Please fill out the form below:

1.* Headache duration
2.* In the hour before it started, did you notice eyesight interference
such as flashing lights, zigzag lines, blind spots or temporary hand, leg
or face numbness?
No Yes
3.* Was the headache on one side of the head or both? One Both
4.* What was the headache quality?                  Pulsating Pressing Throbbing
5.* Did physical activity (such as walking upstairs) make the headache worse? No Yes
6.* How bad was your headache overall?           Not bad Quite bad Very bad
7.* Were you nauseated? (did you feel you were going to be sick)? No Yes
8.* Did you throw up? No Yes
9.* Were you bothered by the light? No Yes
10.* Were you bothered by the noise? No Yes
11.* Were you bothered by the smell? No Yes
12.* During headache, did you have one of the following: eye redness,
tearing eye, pupil constriction, lower eyelid, runny nose or nasal
congestion, sweating half of the face?
No Yes
* These fields are mandatory