Headache Assessment Questionnaire

Headache Assessment
1. Did the headaches start after an:
3. Are the headaches constant or do they come and go?
4. How often do the headaches occur?
5. Do the headaches occur at a certain time of day?
7. Do the headaches ever wake you up when you're sleeping?
8. Does rest or sleep relieve the headache?
10. Have you ever missed work or school because of a headache?
11. Is the headache pain intense when it starts, or does it start out small and build up?
13. Please check all of the things that bring on the headaches:
14. Are there any warning signs BEFORE the headache begins?
15. Where is the headache located?
16. What does the pain feel like?
17. Are there any other symptoms when you have a headache?
22. Have you had any of the following tests? (tick all that apply)

Headache Diary

If your GP has asked you to complete the headache diary as well, you can access them here: PDF | Word

Once complete you can either hand in at reception, or use our file upload form.

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