|
most days
once every week or two
less than once a month
|
|
|
Are your headaches |
|
mild?
moderate?
severe? |
|
| Do
any of the following symptoms accompany your headaches? |
| visual
disturbances vomiting or nausea |
| intense
throbbing pain
sensitivity to light, sound or smell |
|
| Do
you suffer from neck ache or stiffness in the neck/shoulders? |
| yes
no
|
|
|
| How
long do you sit in front of a computer terminal? |
| less
than 3 hours/day
more
than 3 hours/day |
|
| How
often do you feel stressed? |
| most
days I feel stressed I
sometimes feel stressed
I
rarely feel stressed |
|
| Do
you have eyesight problems? |
| yes
no
|
|
| Do
you regularly take headache tablets? |
| yes
no
|
|
| Do
you suffer from hay-fever or sinus congestion? |
| yes
no
|
|
| How
often do you eat chocolate? |
| Occasionally/never
every
day
a
few times each week |
|
| How
often do you eat hard cheeses? |
| Occasionally/never
every
day
a
few times each week |
|
| How
often do you consume alcohol? |
| Occasionally/never
every
day
a
few times each week |
|
| How
often do you consume artificial sweetners e.g. 'diet' drinks, cakes/biscuits
& sweets? |
| Occasionally/never
every
day
a
few times each week |
|
| How
often do you eat chinese takeaways, crisps or packaged foods? |
| Occasionally/never
every
day
a
few times each week |
|
