Complete the Headache Profile

To give your doctor more information about your headaches, complete the headache profile below.

Once you've answered all the questions below to complete your profile, click the button at the bottom of the page to print the results. Then take your results to your doctor to discuss if your headaches are migraines. If you are diagnosed with migraines, your doctor can prescribe an effective medicine made for the treatment of migraines.
 
Headache Profile
Select your gender: Male Female
Please answer these questions with a "yes"or "no": No Yes N/A
Do some of your headaches come just before or during your monthly menstrual cycle?
When you have headaches, how often do you: Never Rarely Usually Always
Feel them coming on before they become headaches?
Feel fed up or irritated by your headaches?
Feel "drained" or too tired to want to do daily activities?
Feel a reduced ability to concentrate?
Want to lie down in a quiet, dark room?
See visual disturbances, spots, or light flashes?
Check all of these statements that are true for the medicine you take for your headaches:
My headache medicine does not make me pain-free.
My headache medicine does not treat other symptoms,
like nausea or sensitivity to light and sound.
I take my headache medicine more than 2 or 3 times per week.
My headache medicine makes me drowsy.
I take more than one kind of medicine for my headaches.
Check any of the following that ever bring on one of these headaches:
Intense lights, smells, or sounds
Weather changes
Allergies or sinus pain/pressure
Stress or tension
Monthly menstrual cycle/hormonal changes  
Too little sleep or too much sleep  
Missed meals  
Lack of caffeine or too much caffeine  
Changes in mood/excitement  
Foods or alcoholic beverages  
Answer these additional questions:
At what age did you first experience these headaches?
On average, how often do you get these headaches?
 
Congratulations! You've taken the first step. Now take the next step and take this Headache Profile along with your completed Quiz to your doctor.
GSK Corporation    GSK For You    Contact Us

This site is intended for US residents only.
© 1997-2008 GlaxoSmithKline. All Rights Reserved.
Legal Notices | Privacy Statement | Medicine Savings | Contact Us