Migraine Conversation Guide · Migraine Conversation Guide Having to live with chronic pain is...
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© Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 1 ASSOCIATED SYMPTOMS Migraine Conversation Guide Having to live with chronic pain is difficult enough without the added burden of migraine headaches. This guide will help you to have a meaningful conversation with your health care provider. Use this tool before you go to your next appointment. Pain level 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 None Extreme 10-20 20-30 40-50 60-70+ 50-60 Young Later in life Age onset Frequency of headaches per month None None 10 or more All the time Any associated with aura Nausea None Severe nausea Sweating None Sweating Supported by a grant from 30-40
Transcript of Migraine Conversation Guide · Migraine Conversation Guide Having to live with chronic pain is...
© Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 1
ASSOCIATED SYMPTOMS
Migraine Conversation Guide
Having to live with chronic pain is difficult enough without the added burden of migraine headaches. This guide will help you to have a meaningful conversation with your health care provider. Use this tool before you go to your next appointment.
Pain level
0 1 2 3 4 5 6 97 8 10
0 1 2 3 4 5 6 97 8 10
0 1 2 3 4 5 6 97 8 10
0 1 2 3 4 5 6 97 8 10
0 1 2 3 4 5 6 97 8 10
None Extreme
10-20 20-30 40-50 60-70+50-60Young Later in life
Age onset
Frequency of headaches per month
None
None
10 or more
All the time
Any associated with aura
Nausea
None Severe nausea
Sweating
None Sweating
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30-40
© Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 2
Migraine Conversation Guide
Blood shot eyes
0 1 2 3 4 5 6 97 8 10
0 1 2 3 4 5 6 97 8 10
0 1 2 3 4 5 6 97 8 10
0 1 2 3 4 5 6 97 8 10
0 1 2 3 4 5 6 97 8 10
None Severely blood shot
Sensitivity to light
Sensitivity to sound
None
None
None
Extreme sensitivity
Extremely sensitive
Extreme mood swings
Mood changes
Congestion
None Severe congestion
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Smells
None Extreme sensitivity0 1 2 3 4 5 6 97 8 10
© Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 3
Migraine Conversation Guide
FoodAlcohol
OTHER TRIGGERS (please list)
Body Positions
Weather
Activity
Chewing Coffee Environment/smells Hormone changes
TRIGGERS OR MAKES PAIN WORSE
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❏ Yes
❏ No
❏ Yes
❏ No
❏ Yes
❏ No
❏ Cold
❏ Hot
❏ Dry
❏ Other (specify) _______________________
❏ Stormy
❏ Wet
❏ Yes
❏ No
❏ Yes
❏ No
❏ Yes
❏ No
❏ Yes
❏ No
❏ Yes
❏ No
❏ Yes
❏ No
0 1 2 3 4 5 6 97 8 10
Sleep Disturbance
None Severe insomnia
Stress
Noises
❏ Yes
❏ No
© Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 4
Migraine Conversation Guide
WHAT MAKES PAIN BETTER (check all that apply)
❏ Ice
❏ Heat
TREATMENTS TRIED (please list)
❏ Darkness
❏ Quiet
❏ Medication
❏ Sleep
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