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Adult Migraine Questionnaire
* Indicates required question
Email
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Your email
Today's Date
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MM
/
DD
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YYYY
Do you have at least 1 year history of Migraine (with or without aura)?
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Yes
No
If untreated, do your Migraine attacks last an average between 4-72 hours?
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Yes
No
In the last 3 months, are you able to report between 4-14 migraine attacks?
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Yes
No
Can you tell the difference between a Migraine attack and a tension/cluster headache?
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Yes
No
Are you currently on any medications for your Migraine attacks?
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Yes
No
If Yes, please list the medications you are currently taking for Migraine:
Your answer
Do you consent to a Urine Drug Screen prior to participating in the study? (provided on the first visit; a positive drug screen will exclude you from the study)
*
Yes
No
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