What does this Questionnaire do?
The Accurx Headache Questionnaire allows the sending of an online questionnaire to patients to collect information regarding their headache symptoms to facilitate their ongoing management.
The questionnaire link is sent via SMS or email. The patient fills in the questionnaire through a browser so can use their phone, tablet, laptop or desktop to complete it.
The responses are returned to the user or organisation via the Accurx Web inbox. The responses can be assigned to other colleagues.
This questionnaire was designed and built in collaboration with Dr Tina Ramnani, Consultant Neurologist and Headache Specialist at University Hospitals of Leicester.
What does it look like for the clinician and patient?
Clinician view of sending a Questionnaire👇
They can edit the SMS message if required
Patient perspective of viewing and completing the Headache questionnaire👇
Questions:
1. What year did you start getting headaches?
Please enter an estimated year, for example, 2019 or 2020.
Enter text
2. Are you aware of a particular trigger for your headaches when they first began?
For example, this may have been a life event or personal situation.
Yes
If selected → Please tell us more about the trigger for your headaches when they first began (For example, this may have been a life event or personal situation)
Free text
No
I’m not sure
3. Which side of your head do you feel the headaches?
Select all that apply
Left side
Right side
Both sides
4. Where in your head do you feel the headaches?
Select all that apply
Front of my head (forehead)
Side of my head (temples)
Back of my head
Top of my head (crown area)
My face
My neck
Behind the eyes
All over my head
Other
If selected → Please describe where you feel your headache
5. How would you describe the type of pain your headaches cause?
Select all that apply
Dull
Throbbing
Stabbing
Aching
Pulsating
Sharp
Electric shock
Tightening
Other
If selected → Please describe the pain your headache causes
Free text
6. On average, how long will your headaches last for?
Please give a range, for example, 1 to 5 minutes or 3-10 hours. If your headache is constant, please specify.
Free text
7. How many days per month do you have any sort of headache?
Free text
8. Which of the following symptoms do you experience with your headache?
Select all that apply
Nausea (feeling sick)
Vomiting
Uncomfortable with bright lights
Uncomfortable with noise
Uncomfortable with strong smells
Uncomfortable with movement
Weakness or numbness in my arms or legs
None of the above
9. Do you notice any of the following changes in your vision with, or just before, your headache?
Select all that apply
Seeing flashing or flickering lights
Noticing zigzag lines
Blind spots or areas of vision loss
Blurry vision
Seeing colourful spots or dots
Double vision
I’m not sure
If selected → Please describe the changes in your vision with, or just before, your headache
Free text
10. Which of the following symptoms do you experience with your headache?
Select all that apply
Watery eye
Red eye
Swollen eye
Droopy eyelid
Blocked nose
Runny nose
None of the above
11. If you experience migraine headaches, how many days per month do you experience migraine features?
Migraine features can include:
Nausea and vomiting
Sensitivity to light, sound or smells
Having to go to bed due to the headache
Visual symptoms such as flashing lights, zig zag lines or blind spots
Enter 0 if you do not experience migraine features with your headaches.
Free text
12. What is the minimum and maximum severity of your headaches between 0 (no pain) and 10 (worst ever pain)?
For example, 2 to 6 or 4 to 10
Free text
13. Do any of the following trigger (bring on) your headache?
Select all that apply
Certain foods
If selected → Please describe what foods can bring on your headaches.
Free text
Stress
Changes in the weather
Menstruation
Other
If selected → Please describe what other triggers can bring on your headaches
Free text
None of the above
14. Does anybody in your immediate family suffer from headaches?
Immediate family includes your parents, children or siblings.
Yes
Please tell us more about who it was and the cause of their headaches (if known)
Free text
No
I’m not sure
15. Which of the following pain relief medications do you take for any reason including headache?
Select all that apply. Click continue if you take none of these medication.
Paracetamol
Ibuprofen
Naproxen
Diclofenac
Aspirin
Codeine
Co-codamol
Dihydrocodeine
Tramadol
Morphine
Triptains (e.g. Sumitriptan, Zizatriptan, Zolmitriptan, Frovatriptan, Naratriptan)
For the above question, for any medications selected the patient is asked a follow-up question:
On average, how many days per month do you take any amount of *selected medication*
Free text
16. What medications are you currently taking to help prevent your headaches?
List all preventative medicines you are currently taking (e.g. Propranolol, Amitriptyline, Nortriptyline, Topiramate, Candesartan). Please do not include pain relief medication submitted in previous questions. For each medication please include:
Name of medication
Current dose of medication
How long you have been taking it at the current dose
Any side effects when you take the medication
Free text
17. What previous medications have you taken to help prevent your headaches?
List all preventative medicines you have previously taken (e.g. Propranolol, Amitriptyline, Nortriptyline, Topiramate, Candesartan). Please do not include pain relief medication submitted in previous questions. For each medication please include:
Name of medication
How long you took the medication for at the maximum dosage you reached
The reason you stopped taking this medication (e.g. side effects or ineffective)
Any side effects you had when taking this medication
Free text
18. Do you have any allergies?
Yes
If selected → Please list any allergies you have below and what reaction you get with them
Free text
No
When they have submitted their answers, they will be thanked for completing the questionnaire, sent a confirmation SMS and be given some safety netting information 👇
Clinician view of the Headache Questionnaire response
A red dot notification in Accurx Web and an email notification indicating a patient response has arrived. 👇
The screenshot below shows the inbox view showing a questionnaire response for a patient 👇
Users can assign the response to a different team by clicking on the pen icon to edit the assignee. 👇
Users can download a PDF version of the questionnaire response, which they can use to save responses to their paper or electronic medical records. 👇
If you still have any questions or concerns, feel free to chat with us using the green message bubble in the bottom right-hand corner of this page. 👉