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Billing: (716) 281-0055
What We Do
Partners in Health
How We Help
About Chiropractic Care
Patient Services – Botox
Tendon Pain Management
Regenerative Injection Therapy
Pain Counseling Services
Lower Back Pain Therapy
Joint Medical Injections
Pain Counseling Service
The Role of Surgery
Preparation for Visits
Preparation for First Physical Therapist Visit
Accessing The Patient Portal
Chronic Migraine Questionnaire
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A. How many days in the past month did you spend with headache/migraine? (Include ALL days with any headache pain of any kind, even those you didn't feel you needed to take any medication for or only took an over-the-counter medication).
B. How many days in the past month did you spend without ANY headache pain of any kind (headache-free days)?
C. Days with headache (31 minus days with no headache)
1. Do the days in either A or C equal 15 or more?
2. Did any of your headaches/migraines last more than 4 hours if you didn't treat them?
3. Have you ever been diagnosed as having chronic headaches (including chronic tension-type or chronic sinus headaches)?
4. Have you ever been diagnosed as having migraines?
5. Do your headaches/migraines impact your daily life?
Rate impact on your daily life, from 1 (Mild) through 10 (Severe):
How many days in the past month have your headaches/migraines severely affected your daily life?
6. In the past month, did you take anything to treat you headaches/migraines?
If "yes," how many days in the past month did you take something to treat your headaches/migraines (including over-the-counter drugs, prescription medication, and vitamins/herbal remedies)?
Please list what you took:
Check below if the following applies
Check here if you answered "YES" to both 1 and 2 and at least one of the other questions. You may have chronic migraine.