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CDE Detailed Report
This report contains detailed information about the selected CDEs.
Note: If at least one CDE was selected from a copyright- or trademark-protected instrument/scale then all of the CDEs from that instrument/scale are included in this report.
Disease: Headache
Sub-Domain: Quality of Life/Patient Reported Outcomes
CRF: Headache Impact Questionnaire (HImQ)
Item count: 18 (18 distinct CDEs)
CDE ID
CDE Name
Variable Name
Definition / Description
Question Text
Permissible Value
Description
Data Type
Instructions
References
Population
Classification (e.g., Core)
Version #
Version Date
Aliases for Variable Name
CRF Module / Guideline
© or TM
Sub-Domain
Domain
Previous Title
Size
Input Restrictions
Min Value
Max Value
Measurement Type
LOINC ID
SNOMED
caDSR ID
CDISC ID
C17004
Headache Impact Questionnaire (HImQ) - headache days 3 months count
HImQHdchDay3MoCt
Count the days of your headaches during the past 3 months, as part of Headache Impact Questionnaire.
On how many days in the last 3 months have you had a headache?
  
Numeric Values
Please answer the questions about headaches you have had in the last three months. Answer in number of days
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q1
 
Free-Form Entry
0
92
     
C17005
Headache Impact Questionnaire (HImQ) - last headache time count
HImQLstHdchTimeCt
Count the time of your last headache, as part of Headache Impact Questionnaire.
When was your last headache?
  
Numeric Values
Record in days, weeks or months.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q2
 
Free-Form Entry
       
C17006
Headache Impact Questionnaire (HImQ) - headache duration
HlmQHdchDur
The duration your headaches usually last, as part of Headache Impact Questionnaire.
How long do your headaches usually last?
  
Numeric Values
Record in hours and/or minutes.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q3
 
Free-Form Entry
       
C17007
Headache Impact Questionnaire (HImQ) - headache scale
HlmQHdchScale
Scale the pain from your headache on a scale of 0 to 10, as part of Headache Impact Questionnaire.
How would you rate the pain from your headache on a scale of 0 to 10?
0;1;2;3;4;5;6;7;8;9;10;
No pain at all;1;2;3;4;5;6;7;8;9;Pain as bad as it can be;
Numeric values
0 is 'no pain at all' and "10" is 'pain as bad as it can be' Mark and "X" on the line.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q4
 
Single Pre-Defined Value Selected
       
C17008
Headache Impact Questionnaire (HImQ) - severe headache percent frequency
HlmQSevHdchPercntFreq
Frequency represented by percentage of time having severe headaches, as part of Headache Impact Questionnaire.
When you have headaches, how often is the pain severe?
0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100%;
Never;10%;20%;30%;40%;Half the time;60%;70%;80%;90%;Always;
Alphanumeric
Mark and "X" on the line.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q5
 
Single Pre-Defined Value Selected
  
percent
    
C17009
Headache Impact Questionnaire (HImQ) - lie down headache percent frequency
HlmQLieDwnHdchPercntFreq
Frequency represented by percentage of time you lie down to rest when you have a headache, as part of Headache Impact Questionnaire.
When you have a headache, how often do you lie down and rest where 0% is never and 100% is always?
0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100%;
Never;10%;20%;30%;40%;Half the time;60%;70%;80%;90%;Always;
Alphanumeric
Mark and "X" on the line.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q6
 
Single Pre-Defined Value Selected
  
percent
    
C17010
Headache Impact Questionnaire (HImQ) - lie down days 3-month headache count
HlmQLieDwnDay3MoHdchCt
Count the days you lied down for an hour or more in the last 3 months because of your headaches, as part of Headache Impact Questionnaire.
How many days in the last 3 months did you actually lie down for an hour or more because of your headaches?
  
Numeric Values
Please answer the questions about headaches you have had in the last three months.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q7
 
Free-Form Entry
0
92
     
C17011
Headache Impact Questionnaire (HImQ) - miss school work headache percent frequency
HlmQMisSchWrkHdchPercntFreq
Frequency represented by percentage of time you missed work or school for all or part of the day when you have a headache, as part of Headache Impact Questionnaire.
When you have a headache, how often do you miss work or school for all or part of the day where 0% is never and 100% is always?
0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100%;
Never;10%;20%;30%;40%;Half the time;60%;70%;80%;90%;Always;
Alphanumeric
Answer Q8, Q9, and Q10 if you are currently employed outside the home or if you go to school. If not, skip to Q11. '0' is 'Never', '50%' is 'Half the time' and '100%' is always Mark an "X" on the line.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q8
 
Single Pre-Defined Value Selected
  
percent
    
C17012
Headache Impact Questionnaire (HImQ) - off school work 3-month headache count
HlmQOffSchWrkDay3MoHdchCt
Count the days you have been kept from work activities (work or school) for at least half of the day in the last 3 months because of your headaches, as part of Headache Impact Questionnaire.
How many days in the last 3 months have you been kept from work activities (work or school) for at least half of the day because of your headaches?
  
Numeric Values
Answer Q8, Q9, and Q10 if you are currently employed outside the home or if you go to school. If not, skip to Q11.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q9
 
Free-Form Entry
0
92
     
C17013
Headache Impact Questionnaire (HImQ) - work ability reduced percentage measurement
HlmQWrkAbltyRedHdchPercntMeasr
Measurement of percentage of reduced ability to work when you have a headache, as part of Headache Impact Questionnaire.
When you have a headache while you work (work or school), how much is your ability to work reduced?
0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100%;
Not reduced at all;10%;20%;30%;40%;Reduced by half;60%;70%;80%;90%;Unable to work;
Alphanumeric
Answer Q8, Q9, and Q10 if you are currently employed outside the home or if you go to school. If not, skip to Q11. Mark an "X" on the line.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q10
 
Single Pre-Defined Value Selected
  
percent
    
C17014
Headache Impact Questionnaire (HImQ) - off chores 3-month headache count
HlmQOffChoreDay3MoHdchCt
Count the days in the last 3 months you have been kept from doing housework or chores for at least half of the day because of your headaches, as part of Headache Impact Questionnaire.
How many days in the last 3 months have you been kept from doing housework or chores for at least half of the day because of your headaches?
  
Numeric Values
Record number of days.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q11
 
Free-Form Entry
0
92
     
C17015
Headache Impact Questionnaire (HImQ) - Chore ability reduced headache percent measure
HlmQChoreAbRedHdchPercntMeasr
Measurement of percentage of reduced ability to do housework or chores when you have a headache, as part of Headache Impact Questionnaire.
When you have a headache, how much is your ability to do housework or chores reduced?
0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100%;
Not reduced at all;10%;20%;30%;40%;Reduced by half;60%;70%;80%;90%;Unable to work;
Alphanumeric
0% is 'not at all' and 100% is 'unable to work' Mark an "X" on the line.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q12
 
Single Pre-Defined Value Selected
  
percent
    
C17016
Headache Impact Questionnaire (HImQ) - off non-work activities 3-month headache count
HlmQOffNonWrkActDay3MoHdchCt
Count the days in the last 3 months you have been kept from non-work activities (family, social, or recreational) because of your headaches, as part of Headache Impact Questionnaire.
How many days in the last 3 months have you been kept from non-work activities (family, social, or recreational) because of your headaches?
  
Numeric Values
Record number of days.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q13
 
Free-Form Entry
0
92
     
C17017
Headache Impact Questionnaire (HImQ) - activities ability reduced percentage measurement
HlmQActAbltyRedHdchPercntMeasr
Measurement of percentage of reduced ability to engage non-work activities (family, social, or recreational) when you have a headache, as part of Headache Impact Questionnaire.
When you have a headache, how much is your ability to engage in non-work activities (family, social, or recreational) reduced?
0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100%;
Not reduced at all;10%;20%;30%;40%;Reduced by half;60%;70%;80%;90%;Unable to do activities;
Alphanumeric
0% is 'not at all' and 100% is 'unable to do activities'
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q14
 
Single Pre-Defined Value Selected
  
percent
    
C17018
Headache Impact Questionnaire (HImQ) - nausea headache frequency
HlmQNauseaHdchFreq
Frequency of nausea while having a headache as part of Headache Impact Questionnaire, as part of Headache Impact Questionnaire.
With your headaches, how often do you have nausea?
Never;Rarely;Less than half the time;Half the time or more often;
Never;Rarely;Less than half the time;Half the time or more often;
Alphanumeric
Check the best answer
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q15
 
Single Pre-Defined Value Selected
       
C17019
Headache Impact Questionnaire (HImQ) - avoid light sound headache frequency
HlmQAvoidLghtSndHdchFreq
Frequency of going to a dark or quiet room to avoid light or sound while having headaches, as part of Headache Impact Questionnaire.
With your h headaches, how often do you go to a dark or quiet room to avoid light or sound?
Never;Rarely;Less than half the time;Half the time or more often;
Never;Rarely;Less than half the time;Half the time or more often;
Alphanumeric
Check the best answer
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q16
 
Single Pre-Defined Value Selected
       
C17020
Headache Impact Questionnaire (HImQ) - headache changed 3-month type
HlmQHdchChnged3MoTyp
Type of changed headache during the last 3 months, as part of Headache Impact Questionnaire.
If your headaches have changed during the last 3 months, how have they changed?
0;1;2;3;4;5;6;7;
No change at all;Headaches are more frequent;Headaches are less frequent;Headaches last longer;Headaches are shorter;Headaches are more severe;Headaches are less severe;Other, specify;
Alphanumeric
Choose all that apply.
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q17
 
Single Pre-Defined Value Selected
       
C17021
Headache Impact Questionnaire (HImQ) - headache changed 3-month other text
HlmQHdchChnged3MoOthrTxt
Specify the text of change if you answered "Other (Specify)" to the last question, as part of Headache Impact Questionnaire.
Other Specify
  
Alphanumeric
Answer Q8, Q9, and Q10 if you are currently employed outside the home or if you go to school. If not, skip to Q20
Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers.
Adult
Exploratory
3.0
7/16/2013
Aliases for variable name not defined
Headache Impact Questionnaire (HImQ)
Quality of Life/Patient Reported Outcomes
Outcomes and End Points
HImQ Q17 - other
255
Free-Form Entry
       
06-25-2019
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