Get Headache Questionnaire - Bsocalmdsb

Filling out the HEADACHE QUESTIONNAIRE - BSoCalMDSb online is a straightforward process that can assist healthcare providers in understanding your headaches better. This guide will walk you through each section of the questionnaire to ensure accurate and comprehensive information is provided.

Follow the steps to complete the headache questionnaire effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated field labeled 'Patient Name.' Accurate personal identification is essential for healthcare records.
3. Indicate the frequency of your headaches by checking the appropriate boxes next to 'Daily,' 'Weekly,' or 'Per Month.' This helps quantify the occurrence of your headaches.
4. Circle the location of your headaches from the options listed, which include various regions of the head. This provides insight into the pattern of your pain.
5. Rate the severity of your headaches on a scale from 1 to 10 in the provided space, with 10 representing the worst pain. This aids in assessing the intensity of your symptoms.
6. Specify the duration of your headaches in hours in the corresponding field. This assists in understanding how long you typically experience pain.
7. Respond to the questions about whether your headaches affect your sleep pattern by selecting appropriate options.
8. Describe any sensory impacts you may have, such as visual changes or sensitivity to light, using the options provided.
9. If you have a family history of headaches, indicate this and specify who in the space provided.
10. Describe the character of your pain by checking one or more options: Dull, Stabbing, Throbbing, Aching, or Piercing.
11. If applicable, respond to questions regarding menstrual cycle-related headaches and any other location-based patterns.
12. Indicate your average nightly sleep duration to provide context for your headaches.
13. Note any foods or meal patterns that affect your headaches in the designated section.
14. Indicate if weather impacts your headaches, followed by any relevant medical evaluations or tests you've undergone related to your headaches.
15. Finally, fill in the number of times you have visited the emergency room for headaches and how many workdays you miss on average each month due to headaches.
16. After completing the form, review all your entries for accuracy. Save your changes, and if needed, download or print the document for your records.

Begin filling out the HEADACHE QUESTIONNAIRE online today to help your healthcare provider better understand your condition.