Migraine Questionnaire How long have you suffered from migraines? Within the last month. 6 months. About a year. Years. I have been suffering for a long time. How severe are your migraines? SLIGHT (Tolerable and causing no limitation) MODERATE (Tolerable but causing some limitations) SEVERE (Causing significant limitations and getting intolerable) EXTREME (Causing near constant limitations and definitely intolerable) How do your migraines impact your quality of life? It doesn't affect my quality of life much at all It seems to impact my quality of life, but only from time to time It has definitely been a significant burden on my quality of life It basically robbed me of any quality of life that I used to have What have you already tried to help get rid of your migraines? Regarding your location and ability to follow through with treatment: I do not live in Central PA and am not able or willing to travel for treatment. I do not live in Central PA but I can foresee traveling occasionally for treatment. I live within a 1-hour drive of York, PA and am willing to do what it takes to get treatment. I live close enough that appointments will not be a problem for me. Please tell us how you were referred to us or this questionnaire. First Name Last Name Mobile Phone Email Submit Questionnaire
