Migraine Assessment

Migraine AssessmentDeveloper2023-09-26T17:36:52+00:00

This questionnaire was designed to help you describe and communicate the way you feel and what you cannot do because of headaches.

Name

First

Last

This is optional. If you put your name, it will be shown in the PDF report.

This is optional. If you enter a valid email, we will email you your HIT-6 Score in a PDF attachment.

1. When you have headaches, how often is the pain severe? *

Never
Rarely
Sometimes
Very Often
Always

2. How often do headaches limit your ability to do usual daily activities including household work, work, school, or social activities? *

Never
Rarely
Sometimes
Very Often
Always

3. When you have a headache, how often do you wish you could lie down? *

Never
Rarely
Sometimes
Very Often
Always

4. In the past 4 weeks, how often have you felt too tired to do work or daily activities because of your headaches? *

Never
Rarely
Sometimes
Very Often
Always

5. In the past 4 weeks, how often have you felt fed up or irritated because of your headaches? *

Never
Rarely
Sometimes
Very Often
Always

6. In the past 4 weeks, how often did headaches limit your ability to concentrate on work or daily activities? *

Never
Rarely
Sometimes
Very Often
Always

By submitting this form, you agree to our privacy policy.

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