CDE Detailed Report
Disease: Headache
Subdomain Name: History of Disease/Injury Event
CRF: Post-traumatic Headache (PTH) Mild TBI Questionnaire
Displaying 1 - 50 of 63
Subdomain Name: History of Disease/Injury Event
CRF: Post-traumatic Headache (PTH) Mild TBI Questionnaire
Displaying 1 - 50 of 63
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C59630 | Headache laterality anatomic site | HdchLateralAnatSite | Anatomic site location of the headache | Anatomic site location of the headache | Where were the headaches usually located? | Right;Left;Front;Back;Top;Side/Temples | Right;Left;Front;Back;Top;Side/Temples | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:04:11.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C15917 | Headache typical pain intensity rate scale | HeadacheTypPainIntstyRateScl | Rating scale for the pain of this headache on a scale of 0 -10 | Rating scale for the pain of this headache on a scale of 0 -10 | Typical headache pain intensity: 0 (no pain) to 10 (most severe pain) scale | 0;1;2;3;4;5;6;7;8;9;10 | 0;1;2;3;4;5;6;7;8;9;10 | Numeric Values |
Choose one |
Adult;Pediatric | Supplemental | 4.10 | 2023-06-02 10:23:14.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59641 | Headache aura occurrence indicator | HdchAuraOccurInd | Indicator of whether the participant/subject has an aura occur with headache | Indicator of whether the participant/subject has an aura occur with headache | Auras with headaches | Yes;No | Yes;No | Alphanumeric |
Please refer to the ICHD3 document for descriptions of the aura type |
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:22:36.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59609 | Headache post traumatic prior history time unit count | HdchPostTraumaPrrHxTmUnitCt | Number of days, months or years the participant/subject suffered from post traumatic headache | Number of days, months or years the participant/subject suffered from post traumatic headache | If 'Yes', how long ago did you suffer from PTH? | Numeric Values |
Indicate number of days, months or years |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:45:35.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C59620 | Headache severe average monthly frequency | HdchSevereAvgMnthFreq | Frequency of the average monthly headaches the participant/subject experienced with severe severity | Frequency of the average monthly headaches the participant/subject experienced with severe severity | Average monthly headache frequency of any kind with severe severity | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate average number of days patient had any kind of headache of severe severity. For patients who have had post traumatic headache for at least 30 days |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:42:23.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59652 | Aura without headache frequency category | AuraWthoutHdchFreqCat | Category that describes how frequently the headache associated symptom of aura without headache affects the participant/subject | Category that describes how frequently the headache associated symptom of aura without headache affects the participant/subject | Aura without headache | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:43:12.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59631 | Headache laterality type | HdchLateralTyp | Type of side were headache is located | Type of side were headache is located | What side(s) are the headache(s) usually on | Right only;Left only;Both sides;Alternating sides | Right only;Left only;Both sides;Alternating sides | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:06:04.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C15936 | Headache history indicator | HeadachHistInd | Indicates whether participant/subject suffers from headaches | Indicates whether participant/subject suffers from headaches | Did patient have pre-existing headaches? | Yes;No | Yes;No | Alphanumeric |
For patients with pre-existing headache |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59610 | Headache post traumatic prior history unit of measure | HdchPostTraumaPrrHxUOM | Unit of measure for the number of days, months or years the participant/subject suffered from post traumatic headache | Unit of measure for the number of days, months or years the participant/subject suffered from post traumatic headache | If 'Yes', how long ago did you suffer from PTH? | Days;Months;years | Days;Months;years | Alphanumeric |
Check appropriate unit of measure |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:46:05.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59642 | Headache aura symptom type frequency category | HdchAuraSympTypFreqCat | Category that describes how the aura symptom type effects the participant/subject | Category that describes how the aura symptom type effects the participant/subject | Did the individual experience the following aura types with headaches | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:24:09.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59621 | Headache post traumatic complete freedom monthly frequency day count | HdchPstTrmCmplFreeMoFrqDyCt | Count of monthly frequency of headaches the participant/subject experienced completely free from headache | Count of monthly frequency of headaches the participant/subject experienced completely free from headache | Average days per month of complete headache freedom | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate average number of days patient was completely free from headaches. For patients who have had post traumatic headache for at least 30 days |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:43:03.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59653 | Headache post traumatic phenotype type | HdchPostTraumaPhenotypeTyp | Type describing phenotype of post traumatic headache | Type describing phenotype of post traumatic headache | Post-traumatic headache phenotype | Migraine with aura;Migraine without aura;Chronic Migraine;Other, specify;Episodic cluster headache;Chronic cluster headache;Cervicogenic headache;Infrequent episodic tension-type headache;Frequent episodic tension-type headache;Chronic tension-type headache | Migraine with aura;Migraine without aura;Chronic Migraine;Other, specify;Episodic cluster headache;Chronic cluster headache;Cervicogenic headache;Infrequent episodic tension-type headache;Frequent episodic tension-type headache;Chronic tension-type headache | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:44:11.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59632 | Headache maximum pain intensity scale | HdchMaxPainIntstyScl | Rating scale of the maximum headache pain intensity described by the participant/subject | Rating scale of the maximum headache pain intensity described by the participant/subject | Maximum headache pain intensity: 0 (no pain) to 10 (most severe pain) scale | 0;1;2;3;4;5;6;7;8;9;10 | 0;1;2;3;4;5;6;7;8;9;10 | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:07:20.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C15937 | Headache typical severity type | HeadachTypclSevertyTyp | Level of headache intensity described by the participant/subject | Level of headache intensity described by the participant/subject | Intensity | Mild;Moderate;Severe | Mild;Moderate;Severe | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 3.10 | 2023-08-14 08:41:42.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59611 | Headache post traumatic start date | HdchPostTraumaStartDate | Date (and time, if applicable and known) for the start of participant's/subject's post traumatic headache | Date (and time, if applicable and known) for the start of participant's/subject's post traumatic headache | Date that PTH started | Date or Date & Time |
When date/time data are prepared for aggregation or sharing they should be converted to the format specified by ISO 8601, YYYY-MM-DD; hh:mm:ss. |
ISO 8601 - https://www.iso.org/iso-8601-date-and-time-format.html | Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:46:29.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C59643 | Headache aura experience percent value | HdchAuraExprncPctVal | Value of (the percentage of) headaches the participant/subject experience with auras | Value of (the percentage of) headaches the participant/subject experience with auras | Percentage of headaches experienced with auras | Numeric Values |
Percentage value may be an estimation |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:25:45.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
0 | 100 | percent | ||||||||
| C59622 | Headache at least 30 days ratio value | HdchAtLeast30DayRatioVal | Value which represents the headache ratio calculation. Applies only to patients that have had post traumatic headache for at least 30 days | Value which represents the headache ratio calculation. Applies only to patients that have had post traumatic headache for at least 30 days | Headache Ratio calculation (average number of days with mild, moderate, severe headache/ 30 days) x 100 =___ % of days with headache. | Numeric Values |
Example: If patient describes an average of 10 headaches of any severity, ratio calculation is as follows: (10/30) x 100 = 33.3% |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:45:46.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C59654 | Headache post traumatic phenotype type other text | HdchPostTraumaPhenotypOTH | The free-text field related to 'Headache post traumatic phenotype type' specifying other text | The free-text field related to 'Headache post traumatic phenotype type' specifying other text | Other, Specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:49:05.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
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| C59633 | Headache current pain scale | HdchCurrentPainScl | Scale for the current pain of this headache on a scale of 0-10 | Scale for the current pain of this headache on a scale of 0-10 | Current headache pain level 0 (no pain) to 10 (most severe pain) scale | 0;1;2;3;4;5;6;7;8;9;10 | 0;1;2;3;4;5;6;7;8;9;10 | Numeric Values |
Choose one |
Adult;Pediatric | Supplemental | 2.00 | 2023-08-15 12:20:20.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C15950 | Headache typical pain type | HdchTypcPainTyp | Type of pain the participant/subject experiences with the headache | Type of pain the participant/subject experiences with the headache | Quality | Stabbing;Burning;Pressure/Aching;Pulsating/Throbbing | Stabbing;Burning;Pressure/Aching;Pulsating/Throbbing | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59612 | Headache traumatic brain injury onset delay duration category | HdchTBIOnsetDelayDurCat | Category which represents how long after the participant's/subject's traumatic brain injury that their headaches began | Category which represents how long after the participant's/subject's traumatic brain injury that their headaches began | How long after TBI did headaches begin | Immediately;Not immediately, but within 24 hours of the TBI;Between 24-72 hours;72 hours to 7 days;After 7 days | Immediately;Not immediately, but within 24 hours of the TBI;Between 24-72 hours;72 hours to 7 days;After 7 days | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:47:00.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59644 | Nausea without headache frequency category | NausWthoutHdchFreqCat | Category that describes how frequently the headache associated symptom of nausea effects the participant/subject | Category that describes how frequently the headache associated symptom of nausea effects the participant/subject | Nausea | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:27:44.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59623 | Headache after traumatic brain injury frequency change category | HdchAftrTBIFreqChngCat | Category which represents headache frequency since participant/subject experienced a traumatic brain injury | Category which represents headache frequency since participant/subject experienced a traumatic brain injury | Headache frequency since TBI: | stable;decreasing in frequency;increasing in frequency | stable;decreasing in frequency;increasing in frequency | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 2.00 | 2023-08-14 20:48:45.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59655 | Headache category | HeadacheCat | Type of headache experienced by the participant/subject | Type of headache experienced by the participant/subject | Headache Type | Migraine;Post Traumatic Headache;Other Headache | Migraine;Post Traumatic Headache;Other Headache | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:50:50.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59634 | Headache worse with neck movement indicator | HdchWorseWthNeckMvmtInd | Indicator of whether the subject's/participant's headaches worsen with neck movements | Indicator of whether the subject's/participant's headaches worsen with neck movements | Headaches worse with neck movements | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:10:43.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C15961 | Headache worse during activity indicator | HeadachWorsDurngActvtyInd | Indicates whether activity or playing makes headache worse | Indicates whether activity or playing makes headache worse | Headaches worse with physical activity | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59613 | Headache after traumatic brain injury worsen delay duration category | HdchAftTBIWorsenDelayDurCat | Category which represents when the participant's/subject's headaches began to worsen after a traumatic brain injury | Category which represents when the participant's/subject's headaches began to worsen after a traumatic brain injury | If yes, how long after TBI did headaches begin to worsen | Immediately;Not immediately, but within 24 hours of the TBI;Between 24-72 hours;72 hours to 7 days;After 7 days | Immediately;Not immediately, but within 24 hours of the TBI;Between 24-72 hours;72 hours to 7 days;After 7 days | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:47:36.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59645 | Vomiting without headache frequency category | VomitWthoutHdchFreqCat | Category that describes how frequently the headache associated symptom of vomiting affects the participant/subject | Category that describes how frequently the headache associated symptom of vomiting affects the participant/subject | Vomiting | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:29:22.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59624 | Headache after traumatic brain injury intensity change category | HdchAftrTBIIntensChngCat | Category which represents headache intensity since participant/subject experienced a traumatic brain injury | Category which represents headache intensity since participant/subject experienced a traumatic brain injury | Headache intensity since TBI: | stable;decreasing in frequency;increasing in frequency | stable;decreasing in frequency;increasing in frequency | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:49:23.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59656 | Headache category other text | HeadacheCatOTH | The free-text field related to 'Headache category' specifying other text | The free-text field related to 'Headache category' specifying other text | Other Headache Type | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:52:09.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
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| C59635 | Headache worse with mental activity indicator | HdchWorseWthMentalActvInd | Indicator of whether the subject's/participant's headaches worsen with mental activity | Indicator of whether the subject's/participant's headaches worsen with mental activity | Headaches worse with mental activity (e.g., reading, concentration) | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:11:41.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C15972 | Headache aura symptom type | HdchAurasSymTyp | Type of aura (warning) that a headache was going to start | Type of aura (warning) that a headache was going to start | Does the individual experience the following aura types with headaches: | Visual;Sensory;Speech and/or Language;Motor;Brainstem;Retinal;Other, specify | Visual;Sensory;Speech and/or Language;Motor;Brainstem;Retinal;Other, specify | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 3.10 | 2023-08-14 20:18:35.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59614 | Headache continuous indicator | HdchContinuousInd | Indicator of whether the participant's/subject's headaches have been continuous | Indicator of whether the participant's/subject's headaches have been continuous | Have headaches been continuous (i.e., 24/7) since onset? | Yes;No | Yes;No | Alphanumeric |
Choose one If 'yes' is checked, then the headache ratio is automatically 100%. Please skip the headache ratio calculation and move to the section "For all patients with PTH to complete". |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:48:28.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59646 | Sensitivity to light without headache frequency category | LightSensitivWthoutHdchFreqCat | Category that describes how frequently the headache associated symptom of sensitivity to light effects the participant/subject | Category that describes how frequently the headache associated symptom of sensitivity to light effects the participant/subject | Sensitivity to light | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:30:20.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59625 | Week month code | WeekMonthCode | Ordinal week code for the weeks in a single month | Ordinal week code for the weeks in a single month | For patients with less than one month of PTH | Week 1;Week 2;Week 3;Week 4 | Week 1;Week 2;Week 3;Week 4 | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:51:06.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59657 | Headache type family history indicator | HeadacheTypFamHxInd | Indicator as to whether the participant/subject has a family history of diagnosed headache type | Indicator as to whether the participant/subject has a family history of diagnosed headache type | Family History of Headache Type? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:53:18.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59636 | Headache associated symptom type frequency category | HdchAssocSymptmTypFreqCat | Category that describes how frequently the headache associated symptom type effects the participant/subject | Category that describes how frequently the headache associated symptom type effects the participant/subject | Did the individual experience the following symptoms during headache | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:12:27.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C16207 | Family history medical condition first-degree relative type | FamHistMedclCondFrstDegReltTyp | Relationship of the first-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of the first-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of first-degree relative(s) to participant/subject | 1;2;3;4;5;6;7;8;9;10 | Biological Mother;Biological Father;Sibling Male;Sibling Female;Non-identical or dizygotic twin Male;Non-identical or dizygotic twin Female;Identical twin Male;Identical twin Female;Full biologic child Male;Full biologic child Female | Numeric Values |
Select the relationship from the options of the family members provided in the "Name of Family Member with Condition" code list. Record more than 1 family member, if applicable. Choose all that apply. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59615 | Headache day per month frequency | HdchDayPerMonthFreq | Frequency of headaches the participant/subject experienced within the last 30 days | Frequency of headaches the participant/subject experienced within the last 30 days | How many days do you have a headache of any duration (minutes or hours) of any kind of severity (mild, moderate or severe)? | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate number of days (a) For patients who have had post traumatic headache for fewer than 30 days, calculate headache ratio as follows Example: If patient describes having 10 headache days since onset of PTH and is being tested on day 20 post onset of PTH then (10/20) x 100 = 50% |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:48:57.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59647 | Sensitivity to sound without headache frequency category | SoundSensitivWthoutHdchFreqCat | Category that describes how frequently the headache associated symptom of sensitivity to sound effects the participant/subject | Category that describes how frequently the headache associated symptom of sensitivity to sound effects the participant/subject | Sensitivity to sound | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:32:13.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59626 | Headache days per week count | HdchDaysPerWeekCt | Count of days the participant/subject experienced headaches in a week | Count of days the participant/subject experienced headaches in a week | Headache days per week | 0;1;2;3;4;5;6;7 | 0;1;2;3;4;5;6;7 | Numeric Values |
For patients with less than one month of post traumatic headache indicate the number of days per week patient experienced a headache |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:54:36.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59658 | Relative biological first degree diagnosis headache history indicator | RelatvBioFrstDegrDxHxHdchInd | Indicator of whether first-degree biological relatives of the participant/subject has a history of diagnosed headache | Indicator of whether first-degree biological relatives of the participant/subject has a history of diagnosed headache | First Degree Biological Relative? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:54:17.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59637 | Headache additional symptom type | HdchAddtnlSymptmTyp | Type of additional symptoms the participant/subject experienced with headache | Type of additional symptoms the participant/subject experienced with headache | Headache Symptom | Miosis (i.e., excessive constriction of the pupil of the eye);Aural fullness (i.e., stuffy ears or fluid in the ears);Conjunctival Injection (i.e., white of eye gets red);Tearing;Nasal congestion;Eyelid swelling;Eyelid drooping;Facial sweating | Miosis (i.e., excessive constriction of the pupil of the eye);Aural fullness (i.e., stuffy ears or fluid in the ears);Conjunctival Injection (i.e., white of eye gets red);Tearing;Nasal congestion;Eyelid swelling;Eyelid drooping;Facial sweating | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:13:24.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C16208 | Family history medical condition second-degree relative type | FamHistMedclCondScndDegReltTyp | Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of second-degree relative(s) to participant/subject | 11;12;13;14;15;16;17;18;19;20;21;22;23;24 | Half-Sibling Male;Half-Sibling Female;Maternal Grandmother;Maternal Grandfather;Paternal Grandmother;Paternal Grandfather;Maternal Aunt;Maternal Uncle;Paternal Aunt;Paternal Uncle;Grandchild Male;Grandchild Female;Nephew;Niece | Numeric Values |
Separate multiple codes with comma |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59616 | Headache day since onset count | HdchDaySinceOnsetCt | Count of days passed since participant's/subject's onset of post traumatic headache | Count of days passed since participant's/subject's onset of post traumatic headache | Number of days passed since onset of PTH: | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate number of days (b) For patients who have had post traumatic headache for fewer than 30 days, calculate headache ratio, (a/b) x100, where a = number of days with a headache of any duration (minutes or hours) of any kind of severity (mild, moderate or severe), and b = Number of days passed since onset of post traumatic headache |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:49:21.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59648 | Neck pain stiffness without headache frequency category | NeckPnStffnessWthoutHdchFrqCat | Category that describes how frequently the headache associated symptom of neck pain/stiffness affects the participant/subject | Category that describes how frequently the headache associated symptom of neck pain/stiffness affects the participant/subject | Neck Pain/Stiffness | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:34:31.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59627 | Month code | MonthCode | Ordinal month code identifying the month within a specified count of months | Ordinal month code identifying the month within a specified count of months | For patients with greater than one month to 6 months of PTH | Month 1;Month 2;Month 3;Month 4;Month 5;Month 6 | Month 1;Month 2;Month 3;Month 4;Month 5;Month 6 | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:56:16.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59638 | Headache additional symptom type present indicator | HdchAddtnlSympTypPresentInd | Indicator of whether the participant's/subject's headache symptom is present | Indicator of whether the participant's/subject's headache symptom is present | Is Symptom Present? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:15:53.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C19035 | Headache aura symptom other text | HdchAurasSymOTH | The free-text field related to 'Headache aura symptom type' specifying other text. Type of aura (warning) that a headache was going to start | The free-text field related to 'Headache aura symptom type' specifying other text. Type of aura (warning) that a headache was going to start | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.10 | 2023-08-14 20:18:00.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events | 4000 |
Free-Form Entry |
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| C59617 | Headache less than 30 day ratio value | HdchLessThan30DayRatVal | Value which represents the headache ratio calculation. Value calculated by dividing the response from Q (a) by Q (b) and multiplying by 100. Applies only to patients that have had post traumatic headache for less than 30 days | Value which represents the headache ratio calculation. Value calculated by dividing the response from Q (a) by Q (b) and multiplying by 100. Applies only to patients that have had post traumatic headache for less than 30 days | Headache Ratio calculation (a/b) x100 | Numeric Values |
For patients who have had post traumatic headache for fewer than 30 days, calculate headache ratio as follows: |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:27:07.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
