Variable* | Question | Response format |
---|---|---|
Headache characteristics | ||
Frequency of headache | How often do you have a headache? | 1–2 days a week, 3–5 days a week, Almost every day |
Duration of episode | How long does your headache last? | Less than 2 h, 2 h up to half a day, The whole day, All day and all night. Dichotomized into ‘Less than 2 h’ and ‘2 h or more’ |
Typical location | Where is your headache most commonly located? | Whole head, Backside of the head, One side of the head, The neck, The forehead, Behind one eye, Varies a lot |
Co-occurring symptoms | Do you have other symptoms with your headache? | Nausea, Vomiting, Light sensitivity, Sound sensitivity |
Aggravation by sports | Does sport give you a headache? | Yes, no |
Typical pain intensity | Pick the number on a 0–10 pain scale that describes your most common headache | 0–10 (numerical rating scale; no pain to worst imaginable pain) |
Baseline information | ||
Age | 7–14 | |
Sex | Male, female | |
Height | Height in cm (mean, 10th and 90th percentile) | |
Weight | Weight in kg (mean, 10th and 90th percentile) | |
Overweight♣ | Yes, no | |
Obese♣ | Yes, no | |
Cervical dysfunction** | Variable generated on the basis on cervical joint dysfunctions found on examination | Yes, no |
Decreased cervical motion** | Found on examination | Yes, no |
Thoracic dysfunction** | Variable generated on the basis on thoracic joint dysfunctions found on examination | Yes, no |
Lumbar dysfunction** | Variable generated on the basis on lumbar joint dysfunctions found on examination | Yes, no |
Pelvic dysfunction** | Variable generated on the basis on pelvic joint dysfunctions found on examination | Yes, no |
Temperomandibular dysfunction** | Variable generated on the basis on temperomandibular joint dysfunctions found on examination | Yes, no |
Duration of headache | How long have you suffered from headache? | 0.5–1 year, 1–3 years, More than 3 years |
Typical onset of attack | When does the headache most often begin? | Morning, Late morning, Afternoon, Evening/night, Varies over day and night |
Co-occurring symptoms | Do you have other symptoms with your headache? | Dizziness, Stomach pain, Visual disorder, Spots in from of eyes, Numbness in arms, Other |
Trigger factors | Does any of these give you a headache? | Neck pain, Back pain, Stress, Sitting, Reading, Computer/tv, Menstruation |
Relieving factors | Does any of these relieve your headache? | Lying sown, Sleeping, Eating, drinking, Fresh air, Sports, Medicine |
Neck pain last year | Have you had neck pain within the last year? | Yes, no |
Back pain last year | Have you had back pain within the last year? | Yes, no |
Dental braces | Do you wear braces on your teeth? | Yes, no |
Non-prescriptive medicine | How often do you do you take non-prescription medication for headache? | Never, 1–3 times a month, 1–3 times a week, More than 3 times a week |
Prescriptive medicine | Do you take prescription medication for your headache? | Yes, no |
Medication other disease | Do you take medication regularly for other diseases? | Yes, no |
Examination general practitioner | Were you ever examined by a general practitioner for your headache? | Yes, no |
Examination pediatric specialist | Were you ever examined by a pediatric specialist for your headache? | Yes, no |
Previous treatment | Did you ever get treatment for your headache? | Yes, no |
Treatment | Who gave you the treatment? | General practitioner, pediatrician, physiotherapist, chiropractor, other (reflexology, massage, other) |
Trauma to head/neck without need to see doctor | How many times have you hurt your head and/or neck without seeking a doctor or emergency room? | Never, 1–3 times, More than 3 times |
Trauma to head/neck with need to see doctor | How many times have you hurt your head and/or neck and been seen by doctor or gone to the emergency room? | Never, 1–3 times, More than 3 times |
Concussion | Have you ever had a concussion? | Yes, no |
Allergies | Do you have any allergies (pollen, food, perfume, colourants, animals, dust mite, smoke, other)? | Yes, no |
Stomach pain | Do you have stomach pain? | No, Rarely (1–5 times a year), Sometimes (6–12 times a year), Often (more than once a month) |
Smoking in the home | Does anybody smoke in your home? | Yes, no |
Number of days with sport per week | How many hours per week do you do sports? | 0 times, 1–3 times, More than 3 times |
Screentime | How many hours per day do you spend on computer/TV/I-pad/mobile phone? | 0–1 h, 2–4 h, 5–6 h, More than 6 h |
Poor sleep | Do you sleep well? | Yes, no |
Menstruation | Do you have menstruation and at what age did it start? | No, Start 8–11 years of age, Start 12–14 years of age |
Glasses/contact lenses | Do you use glasses/contact lenses? | Yes, no |