Chronic Migraine Questionnaire

"*" indicates required fields

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):
6. In the past month, did you take anything to treat you headaches/migraines?
Check below if the following applies