On this page you will find the headache questionnaire.
Please download the files that apply to you and open them with Adobe Acrobat Reader.
If you do not have this program on your computer, you can use this link to download it safely and free of
charge: click here to download Adobe Acrobat Reader.
When you have opened the file with Adobe Acrobat Reader, you will see the option "Fill in and sign"
on the right side of the screen. Select this to be able to type in the file.
Save the completed questionnaire as a PDF file on your computer and mail it to me in an attachment
(moc.liamg@oruen.siuol ) before your consultation.
For headaches: please download "headache questionnaire men/ women", as well as "headache diary men/ women".
This last document is a diary to record your headache days, days with nausea and medication intake. You can fill in both of these documents with Adobe Acrobat Reader.
In case you also have vertigo/ dizziness, please download and fill in the document "dizziness questionnaire". This questionnaire is intended only to get additional information for patients with dizziness in the context of headaches and migraine in particular.
In case of neck pain, please download and fill in the document "neck pain questionnaire".
In case of facial pain, please download and fill in the document "facial pain questionnaire".
If you have difficulties completing it on the computer, you can print out the questionnaire and complete it in writing on paper. It is best to scan it afterwards and send it as a PDF document. If you have problems with this, the last solution is to bring the completed questionnaire on paper to the consultation.