Get the free Hartford Headache Center - Initial Consultation Questionnaire

This document is a questionnaire for patients visiting the Hartford Headache Center to collect initial consultation information regarding their headaches and related medical history.

How to fill out hartford headache center

How to fill out Hartford Headache Center - Initial Consultation Questionnaire

1. Start with basic information: Fill out your name, contact information, and date of birth.
2. Provide details about your symptoms: Describe the type, frequency, and duration of your headaches.
3. List any medications: Include both prescribed and over-the-counter medications you are currently taking.
4. Document your medical history: Mention any past medical conditions or surgeries relevant to your headaches.
5. Note family history: Indicate if anyone in your family has a history of headaches or related conditions.
6. Complete lifestyle questions: Include information about your diet, exercise habits, and sleep patterns.
7. Review and submit: Double-check all the information for accuracy and completeness before submitting the questionnaire.

Who needs Hartford Headache Center - Initial Consultation Questionnaire?

1. Individuals experiencing recurrent or severe headaches or migraines.
2. Patients seeking a comprehensive evaluation of their headache condition.
3. Anyone who has not found relief through general treatment for headaches.
4. Individuals who want to explore specialized care options for managing headaches.

People Also Ask about

What are the 5 C's of headaches?

What are the 5 Cs of migraine headaches? While dehydration can be a migraine trigger, it's not the best-known one. One commonly suspected set of triggers is known as the 5 Cs – cheese, chocolate, coffee, cola, and citrus fruits.

What are the five items of the migraine screen questionnaire?

The validated tool assesses the following items: frequency, intensity duration of headache, nausea, sensitivity to light/ noise and disability.

What are the top 3 causes of headaches?

About headaches There are different types of headache and many different causes, which explains why the condition is so common. Most headaches have more than one contributing factor. Some of the more common triggers for headache are lifestyle related, such as poor diet, stress, muscle tension, and lack of exercise.

What questions are asked during a migraine screening?

It comprises four questions: (1) "Have you ever had migraine?" (2) "Have you ever had severe headache accompanied by nausea?" (3) "Have you ever had severe headache accompanied by hypersensitivity to sound and light?" (4) "Have you ever had visual disturbances lasting 5-60 min followed by headache?" A telephone

What are the triage questions for headaches?

Have you ever had a headache like this before? What chronic illnesses do you have? What medications do you take daily and what have you taken for the headache so far? Other concerns must be addressed also, such as “Is the patient difficult to awaken, confused or disoriented?

What questions are asked in a headache interview?

Headache Questionnaire How old were you when you remember having your first troublesome headache? Do you think you have more than one type of headache? Yes No Maybe If so, how many different kinds of headaches do you have?

What questions to ask for a headache?

The Standard Headache History Table 1. Since how long have you been having headaches? Where in the head does it pain and how does it radiate? How often does the head pain? How long does each attack last? How severe is the pain? What type of pain is it? What factors can precipitate or worsen the headache.

What questions to ask for headaches?

The Standard Headache History Table 1. Since how long have you been having headaches? Where in the head does it pain and how does it radiate? How often does the head pain? How long does each attack last? How severe is the pain? What type of pain is it? What factors can precipitate or worsen the headache.

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What is Hartford Headache Center - Initial Consultation Questionnaire?

The Hartford Headache Center - Initial Consultation Questionnaire is a form designed to collect pertinent information about a patient's headache history and symptoms to facilitate an effective evaluation and treatment plan.

Who is required to file Hartford Headache Center - Initial Consultation Questionnaire?

Individuals seeking an initial consultation at the Hartford Headache Center are required to complete the Initial Consultation Questionnaire.

How to fill out Hartford Headache Center - Initial Consultation Questionnaire?

To fill out the Hartford Headache Center - Initial Consultation Questionnaire, patients should provide detailed information about their medical history, headache frequency, migraine triggers, current medications, and any relevant family history of headaches, ensuring that all sections are completed accurately.

What is the purpose of Hartford Headache Center - Initial Consultation Questionnaire?

The purpose of the Hartford Headache Center - Initial Consultation Questionnaire is to gather comprehensive data that allows healthcare professionals to assess the patient's condition, identify potential causes of headaches, and determine appropriate treatment options.

What information must be reported on Hartford Headache Center - Initial Consultation Questionnaire?

The information required includes personal details, headache history (type, duration, and frequency), symptom description, medication usage, treatment history, and family history of headaches or related disorders.