CDE Detailed Report

Disease: Epilepsy
Sub-Domain: Assessing Comorbidities
CRF: Migraine Headaches Questionnaire 21-Item

Displaying 1 - 31 of 31
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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C13506 Headache Screening Survey (HSS) - severe headache previous medication indicator HSSSevereHdachePrevMedInd The indicator for having taken prescription medication for headache on a daily basis from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The indicator for having taken prescription medication for headache on a daily basis, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. 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? Yes;No Yes;No Alphanumeric

Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C13485 Household member total count HouseMembTotCt The total number of members in the participant's household. The total number of members in the participant's household. Numeric Values

Write in number

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 20
C13496 Headache Screening Survey (HSS) - household member headache unable to work scale HSSHouseMembHdacheUnabWrkScale The scale to rate the ability to function as a result of a headache experienced by each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The scale to rate the ability to function as a result of a headache experienced by each members of a participant's household who suffer from severe headaches, from Headache Screening Survey (HSS). Each time you have a severe headache, how long are you unable to work or undertake normal activities? 0 days;Less than 1 day;1-2 days;3-5 days;6 or more days 0 days (no activity restriction);Less than 1 day;1-2 days;3-5 days;6 or more days Alphanumeric

Choose only one. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C13507 Headache Screening Survey (HSS) - other current daily medication type HSSOtherCurrentDlyMedTyp The indicator for currently taking prescription medication for headache on a daily basis from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The indicator for currently taking prescription medication for headache on a daily basis, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without appearing to be the main focus of the instrument. Are you currently taking any other medication on a DAILY basis? Water pill or prescription diuretic| or high blood pressure;Prescription medicine (other than water pill) for high blood pressure;Prescription medicine for seizures, epilepsy or fits;Prescription medicine for diabetes;Prescription medicine for cholesterol;Prescription medicine for depression or anxiety Water pill or prescription diuretic| or high blood pressure;Prescription medicine (other than water pill) for high blood pressure;Prescription medicine for seizures, epilepsy or fits;Prescription medicine for diabetes;Prescription medicine for cholesterol;Prescription medicine for depression or anxiety Alphanumeric

Choose all that apply. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Multiple Pre-Defined Values Selected

C13486 Headache Screening Survey (HSS) - household members suffering severe headache count HSSHouseMembSufSevHdacheCt The total number of members of participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The total number of members of participant's household who suffer from severe headaches, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without appearing to be the main focus of the instrument. Numeric Values

Write in number

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 20
C13497 Headache Screening Survey (HSS) - household member headache last 3 month days count HSSHouseMembHdacheL3MnthDCt The number of days a headache was experienced by each members of a participant's household who suffer from severe headaches in the last three months from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The number of days a headache was experienced by each members of a participant's household who suffer from severe headaches in the last three months, as part of the Headache Screening Survey (HSS). On how many days in the last 3 months did you have a headache? Numeric Values

If headache lasted more than 1 day, count each day. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 93 day
C13508 Headache Screening Survey (HSS) - other current daily medication occurrence HSSOtherCurrentDlyMedOccur The occurrence of the last time that person took prescription medication for headache on a daily basis from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The occurrence of the last time that person took prescription medication for headache on a daily basis from Headache Screening Survey (HSS), a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. 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? Currently taking;Last took within the past 3 months;Last took 3 to 12 months ago;Last took more than 12 months ago;Never took Currently taking;Last took within the past 3 months;Last took 3 to 12 months ago;Last took more than 12 months ago;Never took Alphanumeric

Choose only one. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C13487 Headache Screening Survey (HSS) - household member suffering severe headache identifier number HSSHouseMembSufSevHdacheIdNum The numeric identifier for each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The numeric identifier for each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS), a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. Household Member 1;2;3 1;2;3 Numeric Values

Please have each member of your household who suffers from severe headaches complete the rest of this card and the following card.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C13498 Headache Screening Survey (HSS) - household member headache last three month miss work school day count HSSHouMemHdacL3MthMisWrkSchDCt The number of missed work or schools days as a result of a headache experienced by each members of a participant's household who suffer from severe headaches in the last three months from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The number of missed work or schools days as a result of a headache experienced by each members of a participant's household who suffer from severe headaches in the last three months, from Headache Screening Survey (HSS). Because of your headaches on how many days in the last 3 months did you miss work or school? Numeric Values

Write in number of days. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 93 day
C13509 Headache Screening Survey (HSS) - severe headache considered migraine indicator HSSSevereHdacheConsMigraineInd The indicator that person considers severe headache to be migraine from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The indicator that person considers severe headache to be migraine, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. Do you consider your severe headaches to be migraines? Yes;No Yes;No Alphanumeric

Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C13488 Headache Screening Survey (HSS) - household members age value HSSHouseMembAgeVal The age of each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The age of each members of a participant's household who suffer from severe headaches, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. Age Numeric Values

Write in age in years. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 99 year
C13499 Headache Screening Survey (HSS) - household member headache last three month productivity reduced day count HSSHoMemHdaL3MthPrdRdDCt The number of reduced productivity days as a result of a headache experienced by each members of a participant's household who suffer from severe headaches in the last three months from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The number of reduced productivity days as a result of a headache experienced by each members of a participant's household who suffer from severe headaches in the last three months, from Headache Screening Survey (HSS). Because of your headaches on how many days in the last 3 months was your productivity at work/school reduced by half or more? Numeric Values

Write in number of days. Do not include days missed in question 10a. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 93 day
C13510 Headache Screening Survey (HSS) - headache diagnosis type HSSHeadacheDiagTyp The type as related to headache diagnosis from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The type related to headache diagnosis, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. Have you ever been diagnosed by a physician or other health professional as suffering from headaches? Tension headaches;Sinus headaches;Cluster headaches;Stress headaches;"Sick" headaches;Migraine headaches Tension headaches;Sinus headaches;Cluster headaches;Stress headaches;"Sick" headaches;Migraine headaches Alphanumeric

Choose all that apply. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Multiple Pre-Defined Values Selected

C13489 Headache Screening Survey (HSS) - household member sex type HSSHouseMembSexTyp The sex of each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The sex of each members of a participant's household who suffer from severe headaches, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. Male;Female Male;Female Alphanumeric

Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C13500 Headache Screening Survey (HSS) - no household work day count HSSNotHouseholdWorkDayCt The number of days in the last 3 months that person could not do household work because of headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The number of days, in the last 3 months, that person could not do household work because of headaches from Headache Screening Survey (HSS), a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. Because of your headaches on how many days in the last 3 months did you not do household work? Numeric Values

Write in number of days. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 93 day
C13511 Headache Screening Survey (HSS) - migraine diagnosis age value HSSMigraineDiagAgeVal The age value of being diagnosed with migraines from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The age value of being diagnosed with migraines, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. If diagnosed with migraines, at what age were you FIRST DIAGNOSED with migraines? Numeric Values

Write in age. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 99
C13490 Headache Screening Survey (HSS) - household member headache symptom type HSSHouseMembHdacheSympTyp The types of headache symptoms experience by each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The types of headache symptoms experience by each members of a participant's household who suffer from severe headaches, from Headache Screening Survey (HSS). When you have a severe headache, do you experience any of the following? Nausea;Vomiting;Pain on one side of head only;Pulsating/throbbing headaches;Pain-free intervals of days or weeks between severe headache attacks;Sensitivity to light;Sensitivity to noise;Blurring of vision;Seeing shimmering lights, circles, other shapes, or colors before the eyes, before the headache starts;Numbness of lips, tongue, fingers, or legs before the headache starts Nausea;Vomiting;Pain on one side of head only;Pulsating/throbbing headaches;Pain-free intervals of days or weeks between severe headache attacks;Sensitivity to light;Sensitivity to noise;Blurring of vision;Seeing shimmering lights, circles, other shapes, or colors before the eyes, before the headache starts;Numbness of lips, tongue, fingers, or legs before the headache starts Alphanumeric

Choose all that apply. Completed by and answered for each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Multiple Pre-Defined Values Selected

C13501 Headache Screening Survey (HSS) - reduced household work day count HSSReducedHouseholdWorkDayCt The number of days in the last 3 months that productivity in household work was reduced by half or more because of headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The number of days in the last 3 months that productivity in household work was reduced by half or more because of headaches, from Headache Screening Survey (HSS). Because of your headaches on how many days in the last 3 months was your productivity in household work reduced by half or more? Numeric Values

Write in number of days. Do not include days counted in question 10c. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 93 day
C13512 Headache Screening Survey (HSS) - migraine household total count HSSMigraineHousehldTtlCt How many household members (including yourself) suffer from MIGRAINE headaches? How many household members (including yourself) suffer from MIGRAINE headaches, as part of the Headache Screening Survey (HSS) questionnaire. How many household members (including yourself) suffer from MIGRAINE headaches? number who suffer migrain headaches: Numeric Values

Write in number.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 1.00 2012-10-05 00:00:00.0 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 20
C13491 Headache Screening Survey (HSS) - household member headache occurrence week frequency HSSHouseMembHdacheOccWkFreq The number headaches experienced by each members of a participant's household who suffer from severe headaches in a week from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The number headaches experienced by each members of a participant's household who suffer from severe headaches in a week, as part of the Headache Screening Survey (HSS). About how often do your severe headaches occur? number in a week Numeric Values

Answer for headache days per week OR per month OR in a year. Completed by and answered for each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 7 day
C13502 Headache Screening Survey (HSS) - missed activity day count HSSMissedActivityDayCt The number of days in the last 3 months person missed family, social or leisure activities because of headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The number of days in the last 3 months person missed family, social or leisure activities because of headaches, as part of the Headache Screening Survey (HSS). Because of your headaches on how many days in the last 3 months did you miss family, social or leisure activities? Numeric Values

Write in number of days. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 93 day
C13492 Headache Screening Survey (HSS) - household member headache occurrence month frequency HSSHouseMembHdacheOccMnthFreq The number headaches experienced by each members of a participant's household who suffer from severe headaches in a month. The number headaches experienced by each members of a participant's household who suffer from severe headaches in a month, , as part of the Headache Screening Survey (HSS) questionnaire. About how often do your severe headaches occur? number in a month Numeric Values

Answer for headache days per week OR per month OR in a year. Completed by and answered for each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 31 day
C13503 Headache Screening Survey (HSS) - severe headache began age value HSSSevereHeadacheBeginAgeVal The age value of when person began to have severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The age value of when person began to have severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. At what age did you BEGIN having severe headaches? Numeric Values

Write in age. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 99
C01522 Height measurement HgtMeasr Measurement of participant's/subject's height. Measurement of participant's/subject's height. Height/Length Numeric Values

Record the height (or length for the very young) of the participant/subject. To be collected at the visit, not self-reported. Also, indicate whether height was measured in inches (in) or centimeters (cm). Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 400 centimeter 649
C13493 Headache Screening Survey (HSS) - household member headache occurrence year frequency HSSHouseMembHdacheOccYrFreq The number headaches experienced by each members of a participant's household who suffer from severe headaches in a year from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The number headaches experienced by each members of a participant's household who suffer from severe headaches in a year, as part of the Headache Screening Survey (HSS). About how often do your severe headaches occur? number in a year Numeric Values

Answer for headache days per week OR per month OR in a year. Completed by and answered for each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 366 day
C13504 Headache Screening Survey (HSS) - severe headache emergency care indicator HSSSevereHdacheEmergCarInd Indicator for having gone to hospital emergency room or to an urgent care clinic because of severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. Indicator for having gone to hospital emergency room or to an urgent care clinic because of severe headaches, from Headache Screening Survey (HSS). Have you ever gone to the hospital emergency room or to an urgent care clinic because of your severe headaches? Yes;No Yes;No Alphanumeric

Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C01541 Weight measurement WgtMeasr Measurement of participant's/subject's weight Measurement of participant's/subject's weight Weight Numeric Values

Record the weight of the participant/subject. To be collected at the visit, not self-reported. Also, indicate whether weight was measured in pounds (lbs) or kilograms (kg). Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Free-Form Entry

0 500 kilogram 2179689
C13494 Headache Screening Survey (HSS) - household member headache pain scale HSSHouseMembHdachePainScale The scale to rate the pain caused by a headache experienced by each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The scale to rate the pain caused by a headache experienced by each members of a participant's household who suffer from severe headaches, from Headache Screening Survey (HSS). Which statement best describes the pain of your severe headaches? Extremely severe pain;Severe pain;Moderately severe pain;Mild pain Extremely severe pain;Severe pain;Moderately severe pain;Mild pain Alphanumeric

Choose only one. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C13505 Headache Screening Survey (HSS) - severe headaches treatment type HSSSevereHdacheTreatTyp The types of ways that usually treat severe headache from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The types of ways that usually treat severe headache, as part of the Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. Which best describes the way you usually treat severe headaches? Take non-prescription medications;Take prescription medications;Take both prescription and non-prescription medications;Take no medications Take non-prescription medications;Take prescription medications;Take both prescription and non-prescription medications;Take no medications Alphanumeric

Choose only one. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C01582 Height unit of measure HgtUOM Unit of measure for the height numerical value for subject/participant Unit of measure for the height numerical value for subject/participant Height/Length Inches;Centimeters Inches;Centimeters Alphanumeric

Choose either Inches (in) or Centimeters (cm). Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

2538920
C13495 Headache Screening Survey (HSS) - household members headache affect scale HSSHouseMembHdacheAffScale The scale to rate the affect caused by a headache experienced by each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument. The scale to rate the affect caused by a headache experienced by each members of a participant's household who suffer from severe headaches, from Headache Screening Survey (HSS). Which best describes how your are usually affected by severe headaches? Able to work/function normally;Working ability or activity impaired to some degree;Working ability or activity severely impaired;Bed rest required Able to work/function normally;Working ability or activity impaired to some degree;Working ability or activity severely impaired;Bed rest required Alphanumeric

Choose only one. Completed by each member of your household who suffers from severe headaches.

Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657. Adult Supplemental 3.00 2013-08-28 16:08:00.453 Migraine Headaches Questionnaire 21-Item Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

CSV