This questionnaire is designed to help your doctor understand the type, severity, and possible cause of your headache.

PATIENT INSTRUCTIONS

Please answer each question based on your symptoms during the last 3 months.

There are no right or wrong answers. Your responses will assist in differentiating between migraine, sinus-related headache, tension-type headache, cluster headache, and identifying warning signs that require urgent attention.

Please mark one circle per question based on how much each problem has affected you in the last 3 months.

0 = No problem | 5 = Severe problem