Assessment Questionnaire Step 1 of 2 50% Your ConditionIn the case of very new or rapidly changing symptoms, we are not always the best place to help you. Your responses to the following questions allows us to help you find the best place to treat you.Which best describes your condition? Migraine (all varieties) Tension-Type Headache Vestibular Migraine Menstrual Migraine Abdominal/Nausea and vomiting disorder Post-traumatic (whiplash/concussion) Chronic Daily headache Cluster Headache/other TAC I don't know Other If Other, please specify Have you previously seen, or have a future booking to see, Alan Pearce at Neuro Sports Labs, to measure post concussion brain function? Yes No How old are you?* Under 10 10 - 50 years 50 + How long have you been experiencing your symptoms?*More than 3 monthsLess than 3 monthsHave you seen a doctor since your symptoms began?* Yes No Is this the first time you have suffered this type of headache? Yes No Is the pain located in your temple region (side of the head just behind the eye) without changing sides (i.e. locked in on one side or both, but not swapping from left to right) Yes, It’s always the same temple No, mine swaps sides between episodes or from one episode to the next. Is the temple region sore to touch? Yes No Over the past 6 or so months, do you feel that your headaches are staying the same, worsening, or improving?* Better Same Worse Have you seen your doctor since things became worse?* Yes No Your NeckThe nerves at the top of your neck provide a very strong input into brain regions controlling headache, nausea, dizziness and alertness, which is why for some of you, the neck is very sensitive. Understanding your neck symptoms (or lack of) and response to past treatment is important for us to understand the best way to help you.Do you feel your neck is involved?* Yes No What makes you think your neck is related? My neck hurts when i get my headache/migraine episode Neck treatment has either made my symptoms better or worse before If I push on my neck under the base of the skull it hurts/relieves my symptoms Other If Other, please specify Have you had any treatment on your neck? Yes No What was the effect of the treatment? It aggravated my neck and/or symptoms It provided short term relief of my symptoms I felt no significant change Good News! From the information you have provided regarding your condition, we believe an assessment of your neck is an important next step in helping your recovery. While the neck isn't going to be the only cause of your symptoms, when there is dysfunction, it can be one of the most significant. The best way to know whether your neck is contributing to the irritation underlying your condition is to book an assessment for a skilful examination using the Watson Headache® Approach.The importance of your neck Approximately 30% of cases we have treated successfully have reported no obvious neck symptoms prior to assessment and treatment. This is most obvious in nausea and vomiting, and many vestibular disorders. The small muscles under the base of the skull are the most sensitive muscles in the body, helping us detect movement, respond to threats detected by cutaneous, visual, auditory and olfactory systems. As such, small changes in these muscles can have profound impact on sensory processing and our 'threat response' without even causing neck pain or restriction of movement. The good news is that these muscles respond quickly and if they are causing disruption, the impact is obvious within the first 1-2 sessions.But before we see you... Whilst it is likely the neck is still the most significant contributor to your symptoms, there are some rare conditions that may require more urgent medical attention. When someone has a new onset of symptoms we recommend seeing a medical practitioner to exclude potentially serious underlying causes, before booking with us to have your neck assessment.What would you like to do next?* I'll book an appointment with my doctor first I understand and I'd still like to book an appointment to see you Would you like us to follow up with you in about a month?* Yes please No thank you, I'll contact you No problem at all. Please contact us at any time on 0386486487, or via our contact form with any questions you may have. Once you've seen your doctor, and you're ready to make a booking, please complete this assessment questionnaire again.Your DetailsTo request your free 15 minute Telehealth consultation, please fill in your details belowName* First Last Phone (Please double check)*Alternate number (landline/second mobile/repeat first number to double check)*Email* Suburb/Town* Best days/time to be contacted (weekdays 8:30-5:30 only)*Please provide a broad range. Our consultants spend most of there time assessing and treating. Saying 1pm Mon and Thurs may lead to long delays in your being contacted. NameThis field is for validation purposes and should be left unchanged.
