Do you have more than one type of headache?

A. Never
B. Rarely
C. Sometimes
D. Often
E. Very Often

Does your mother, father, siblings or children have similar headaches?

A. Never
B. Rarely
C. Sometimes
D. Often
E. Very Often

Does your headache pain pounds or throbs your head?

A. Never
B. Rarely
C. Sometimes
D. Often
E. All the times

Alcoholic drinks cause or aggravate your headaches.

A. Never
B. Rarely
C. Sometimes
D. Often
E. All the times

Does chocolate, cheese, milk, nuts, Chinese food, or any food cause or worsen your headaches?

A. Never
B. Rarely
C. Sometimes
D. Often
E. All the times

Would you desribe your headache as moderate to severe in intensity?

A. None
B. Light
C. Moderate
D. High
E. Severe

Does your headache ever require you to lie down?

A. Never
B. Rarely
C. Sometimes
D. Often
E. All the times

Do you ever miss work (or school) becaue of the headache?

A. Never
B. Rarely
C. Sometimes
D. Often
E. Lot of times

Is your headache unresponsive to paracetamol or anti-inflammatories? (eg panadol, aspirin, nurofen)

A. Never
B. Rarely
C. Sometimes
D. Often
E. All the times

Do you ever experience difficulty thinking or speaking clearly with a headache?

A. Never
B. Rarely
C. Sometimes
D. Often
E. All the times