])
Employment status
Code List
Are you currently...?
CL Item
Employed full time (35 or more hours/week) (1)
CL Item
Employed part time (less than 35 hours/week) (2)
CL Item
Unemployed (Skip to Qu 51 ) (3)
CL Item
Retired (Skip to Qu 51 ) (4)
CL Item
Student (Skip to Qu 51 ) (5)
CL Item
Homemaker (Skip to Qu 51 ) (6)
CL Item
Disabled ((Skip to Qu 51 ) (7)
CL Item
Volunteer (Skip to Qu 51 ) (8)
CL Item
On medical or maternity leave (Skip to Qu 51 ) (9)
CL Item
Other (Specify) (10)
Working conditions
Item
How many DAYS do you usually work each WEEK? Write In DAYS per week
integer
C0681124 (UMLS CUI [1])
Sick leave
Item
Did you miss a full day of work for any reason in the PAST TWO WEEKS? If no, skip to Qu 43
boolean
C0242807 (UMLS CUI [1])
Item
What were the reason(s) you were not feeling well? (X ALL That Apply)
integer
C1446390 (UMLS CUI [1])
Health problems
Code List
What were the reason(s) you were not feeling well? (X ALL That Apply)
CL Item
Asthma (1)
CL Item
Back pain (2)
CL Item
Breathing problems (not asthma or cold) (3)
CL Item
Cancer (4)
CL Item
Cold (5)
CL Item
Diabetes (6)
CL Item
Digestive problems (7)
CL Item
Flu (8)
CL Item
Headache (9)
CL Item
Heart problems (10)
CL Item
Injury (11)
CL Item
Joint pain/Arthritis (12)
CL Item
Menstrual pain (13)
CL Item
Sad/Blue (14)
CL Item
Seasonal allergies (15)
CL Item
Other (Specify) (16)
Sick leave
Item
Check the reason or reasons why you missed work
integer
C0242807 (UMLS CUI [1])
Item
What were the reason(s) that you were not feeling well at work?
integer
C2364135 (UMLS CUI [1])
Discomfort
Code List
What were the reason(s) that you were not feeling well at work?
CL Item
Asthma (1)
CL Item
Back pain (2)
CL Item
Breathing problems (not asthma or cold) (3)
CL Item
Cancer (4)
CL Item
Cold (5)
CL Item
Diabetes (6)
CL Item
Digestive problems (7)
CL Item
Flu (8)
CL Item
Headache (9)
CL Item
Heart problems (10)
CL Item
Injury (11)
CL Item
Joint pain/Arthritis (12)
CL Item
Menstrual pain (13)
CL Item
Sad/Blue (14)
CL Item
Seasonal allergies (15)
CL Item
Other (Specify) (16)
Discomfort ; get started
Item
When you weren't feeling well, how long, on average, did it take you to start working after you got to work?
integer
C2364135 (UMLS CUI [1])
C0439659 (UMLS CUI [2])
Impact on ability to work
Item
On average, how much of the time did you spend doing a job over because you made a mistake or your supervisor told you to do a job over?
integer
C4049986 (UMLS CUI [1,1])
C4075610 (UMLS CUI [1,2])
Impact on ability to work
Item
On average, how much of the time did you work more slowly or take longer to complete tasks than usual or expected?
integer
C4049986 (UMLS CUI [1,1])
C4075610 (UMLS CUI [1,2])
Mental problems
Item
How much have you been bothered by little interest or pleasure in doing things
integer
C0848067 (UMLS CUI [1])
Mental problems
Item
How much have you been bothered by trouble falling or staying asleep, or sleeping too much
integer
C0848067 (UMLS CUI [1])
Mental problems
Item
How much have you been bothered by poor appetite or overeating
integer
C0848067 (UMLS CUI [1])
Mental problems
Item
How much have you been bothered by trouble concentrating on things, such as reading the newspaper or watching television
integer
C0848067 (UMLS CUI [1])
Mental problems
Item
How much have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way
integer
C0848067 (UMLS CUI [1])
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