Migraine Questionnaire - HomeopathicVibes

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Our Address: 940 E El Camino Real, Sunnyvale, CA - 94087 | 39039 Paseo Padere Parkway,Suite #209,Fremont, CA 94538

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Migraine Questionnaire

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I'm providing homeopathic services for over 20 years in entire California. My clinic is located in Sunnyvale, Fremont, and San Jose. I have treated more than 1000 patients suffering from various conditions. I also provide online consultation if you're not able to visit any of my clinics. I have more than 100 five stars reviews on Google, Yelp, and other reviews websites. If you would like to know more about me, then feel free to reach me out by phone.

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Migraine Questionnaire

940 E. El Camino Real
Sunnyvale, CA 94087
harminder@homeopathicvibes.com
www.homeopathicvibes.com
Office Phone (408)737-7100
Office Fax (408)737-7102

Name *

First

Last

Email *

Marital status

Married
Single
Divorced
widow

How many migraine Headaches you experience each month__________ on average.

How many regular Headaches you experience each month____________on average.

How long does your margarine headache last: Check one?

No more than two hours
Three to four hours
5-12 hours
12-24 hours
Several days
Week or longer

Do you have generalized discomfort or occasional headache to pinpoint?

Never / don't know
Occasional moderate discomfort
Frequent moderate discomfort
Occasional severe pain
Frequent severe pain

Do you suffer from headaches?

I never get headaches
It seems as though I have a headache every day
I sometimes get a headache, never more than 2 or 3 times a month
I suffer from more than 2-3 times a month headaches

Do these headaches interfere with your ability to perform your daily tasks?

Headaches never interfere with my life
These headaches bother me, but I can grin and bear it, and continue through the day
My headaches are so bad that I have to stop what I'm doing to go and lie down in a quiet room

Where does your head hurt?

I cannot pinpoint exactly where it is painful.
My whole head feels as though it is gripped in a vice
Only one side of my head is hurting.
If yes explain: Right or left.

How would you best describe your headache?

Dull, constant pain.
Severe throbbing pain that feels as though your heart is pounding inside your head.
Throbbing pain like hammer are striking.

Do any of the following symptoms coincide with your headache?

Neck pain
Normally, I only have the headache on its own
Nausea or vomiting
Sensitivity to light or noise

Do you ever experience any warning signs before you get a headache?

No, my headache builds up gradually.
If I get nightmares, they are usually followed by headaches the next day.
I sometimes see flashing lights, dark spots or wavy lines before my eyes and then I know the pain will arrive soon.

Have you ever thought your headache was brought on by one of the following?

Change of seasons
Any form of stressful event
Chocolates, coffee or red wine (not a hangover).
None of the above.

Do you have sensitivity to light?

Yes
No
Never

Have you ever noticed a relationship between your menstrual cycle and your headache?

Sometimes my headaches coincide with my menstrual period, but I don't consider it a pattern, since I often have headaches outside my menstrual period
No
My headaches always occur 3 days before, or during my menstrual period
Does not apply to me

My headache is related to my emotional status.

I only get headaches when I am depressed.
I get depressed more due to the fact that I constantly have headaches.
My PMS mood swings trigger the headache

Have you ever been diagnosed as suffering from migraine?

Yes
No
I m unsure

Name

About Me

I have passion for homeopathy. I am blessed to be born in family of Homeopaths. My grand father Dr. Hazara Singh Gill was great homeopath of his times. He did his M.B.H (Bachelor of Medicine in Homeopathy) from Punjab Homeopathic Medical College Lahore in 1925.

Sunnyvale Location

Phone: 408-737-7100
Fax: 408-737-7102
Address: 940 E El Camino Real, Sunnyvale, CA 94087, United States
harminder@homeopathicvibes.com

Fremont Location

Phone: 408-737-7100
Fax: 408-737-7102
Address: 39039 Paseo Padere Parkway,Suite #209,Fremont, CA 94538, USA.
harminder@homeopathicvibes.com

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