Microsoft word - taylor headachequestionaire 2013
Headache Questionnaire Patient Name:_________________________ Date Seen:____________________________ Please answer the following questions regarding your headaches: A. Headache Onset 1) My headaches started _____ years ago at _____ years of age. 2) Any associated head injury? Yes/No 3) Loss of Consciousness? Yes/No 4) Any history of infection around your brain or spinal cord? Yes/No