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Protocol - Migraine - Adult

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Self-Administered Questionnaire for Migraine

Availability:

Publicly available

Description:

The Self-Administered Questionnaire for Migraine is a 20-item questionnaire that assesses the frequency of severe headaches, the level of pain, whether the person is taking medications, and associated complications such as nausea.

Protocol:

1. Over the past year, have you suffered from severe headaches?

[ ] 1 Yes

[ ] 2 No

If Yes, go to question 2.

If No, questionnaire is complete.

2a. Age:

_______(Write In Age)

2b. Sex

[ ] 1 Male

[ ] 2 Female

3. When you have a severe headache, do you experience any of the following? (X ALL That Apply)

[ ] 1 Nausea

[ ] 2 Vomiting

[ ] 3 One side of head only

[ ] 4 Pulsating/throbbing headaches

[ ] 5 Pain-free intervals of days or weeks between severe headache attacks

[ ] 6 Sensitivity to light

[ ] 7 Sensitivity to noise

[ ] 8 Blurring of vision

[ ] 9 Seeing shimmering lights, circles, other shapes, or colors before the eyes, before the headache starts

[ ] 10 Numbness of lips, tongue, fingers, or legs before the headache starts

4. About how often do your severe headaches occur? (Write In Number Of Headache Days You Have Per Week Or Month Or Year)

_______# in a week, OR

_______# in a month, OR

_______# in a year

5. Which statement best describes the pain of your severe headaches? (X ONE)

[ ] 1 Extremely severe pain

[ ] 2 Severe pain

[ ] 3 Moderately severe pain

[ ] 4 Mild pain

6. Which best describes how you are usually affected by severe headaches? (X ONE)

[ ] 1 Able to work/function normally

[ ] 2 Working ability or activity impaired to some degree

[ ] 3 Working ability or activity severely impaired

[ ] 4 Bed rest required

7. Each time you have a severe headache, how long are you unable to work or undertake normal activities? (X ONE)

[ ] 1 0 days (no activity restriction)

[ ] 2 Less than 1 day

[ ] 3 1-2 days

[ ] 4 3-5 days

[ ] 5 6 or more days

8. On how many days in the last 3 months did you have a headache (if headache lasted more than 1 day, count each day)?

_______(Write In # Days)

9. Because of your headaches on how many days in the last 3 months . . . ?

a. did you miss work or school

_______(Write In # Days)

b. was your productivity at work/school reduced by half or more (not including days missed in qu. 9a above)

_______(Write In # Days)

c. did you not do household work

_______(Write In # Days)

d. was your productivity in house-hold work reduced by half or more (not including days counted in qu. 9c above)

_______(Write In # Days)

e. did you miss family, social, or leisure activities

_______(Write In # Days)

10. At what age did you BEGIN having severe headaches?

_______(Write In Age)

11. Have you ever gone to the hospital emergency room or to an urgent care clinic because of your severe headaches?

[ ] 1 Yes

[ ] 2 No

12. Which best describes the way you usually treat severe headaches? (X ONE)

[ ] 1 Take non-prescription medications

[ ] 2 Take prescription medications

[ ] 3 Take both prescription and non-prescription medications

[ ] 4 Take no medications

13. Have you ever taken prescription medication for headache on a DAILY basis, whether or not you have a headache, to help prevent a severe headache from happening in the first place?

[ ] 1 Yes

[ ] 2 No

14. Are you currently taking any other medication on a DAILY basis? (X ALL That Apply)

[ ] 1 Water pill or prescription diuretic for high blood pressure

[ ] 2 Prescription medicine (other than water pill) for high blood pressure

[ ] 3 Prescription medicine for seizures, epilepsy, or fits

[ ] 4 Prescription medicine for diabetes

[ ] 5 Prescription medicine for cholesterol

[ ] 6 Prescription medicine for depression or anxiety

15. When did you last take prescription medication for headache on a DAILY basis to help prevent a severe headache from happening in the first place? (X ONE)

[ ] 1 Currently taking

[ ] 2 Last took within the past 3 months

[ ] 3 Last took 3 to 12 months ago

[ ] 4 Last took more than 12 months ago

[ ] 5 Never took

16. Do you consider your severe headaches to be migraines?

[ ] 1 Yes

[ ] 2 No

17. Have you ever been diagnosed by a physician or other health professional as suffering from . . . ? (X ALL That Apply)

[ ] 1 Tension headaches

[ ] 2 Sinus headaches

[ ] 3 Cluster headaches

[ ] 4 Stress headaches

[ ] 5 "Sick" headaches

[ ] 6 Migraine headaches

18. If diagnosed with migraines, at what age were you FIRST DIAGNOSED with migraines?

_______(Write In Age)

19. Height?

______(Write In) Feet

______(Write In) Inches

20. Current weight?

______(Write In Pounds)

Scoring Instructions

In Lipton et al. (2001), respondents were classified as suffering from migraine if they fulfill the criteria for migraine with aura and migraine without aura established in 1998 by the International Headache Society (IHS) (Headache Classification Committee of the International Headache Society, 1998). This included one or more severe headache in the last year with "unilateral or pulsatile pain, and either nausea, vomiting, or phonophobia with photophobia; or visual or sensory aura before the headache" (Lipton et al., 2001). These criteria were updated by the International Headache Society in 2004 (Headache Classification Subcommittee of the International Headache Society, 2004).

Personnel and Training Required

None

Equipment Needs

The respondent will need a copy of the questionnaire.

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult

Specific Instructions:

None

Research Domain Information

Release Date:

October 8, 2010

Definition

A questionnaire to assess migraines and headaches.

Purpose

This measure is used to screen a general population for the presence of headaches and migraines and to assess some of the associated symptoms.

Selection Rationale

The Self-Administered Questionnaire for Migraine was vetted against similar instruments and chosen because it is a relatively short, validated protocol that is relatively easy to administer and has been used in a large-scale epidemiological study (American Migraine Prevalence and Prevention Study).

Language

English

Standards

StandardNameIDSource
Common Data Elements (CDE)Headache Assessment Description Text3107301CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Migraine proto62765-3LOINC

Process and Review

[link[phenx.org/node/103|Expert Review Panel 4]] (ERP 4) reviewed the measures in the Neurology, Psychiatric, and Psychosocial domains.

Guidance from ERP 4 included the following:

  • No changes

Source

Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L., & Reed, M. (2001). Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache, 41, 646-657.

General References

Headache Classification Committee of the International Headache Society. (1998). Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia, 8(Suppl. 7), 1-96.

Headache Classification Subcommittee of the International Headache Society. (2004). The International Classification of Headache Disorders. Part one: The primary headaches. Cephalalgia, 24(Suppl. 1), 23-136.

Protocol ID:

130501

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX130501_Severe_Headaches_Last_YearPX130501010000Over the past year, have you suffered from severe headaches?4Variable Mapping
PX130501_Current_AgePX130501020100Age:4N/A
PX130501_GenderPX130501020200Sex4N/A
PX130501_Headache_Complications_VomitingPX130501030200When you have a severe headache, do you experience any of the following? (X ALL That Apply) 2 = Vomiting4Variable Mapping
PX130501_Headache_Complications_One_Side_OnlyPX130501030300When you have a severe headache, do you experience any of the following? (X ALL That Apply) 3 = One side of head only4Variable Mapping
PX130501_Headache_Complications_Pulsating_ThrobbingPX130501030400When you have a severe headache, do you experience any of the following? (X ALL That Apply) 4 = Pulsating/throbbing headaches4Variable Mapping
PX130501_Headache_Complications_Intervals_Between_Severe_HeadachesPX130501030500When you have a severe headache, do you experience any of the following? (X ALL That Apply) 5 = Pain-free intervals of days or weeks between severe headache attacks4N/A
PX130501_Headache_Complications_Light_SensitivityPX130501030600When you have a severe headache, do you experience any of the following? (X ALL That Apply) 6 = Sensitivity to light4Variable Mapping
PX130501_Headache_Complications_Noise_SensitivityPX130501030700When you have a severe headache, do you experience any of the following? (X ALL That Apply) 7 = Sensitivity to noise4Variable Mapping
PX130501_Headache_Complications_Vision_BlurringPX130501030800When you have a severe headache, do you experience any of the following? (X ALL That Apply) 8 = Blurring of vision4N/A
PX130501_Headache_Complications_Seeing_Things_BeforePX130501030900When you have a severe headache, do you experience any of the following? (X ALL That Apply) 9 = Seeing shimmering lights, circles, other shapes, or colors before the eyes, before the headache starts4Variable Mapping
PX130501_Headache_Complications_NumbnessPX130501031000When you have a severe headache, do you experience any of the following? (X ALL That Apply) 10 = Numbness of lips, tongue, fingers, or legs before the headache starts4N/A
PX130501_Severe_Headaches_Average_FrequencyPX130501040000About how often do your severe headaches occur? (Write In Number Of Headache Days You Have Per Week Or Month Or Year)4Variable Mapping
PX130501_Severe_Headaches_AverageFrequency_Time_FramePX130501040100About how often do your severe headaches occur? (Write In Number Of Headache Days You Have Per Week Or Month Or Year)4Variable Mapping
PX130501_Severe_Headache_Pain_TypePX130501050000Which statement best describes the pain of your severe headaches? (X ONE)4N/A
PX130501_How_Affected_By_HeadachesPX130501060000Which best describes how you are usually affected by severe headaches? (X ONE)4N/A
PX130501_How_Long_Unable_To_WorkPX130501070000Each time you have a severe headache, how long are you unable to work or undertake normal activities? (X ONE)4N/A
PX130501_Headache_Frequency_Last_Three_MonthsPX130501080000On how many days in the last 3 months did you have a headache (if headache lasted more than 1 day, count each day)?4N/A
PX130501_Number_Days_Miss_SchoolPX130501090100Because of your headaches on how many days in the last 3 months... ? did you miss work or school4N/A
PX130501_Headache_Complications_NauseaPX130501030100When you have a severe headache, do you experience any of the following? (X ALL That Apply) 1 = Nausea4Variable Mapping
PX130501_Number_Days_Reduced_ProductivityPX130501090200Because of your headaches on how many days in the last 3 months... ? was your productivity at work/school reduced by half or more (not including days missed in qu. 9a above)4N/A
PX130501_Number_Days_No_House_WorkPX130501090300Because of your headaches on how many days in the last 3 months... ? did you not do household work4N/A
PX130501_Number_Days_HouseWork_Reduced_HalfPX130501090400Because of your headaches on how many days in the last 3 months... ? was your productivity in house-hold work reduced by half or more (not including days counted in qu. 9c above)4N/A
PX130501_Number_Days_Miss_ActivitiesPX130501090500Because of your headaches on how many days in the last 3 months... ? did you miss family, social, or leisure activities4N/A
PX130501_Age_Headaches_BeganPX130501100000At what age did you BEGIN having severe headaches?4N/A
PX130501_Ever_GoneTo_Hospital_For_HeadachesPX130501110000Have you ever gone to the hospital emergency room or to an urgent care clinic because of your severe headaches?4N/A
PX130501_Usual_Headache_TreatmentPX130501120000Which best describes the way you usually treat severe headaches? (X ONE)4N/A
PX130501_Headache_Prescription_Medication_Daily_BasisPX130501130000Have you ever taken prescription medication for headache on a DAILY basis, whether or not you have a headache, to help prevent a severe headache from happening in the first place?4N/A
PX130501_Any_Other_Daily_Medication_Water_Pill_Diuretic_High_BPPX130501140100Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 1 = Water pill or prescription diuretic for high blood pressure4N/A
PX130501_Any_Other_Daily_Medication_Other_Prescription_High_BPPX130501140200Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 2 = Prescription medicine (other than water pill) for high blood pressure4N/A
PX130501_Any_Other_Daily_Medication_Prescription_SeizuresPX130501140300Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 3 = Prescription medicine for seizures, epilepsy, or fits4N/A
PX130501_Any_Other_Daily_Medication_Prescription_DiabetesPX130501140400Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 4 = Prescription medicine for diabetes4N/A
PX130501_Any_Other_Daily_Medication_Prescription_CholesterolPX130501140500Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 5 = Prescription medicine for cholesterol4N/A
PX130501_Last_Took_Daily_Headache_MedicationPX130501150000When did you last take prescription medication for headache on a DAILY basis to help prevent a severe headache from happening in the first place? (X ONE)4N/A
PX130501_Consider_Headaches_ToBe_MigrainesPX130501160000Do you consider your severe headaches to be migraines?4N/A
PX130501_Diagnosed_With_Headache_Type_TensionPX130501170100Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 1 = Tension headaches4N/A
PX130501_Diagnosed_With_Headache_Type_SinusPX130501170200Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 2 = Sinus headaches4N/A
PX130501_Diagnosed_With_Headache_Type_ClusterPX130501170300Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 3 = Cluster headaches4N/A
PX130501_Diagnosed_With_Headache_Type_StressPX130501170400Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 4 = Stress headaches4N/A
PX130501_Diagnosed_With_Headache_Type_SickPX130501170500Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 5 = Sick headaches4N/A
PX130501_Diagnosed_With_Headache_Type_MigrainePX130501170600Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 6 = Migraine headaches4N/A
PX130501_Age_Diagnosed_With_MigrainesPX130501180000If diagnosed with migraines, at what age were you FIRST DIAGNOSED with migraines?4Variable Mapping
PX130501_Height_FeetPX130501190000Height?4N/A
PX130501_Height_InchesPX130501190100Height?4N/A
PX130501_WeightPX130501200000Weight?4Variable Mapping
PX130501_Any_Other_Daily_Medication_Prescription_DepressionPX130501140600Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 6 = Prescription medicine for depression or anxiety4N/A