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Protocol - Migraine - Adult

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Description:

The Self-Administered Questionnaire for Migraine is a 20-item questionnaire that assesses the frequency of severe headaches, the level of pain, whether the person is taking medications, and associated complications such as nausea.

Protocol:

1. Over the past year, have you suffered from severe headaches?

[ ] 1 Yes

[ ] 2 No

If Yes, go to question 2.

If No, questionnaire is complete.

2a. Age:

_______(Write In Age)

2b. Sex

[ ] 1 Male

[ ] 2 Female

3. When you have a severe headache, do you experience any of the following? (X ALL That Apply)

[ ] 1 Nausea

[ ] 2 Vomiting

[ ] 3 One side of head only

[ ] 4 Pulsating/throbbing headaches

[ ] 5 Pain-free intervals of days or weeks between severe headache attacks

[ ] 6 Sensitivity to light

[ ] 7 Sensitivity to noise

[ ] 8 Blurring of vision

[ ] 9 Seeing shimmering lights, circles, other shapes, or colors before the eyes, before the headache starts

[ ] 10 Numbness of lips, tongue, fingers, or legs before the headache starts

4. About how often do your severe headaches occur? (Write In Number Of Headache Days You Have Per Week Or Month Or Year)

_______# in a week, OR

_______# in a month, OR

_______# in a year

5. Which statement best describes the pain of your severe headaches? (X ONE)

[ ] 1 Extremely severe pain

[ ] 2 Severe pain

[ ] 3 Moderately severe pain

[ ] 4 Mild pain

6. Which best describes how you are usually affected by severe headaches? (X ONE)

[ ] 1 Able to work/function normally

[ ] 2 Working ability or activity impaired to some degree

[ ] 3 Working ability or activity severely impaired

[ ] 4 Bed rest required

7. Each time you have a severe headache, how long are you unable to work or undertake normal activities? (X ONE)

[ ] 1 0 days (no activity restriction)

[ ] 2 Less than 1 day

[ ] 3 1-2 days

[ ] 4 3-5 days

[ ] 5 6 or more days

8. On how many days in the last 3 months did you have a headache (if headache lasted more than 1 day, count each day)?

_______(Write In # Days)

9. Because of your headaches on how many days in the last 3 months . . . ?

a. did you miss work or school

_______(Write In # Days)

b. was your productivity at work/school reduced by half or more (not including days missed in qu. 9a above)

_______(Write In # Days)

c. did you not do household work

_______(Write In # Days)

d. was your productivity in house-hold work reduced by half or more (not including days counted in qu. 9c above)

_______(Write In # Days)

e. did you miss family, social, or leisure activities

_______(Write In # Days)

10. At what age did you BEGIN having severe headaches?

_______(Write In Age)

11. Have you ever gone to the hospital emergency room or to an urgent care clinic because of your severe headaches?

[ ] 1 Yes

[ ] 2 No

12. Which best describes the way you usually treat severe headaches? (X ONE)

[ ] 1 Take non-prescription medications

[ ] 2 Take prescription medications

[ ] 3 Take both prescription and non-prescription medications

[ ] 4 Take no medications

13. 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?

[ ] 1 Yes

[ ] 2 No

14. Are you currently taking any other medication on a DAILY basis? (X ALL That Apply)

[ ] 1 Water pill or prescription diuretic for high blood pressure

[ ] 2 Prescription medicine (other than water pill) for high blood pressure

[ ] 3 Prescription medicine for seizures, epilepsy, or fits

[ ] 4 Prescription medicine for diabetes

[ ] 5 Prescription medicine for cholesterol

[ ] 6 Prescription medicine for depression or anxiety

15. 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? (X ONE)

[ ] 1 Currently taking

[ ] 2 Last took within the past 3 months

[ ] 3 Last took 3 to 12 months ago

[ ] 4 Last took more than 12 months ago

[ ] 5 Never took

16. Do you consider your severe headaches to be migraines?

[ ] 1 Yes

[ ] 2 No

17. Have you ever been diagnosed by a physician or other health professional as suffering from . . . ? (X ALL That Apply)

[ ] 1 Tension headaches

[ ] 2 Sinus headaches

[ ] 3 Cluster headaches

[ ] 4 Stress headaches

[ ] 5 "Sick" headaches

[ ] 6 Migraine headaches

18. If diagnosed with migraines, at what age were you FIRST DIAGNOSED with migraines?

_______(Write In Age)

19. Height?

______(Write In) Feet

______(Write In) Inches

20. Current weight?

______(Write In Pounds)

Scoring Instructions

In Lipton et al. (2001), respondents were classified as suffering from migraine if they fulfill the criteria for migraine with aura and migraine without aura established in 1998 by the International Headache Society (IHS) (Headache Classification Committee of the International Headache Society, 1998). This included one or more severe headache in the last year with "unilateral or pulsatile pain, and either nausea, vomiting, or phonophobia with photophobia; or visual or sensory aura before the headache" (Lipton et al., 2001). These criteria were updated by the International Headache Society in 2004 (Headache Classification Subcommittee of the International Headache Society, 2004).

Protocol Name from Source:

Self-Administered Questionnaire for Migraine

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

The respondent will need a copy of the questionnaire.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Life Stage:

Adult

Participants:

Adult, aged 18 years or older.

Specific Instructions:

None

Selection Rationale

The Self-Administered Questionnaire for Migraine was vetted against similar instruments and chosen because it is a relatively short, validated protocol that is relatively easy to administer and has been used in a large-scale epidemiological study (American Migraine Prevalence and Prevention Study).

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Headache Assessment Description Text 3107301 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Migraine proto 62765-3 LOINC
Process and Review

Expert Review Panel 4 (ERP 4) reviewed the measures in the Neurology, Psychiatric, and Psychosocial domains.

Guidance from ERP 4 included the following:

  • No changes

Source

Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L., & Reed, M. (2001). Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache, 41, 646-657.

General References

Headache Classification Committee of the International Headache Society. (1998). Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia, 8(Suppl. 7), 1-96.

Headache Classification Subcommittee of the International Headache Society. (2004). The International Classification of Headache Disorders. Part one: The primary headaches. Cephalalgia, 24(Suppl. 1), 23-136.

Protocol ID:

130501

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX130501_Age_Diagnosed_With_Migraines PX130501180000 If diagnosed with migraines, at what age were you FIRST DIAGNOSED with migraines? 4 Variable Mapping
PX130501_Age_Headaches_Began PX130501100000 At what age did you BEGIN having severe headaches? 4 N/A
PX130501_Any_Other_Daily_Medication_Other_Prescription_High_BP PX130501140200 Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 2 = Prescription medicine (other than water pill) for high blood pressure 4 N/A
PX130501_Any_Other_Daily_Medication_Prescription_Cholesterol PX130501140500 Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 5 = Prescription medicine for cholesterol 4 N/A
PX130501_Any_Other_Daily_Medication_Prescription_Depression PX130501140600 Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 6 = Prescription medicine for depression or anxiety 4 N/A
PX130501_Any_Other_Daily_Medication_Prescription_Diabetes PX130501140400 Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 4 = Prescription medicine for diabetes 4 N/A
PX130501_Any_Other_Daily_Medication_Prescription_Seizures PX130501140300 Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 3 = Prescription medicine for seizures, epilepsy, or fits 4 N/A
PX130501_Any_Other_Daily_Medication_Water_Pill_Diuretic_High_BP PX130501140100 Are you currently taking any other medication on a DAILY basis? (X ALL That Apply) 1 = Water pill or prescription diuretic for high blood pressure 4 N/A
PX130501_Consider_Headaches_ToBe_Migraines PX130501160000 Do you consider your severe headaches to be migraines? 4 N/A
PX130501_Current_Age PX130501020100 Age: 4 N/A
PX130501_Diagnosed_With_Headache_Type_Cluster PX130501170300 Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 3 = Cluster headaches 4 N/A
PX130501_Diagnosed_With_Headache_Type_Migraine PX130501170600 Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 6 = Migraine headaches 4 N/A
PX130501_Diagnosed_With_Headache_Type_Sick PX130501170500 Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 5 = Sick headaches 4 N/A
PX130501_Diagnosed_With_Headache_Type_Sinus PX130501170200 Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 2 = Sinus headaches 4 N/A
PX130501_Diagnosed_With_Headache_Type_Stress PX130501170400 Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 4 = Stress headaches 4 N/A
PX130501_Diagnosed_With_Headache_Type_Tension PX130501170100 Have you ever been diagnosed by a physician or other health professional as suffering from... ? (X ALL That Apply) 1 = Tension headaches 4 N/A
PX130501_Ever_GoneTo_Hospital_For_Headaches PX130501110000 Have you ever gone to the hospital emergency room or to an urgent care clinic because of your severe headaches? 4 N/A
PX130501_Gender PX130501020200 Sex 4 N/A
PX130501_Headache_Complications_Intervals_Between_Severe_Headaches PX130501030500 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 5 = Pain-free intervals of days or weeks between severe headache attacks 4 N/A
PX130501_Headache_Complications_Light_Sensitivity PX130501030600 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 6 = Sensitivity to light 4 Variable Mapping
PX130501_Headache_Complications_Nausea PX130501030100 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 1 = Nausea 4 Variable Mapping
PX130501_Headache_Complications_Noise_Sensitivity PX130501030700 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 7 = Sensitivity to noise 4 Variable Mapping
PX130501_Headache_Complications_Numbness PX130501031000 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 10 = Numbness of lips, tongue, fingers, or legs before the headache starts 4 N/A
PX130501_Headache_Complications_One_Side_Only PX130501030300 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 3 = One side of head only 4 Variable Mapping
PX130501_Headache_Complications_Pulsating_Throbbing PX130501030400 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 4 = Pulsating/throbbing headaches 4 Variable Mapping
PX130501_Headache_Complications_Seeing_Things_Before PX130501030900 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 9 = Seeing shimmering lights, circles, other shapes, or colors before the eyes, before the headache starts 4 Variable Mapping
PX130501_Headache_Complications_Vision_Blurring PX130501030800 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 8 = Blurring of vision 4 N/A
PX130501_Headache_Complications_Vomiting PX130501030200 When you have a severe headache, do you experience any of the following? (X ALL That Apply) 2 = Vomiting 4 Variable Mapping
PX130501_Headache_Frequency_Last_Three_Months PX130501080000 On how many days in the last 3 months did you have a headache (if headache lasted more than 1 day, count each day)? 4 N/A
PX130501_Headache_Prescription_Medication_Daily_Basis PX130501130000 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? 4 N/A
PX130501_Height_Feet PX130501190000 Height? 4 N/A
PX130501_Height_Inches PX130501190100 Height? 4 N/A
PX130501_How_Affected_By_Headaches PX130501060000 Which best describes how you are usually affected by severe headaches? (X ONE) 4 N/A
PX130501_How_Long_Unable_To_Work PX130501070000 Each time you have a severe headache, how long are you unable to work or undertake normal activities? (X ONE) 4 N/A
PX130501_Last_Took_Daily_Headache_Medication PX130501150000 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? (X ONE) 4 N/A
PX130501_Number_Days_HouseWork_Reduced_Half PX130501090400 Because of your headaches on how many days in the last 3 months... ? was your productivity in house-hold work reduced by half or more (not including days counted in qu. 9c above) 4 N/A
PX130501_Number_Days_Miss_Activities PX130501090500 Because of your headaches on how many days in the last 3 months... ? did you miss family, social, or leisure activities 4 N/A
PX130501_Number_Days_Miss_School PX130501090100 Because of your headaches on how many days in the last 3 months... ? did you miss work or school 4 N/A
PX130501_Number_Days_No_House_Work PX130501090300 Because of your headaches on how many days in the last 3 months... ? did you not do household work 4 N/A
PX130501_Number_Days_Reduced_Productivity PX130501090200 Because of your headaches on how many days in the last 3 months... ? was your productivity at work/school reduced by half or more (not including days missed in qu. 9a above) 4 N/A
PX130501_Severe_Headaches_AverageFrequency_Time_Frame PX130501040100 About how often do your severe headaches occur? (Write In Number Of Headache Days You Have Per Week Or Month Or Year) 4 Variable Mapping
PX130501_Severe_Headaches_Average_Frequency PX130501040000 About how often do your severe headaches occur? (Write In Number Of Headache Days You Have Per Week Or Month Or Year) 4 Variable Mapping
PX130501_Severe_Headaches_Last_Year PX130501010000 Over the past year, have you suffered from severe headaches? 4 Variable Mapping
PX130501_Severe_Headache_Pain_Type PX130501050000 Which statement best describes the pain of your severe headaches? (X ONE) 4 N/A
PX130501_Usual_Headache_Treatment PX130501120000 Which best describes the way you usually treat severe headaches? (X ONE) 4 N/A
PX130501_Weight PX130501200000 Weight? 4 Variable Mapping
Research Domain Information
Measure Name:

Migraine

Release Date:

October 8, 2010

Definition

A questionnaire to assess migraines and headaches.

Purpose

This measure is used to screen a general population for the presence of headaches and migraines and to assess some of the associated symptoms.

Keywords

Neurology, headache, pain, sickle cell disease, SCD