Blackwell Science, LtdOxford, UKCHACephalalgia0333-1024Blackwell Science, 200222Original ArticleHeadache diagnosis and prevalence in SingaporeK-H Ho & BK-C Ong

A community-based study of headache diagnosis and prevalence in

Singapore

Ho K-H & Ong BK-C. A community-based study of headache diagnosis and prevalence in
Singapore. Cephalalgia 2003; 23:6–13. London. ISSN 0333-1024
We present the results of a community survey based on the diagnostic criteria of the
International Headache Society (IHS) describing headache prevalence and symptomatol-
ogy in the Singapore population. A questionnaire administered by trained personnel was
completed by 2096 individuals from a randomized sample of 1400 households. The overall
lifetime prevalence of headache was 82.7%. The migraine prevalence was 2.4% in males
and 3.6% in females; for episodic tension-type headache and chronic tension-type headache
the corresponding figures were 11.1%/11.8% and 0.9%/1.8%, respectively. Inclusion of
borderline cases (IHS codes 1.7 and 2.3) resulted in prevalences of 9.3% for migraine, 39.9%
for episodic tension headache and 2.4% for chronic tension headache. Headaches described
by 31.2% of the respondents were unclassifiable. The different premonitory symptoms,
precipitants and aggravating factors in migraine and tension-type headache in our study
population suggest that they represent two distinct syndromes rather than opposite ends
of a clinical spectrum. Migraine, tension headache, International Headache Society headache
classification

Dr King-Hee Ho, c/o Department of Medicine, National University of Singapore, 5 Lower

Kent Ridge Road, Singapore 119074. Tel. 65-7795555, fax 65-7794112, e-mail
mdchokh@leonis.nus.edu.sg Received 25 April 2001, accepted 24 July 2001

local university to 2096 individuals ≥12 years of age. The

Introduction
sampling frame was based on data from the 1990 Sin-
Several community-based studies (1–11) in various coun- gapore Population Census and involved 1400 randomized
tries have explored the prevalence and associated features households nationwide equivalent to a estimated study
of the primary headache syndromes according to the oper- population of 3000. Interviewers attended a training ses-
ational diagnostic criteria of the International Headache sion to ensure an adequate understanding of the informa-
Society (IHS) (12). We have previously used a self-assessed tion required from each question, and to standardize
questionnaire to investigate headache features in a local questions in Mandarin, Mandarin dialect and Malay
undergraduate population fluent in the English language where the respondents could not understand English. In
(13), and now present the findings of the first study of order to encourage an adequate response rate, the local
headache diagnosis and prevalence in the highly urban- newspaper and television media provided publicity
ized, multiethnic (79.0% Chinese, 14.4% Malay, 6.2% regarding the survey as well as on headaches in general.
Indian) Singapore community. The relative contribution of Interviewers were instructed to visit households after
individual IHS criteria in diagnosis of headache in the office hours to permit inclusion of working and schooling
study population as well as the relationship of headache family members in the interview process. A household
type to age, gender, premonitory symptoms and precipi- was considered non-respondent after failure of three sep-
tants are given special attention. arate attempts at contact on 3 different days. A research
co-ordinator subsequently confirmed each visit to a house-
hold and rectified obvious errors and omissions in the
interview form with a telephone call.
Materials and methods The characteristics of the ‘usual’ headache experienced
A questionnaire incorporating demographic data, head- by the interviewee were taken into account in the ques-
ache symptomatology and management as well as the tionnaire. Blood pressure, urinalysis and visual acuity
operational diagnostic criteria of the IHS was adminis- assessments were obtained in consenting individuals, but
tered during door-to-door visits by undergraduates of a no formal physical examination was performed.

6 © Blackwell Publishing Ltd Cephalalgia, 2003, 23, 6–13

 Headache diagnosis and prevalence in Singapore 7

Table 1 Gender, headache prevalence and age of onset by age group within the study population

M:F ratio of Lifetime prevalence Point prevalence Mean age of

Age group study population of all headaches of all headaches headache onset

10–19, 9.8% (205) 107:98 = 1:1.09 84.9% (174) 6.8% (14) 10.0 ± 5.5
20–29, 25.0% (523) 252:271 = 1:0.93 84.3% (441) 5.4% (28) 13.0 ± 7.2
30–39, 31.2% (654) 302:352 = 1:0.86 83.2% (544) 6.3% (41) 15.2 ± 9.8
40–49, 20.2% (423) 203:220 = 1:0.92 85.1% (360) 4.7% (20) 17.0 ± 12.2
50–59, 11.2% (234) 103:131 = 1:0.79 73.1% (171) 2.1% (5) 16.6 ± 14.5
60–69, 2.4% (50) 19:31 = 1:0.61 74.0% (37) 0.0% (0) 14.8 ± 14.7
70–79, 0.2% (5) 3:2 = 1:1.5 100.0% (5) 0.0% (0) 27.2 ± 27.4

Data were entered into a database program (Access 2.0;
Microsoft) and subsequently analysed with the Statistical
Package for the Social Sciences (SPSS for Windows, Chi-
cago, IL, USA) and Epistat programs. The c2 test or
Fisher’s exact test was used to determine the significance
of differences in proportions, while Student’s t-test and
analysis of variance with Duncan post hoc testing were
used to determine the significance of differences of means.
The c2 test for trend was used to determine the significance
of age-related changes in proportions. P-values < 0.05 were
regarded as statistically significant.
Headaches were classified as migraines without aura
(IHS code 1.1), episodic and chronic tension-type head-
aches (IHS code 2.1 and 2.2, respectively), as well as
migrainous headache and tension-type headache not ful-
filling all the diagnostic criteria of the previous categories
(IHS codes 1.7 and 2.3, respectively). The identification of
migraines with aura according to the IHS classification in
a questionnaire-based study was not attempted because of
the complex temporal criteria involved. For this reason,
only approximations of the prevalence of the latter condi-
tion were possible. Specific inquiries were made regarding
visual scotomata, ‘basilar’ symptoms (vertigo/diplopia)
and focal sensory/motor deficits. No attempt was made to
identify further diagnostic categories because a physician-
directed interview and examination was not performed.
The age of headache onset for each individual was taken
to be the midpoint of the range provided if an exact figure
could not be provided. ‘Environmental factors’ that pre-
cipitated headaches were defined as changes in ambient
temperature, lighting and air quality.
Results
Population profile
An estimated 69.9% (2096/3000) of the sample popula-
tion underwent an interview. Their mean age was
35.6 ± 11.9 years (range 14–74 years). Males comprised
47.2% of the respondents, females 52.8%. The racial distri-
bution of our study population (79.1% Chinese, 14.4%
Malay, 6.2% Indian, 0.7% other races) did not differ signif-
icantly (P < 0.05) from that of the population at large
(76.9% Chinese, 14.0% Malays, 7.7% Indians and 1.1%
other races) as found in the 1990 National Census. The
overall lifetime prevalence of headache was 82.7%: 80.0%
in males and 85.1% in females, a statistically significant
gender difference (P = 0.002). The corresponding figures
for point prevalence, defined as the proportion of respon-
dents with headache at the time of interview, were 5.1%
and 5.2%, respectively. No significant gender predisposi-
tion was therefore present (P = 0.95). Table 1 and Table 2
summarize the age-related changes in gender, headache
diagnosis and prevalence as well as mean age of headache
onset. Lifetime prevalence diminished with increasing age
(P = 0.001), but point prevalence did not significantly
correlate with age (P = 0.11), gender (P = 0.47), or mean
age of headache onset (P > 0.05). The mean age of head-
ache onset was earlier in men (17.0 ± 8.9 years) than
women (18.4 ± 8.9 years) (P = 0.001). The age of onset of
headache did not differ between individuals experiencing
migrainous (IHS codes 1.1 and 1.7) and tension-type head-
aches (IHS 2.1–2.3) (P = 0.53).
Headache classification
A female preponderance was present amongst headache
sufferers as a whole (80.1%:85.1%, P = 0.003), as well as in
those with migrainous (IHS codes 1.1 and 1.7) headaches
(7.1%:11.1%, P = 0.002). Males and females were equally
likely (41.9%:42.5%, P = 0.78) to experience tension-type
(IHS codes 2.1–2.3) headaches (Table 3).
Symptoms possibly due to a migrainous aura were
reported by 275 individuals (13.1%). These included 25
respondents otherwise classifiable as having migraines
without aura, 12 otherwise classifiable as having chronic
tension-type headaches and 24 otherwise classifiable as
having episodic tension-type headaches. No aura types
other than those included in Table 3 were reported in asso-
ciation with a headache. Without taking into account the
temporal features of the aura, migraine with aura had a
potential prevalence ranging from 1.2% (if all the features

© Blackwell Publishing Ltd Cephalalgia, 2003, 23, 6–13

8 K-H Ho & BK-C Ong

Table 2 Age- and gender-specific prevalence rates for migraine without aura and episodic tension-type headache in the Singapore
population (n = 2096)

Migraine without aura (IHS 1.2) 3.1% Episodic tension-type headache (IHS 2.1) 11.5%
(n = 64/2096) (n = 241/2096)
Male Female Male Female
Age (years) (n = 989) (n = 1107) (n = 989) (n = 1107)

10–19 3.7% (4/107) 2.0% (2/98) 5.6% (6/107) 13.3% (13/98)

20–29 3.2% (8/252) 3.7% (10/271) 8.5% (30/252) 13.3% (36/271)
30–39 2.0% (6/302) 3.1% (11/352) 11.3% (34/302) 9.7% (34/352)
40–49 3.0% (6/203) 6.8% (15/220) 14.3% (29/203) 12.3% (27/220)
50–59 0.0% (0/103) 1.5% (2/131) 8.7% (9/103) 9.1% (12/131)
60–69 0.0% (0/19) 0.0% (0/31) 5.3% (1/19) 22.6% (7/31)
70 0.0% (0/3) 0.0% (0/2) 33.3% (1/3) 0.0% (0/2)
Total 2.4% (24/989) 3.6% (40/1107) 11.1% (110/989) 11.8% (131/1107)

Table 3 The relationship of the IHS headache classification with gender

Overall
Males Females prevalence
(n = 989) (n = 1107) (n = 2096) P-value

Migraine without aura. 2.4% (24) 3.6% (40) 3.1% (64) 0.06
Migrainous headache not fulfilling criteria for IHS code 1.1–1.6 4.7% (46) 7.5% (83) 6.2% (129) 0.004*
(IHS code 1.7)
Episodic tension-type headache 11.1% (110) 11.8% (131) 11.5% (241) 0.61
Episodic tension-type headache not fulfilling criteria for IHS 29.1% (288) 27.7% (307) 28.4% (595) 0.51
code 2.1 (IHS code 2.3)
Chronic tension-type headache 0.9% (9) 1.8% (20) 1.4% (29) 0.06
Chronic tension-type headache not fulfilling criteria for IHS 0.7% (7) 1.2% (13) 1.0% (20) 0.19
code 2.2 (IHS code 2.3)
Headache fulfilling criteria for both migraine without aura and 0.0% (0) 0.3% (3) 0.3% (3) 0.15
chronic tension-type headache
‘Aura symptoms’ 11.1% (110) 14.9% (165) 13.1% (275) 0.01*
visual 5.2% (51) 7.8% (86) 6.5% (137) 0.01*
basilar 4.6% (45) 6.7% (74) 7.0% (119) 0.02*
hemisensory/hemiparetic 3.8% (38) 4.8% (53) 4.3% (91) 0.30
Unclassifiable headache 31.1% (308) 31.2% (345) 31.2% (653) 0.97
Never headaches 19.9% (197) 14.9% (165) 17.3% (362) 0.002*

*Significant (c2 test) gender difference within each diagnostic group.

of migraine without aura were taken as a prerequisite) to
13.1% (if all other features were disregarded). The preva-
lences of other headache entities were calculated without
taking into account the diagnostic implications of the pos-
sible aura. Three respondents fulfilled the IHS criteria for
both chronic tension-type headache and migraine without
aura; they had chronic (>6 months), frequent (>180 days/
year) headaches that were bilateral, throbbing, worse with
exertion, mild or moderate in intensity and associated
with nausea but not with vomiting, phonophobia nor
photophobia.
Table 4 shows that no single criterion used in the diag-
nosis of either migraine or episodic tension-type headache
was associated with both high sensitivity and specificity.
The great majority (87.2%) of borderline (IHS codes 1.7
and 2.3) cases of migraine and tension-type headache
failed to meet IHS criteria for previous number of similar
episodes (43.9%) or for duration of the episode (43.3%)
(Table 5).
Headache frequency, associated symptoms and
precipitants
Over the previous year, 34.4% of the migraineurs experi-
enced headache episodes ‘every few months’, 53.1% ‘a few
times a month’ and 10.9% ‘a few times a week’. Migraines

© Blackwell Publishing Ltd Cephalalgia, 2003, 23, 6–13

 Headache diagnosis and prevalence in Singapore 9

Table 4 Specificity and sensitivity of the IHS criteria in migraine and episodic tension headache

Migraine without aura Episodic tension headache

Specificity Sensitivity Sensitivity Specificity
IHS diagnostic criteria (n = 64) (n = 64) (n = 241) (n = 1493)

A No. of episodes 100.0% (64) 50.6% (755) 100.0% (241) 60.4% (902)
B Duration 100.0% (64) 75.2% (1256) 100.0% (241) 50.6% (755)
C 1 Unilateral/bilateral 43.8% (28) 80.7% (1347) 85.5% (206) 22.0% (328)
2 Pulsating/pressing 59.4% (38) 61.2% (1022) 57.7% (139) 56.1% (838)
3 Moderate–severe/mild–moderate intensity 70.3% (45) 73.2% (1223) 93.4% (225) 12.9% (192)
4 Effect of physical activity 87.5% (56) 45.9% (766) 53.9% (130) 58.1% (868)
D 1 Nausea absent/present 70.3% (45) 79.9% (1335) 100.0% (241) 25.5% (380)
1 Vomiting absent/present 37.5% (24) 90.8% (1516) 100.0% (241) 11.9% (178)
2 Photophobia absent/present 57.8% (37) 91.4% (1527) 93.8% (226) 11.1% (165)
2 Phonophobia absent/present 48.4% (31) 90.4% (1510) 93.4% (225) 11.7% (175)

There were a total of 1734 headache sufferers in the study population.

Table 5 The IHS diagnostic criteria in subjects with headache not completely fulfilling the criteria for migraine and tension-type
headache (IHS codes 1.7 and 2.3, respectively)

Migrainous headache Episodic tension-type Chronic tension-type

(IHS code 1.7), headache (IHS code 2.3), headache (IHS code 2.3),
Disqualifying IHS criterion n = 129 n = 595 n = 20

A. Insufficient number of episodes 31 (24.0%) 296 (49.7%) –

B. Duration
too short 93 (72.1%) 228 (38.3%) –
too long 1 (0.8%) – –
C. Nature, site, relationship with 4 (3.1%) 13 (21.8%) 10 (50.0%)
physical activity and severity
D. Nausea, vomiting, phonophobia 0 (0.0%) 58 (9.7%) 10 (50.0%)
and photophobia

occurred significantly more frequently than episodic
tension-type headaches (P < 0.001) or headaches in general
(P < 0.001).
Insufficient sleep was the commonest precipitant of
tension-type headache and headaches in general, and was
second only to ‘mental stress’ in importance as a headache
precipitant in migraineurs (Table 6). Alcohol was the com-
monest single precipitant mentioned by those whose head-
aches were brought on by dietary factors (20.4%, 21/103
respondents), followed by spicy food in 9.7% (n = 10),
‘heaty’ food in 7.7% (n = 8), coffee in 5.8% (n = 6) and ‘oily’
food in 4.9% (n = 5). No instance of food craving was noted
preceding headaches. Table 6 also shows several signifi-
cant differences in the other precipitants and associated
symptomatology of migraines and tension headaches.
Discussion
Headache classification may be difficult in questionnaire-
based prevalence studies, varying from that obtained from
a clinical interview even when the two are performed on
the same occasion (14). The IHS classification requires
exclusion of a secondary headache syndrome with a phys-
ical examination, but the rarity of isolated symptomatic
headache syndromes (15) ensures that, while a clinical
assessment is important in individuals, it assumes less
significance in epidemiological studies.
It is especially difficult to diagnose migraines with aura
in a non-physician directed context (14, 16). The relatively
high rate of aura-like symptoms in our population may be
due to a degree of suggestibility in the interview process,
since the visual, basilar and hemisensory/hemiparetic
symptoms specifically inquired for were common, but no
other symptoms (such as speech difficulty) were men-
tioned. Visual and focal sensorimotor, but not ‘basilar’,
symptoms do occur much more frequently in those with
migrainous pain than in those with tension-type headache,
and it is likely that some of these are true auras. In view
of the known relative prevalence of migraine with and
without aura, and because pain features of the latter

© Blackwell Publishing Ltd Cephalalgia, 2003, 23, 6–13

10 K-H Ho & BK-C Ong

Table 6 Headache precipitants and associated symptoms in migraine and tension-type headache

Chronic and
Migraine episodic tension Other headache All
without aura headache type headaches
(n = 64) (n = 270) (n = 1400) (n = 1734) P-value

Lack of sleep 60.9% (39) 71.8% (181) 67.0% (934) 66.7% (1157) 0.19
Mental stress 64.2% (43) 56.0% (141) 46.9% (665) 49.0% (849) 0.02*
Environmental factors 59.4% (38) 35.2% (95) 38.6% (541) 38.8% (674) <0.001*
Physical exertion 31.3% (20) 30.7% (83) 37.8% (529) 36.4% (632) 0.52
Acute illness 29.7% (19) 23.0% (62) 26.6% (372) 26.1% (453) 0.17
Menstruation 40.0% (16) 11.9% (18) 14.3% (109) 15.2% (143) <0.001*
Dietary factors 14.1% (9) 6.7% (18) 5.4% (76) 5.9% (103) 0.05*
Aggravated by bending over/straining 60.9% (39) 38.9% (105) 37.4% (524) 38.5% (668) 0.001*
Mood change as a premonitory symptom 21.9% (14) 5.9% (16) 7.5% (105) 7.8% (135) <0.001*
‘Aura’ symptoms
Visual 23.4% (15) 4.8% (13) 7.8% (109) 7.9% (137) <0.001*
Vertigo/diplopia 7.8% (5) 6.6% (18) 6.9% (96) 6.9% (119) 0.46
Hemisensory/hemiparetic 18.8% (12) 5.2% (14) 4.6% (65) 5.2% (91) <0.001*

*Significant difference (c2 test) in the prevalence of a particular symptom between migraines and tension headaches.

are usually present in the former entity (17), its inclusion
as an additional diagnostic category is unlikely to affect
greatly the proportion of unclassifiable headaches in our
population.
The diagnosis of migraine without aura is a less subjec-
tive process, and the subset of respondents classified as
migraineurs do share symptoms unrelated to the IHS cri-
teria that set them apart from those with episodic or
chronic tension headache. Together with other epidemio-
logical evidence (18), these differences between migraine
and tension headache suggest that they are less likely to
represent opposite ends of a spectrum of a single disorder,
but are conditions with distinct clinical features and
origins.
Several reasons may account for the relatively high pro-
portion of atypical and unclassifiable headaches in our
study population. The absence of a physician to guide the
process of history taking and diagnosis must rank as the
most important. The sole published study of headache
prevalence in a general population based on a clinical
interview (4) found that the IHS criteria successfully clas-
sified all but two of 740 cases. The request for respondents
to provide the ‘usual’ details of only their ‘usual’ head-
aches would also have resulted in loss of information and
the possibility of confusion in recall where more than one
headache type, or overlap headache entities, was present
in an individual. Because tension-type headache is more
common than migraine, it is reasonable to assume that
migraine prevalence would be underestimated because of
cases with overlap headaches or multiple headache types.
It is also possible that the duration of many episodes of
‘true’ migraine and tension headache in the Singaporean
population is shorter than that demanded by the IHS clas-
sification. Finally, the diagnostic requirement for at least
10 similar episodes of episodic tension-type headache is
probably unnecessarily restrictive in a community-based
study.
The increasing number of published community-based
studies using the diagnostic criteria of the IHS has made
it evident that the wide geographical variation in migraine
prevalence cannot be adequately accounted for by differ-
ences in case definition. The 3.1% prevalence of migraine
in our study population is consistent with the finding of a
generally lower prevalence of migraine in predominantly
Chinese (0.63–1.5%) (8, 19, 20) compared with Caucasian
(8.1–16%) (4–10) or African (3.0–7.2%) (11, 21–23) commu-
nities. The relative importance of genetic and environ-
mental/cultural factors remains unclear. There is a small,
but definite (M:F = 1:1.5) female preponderance in our
migraineurs, rising to 1:1.75 if all migrainous headaches
are included. This is less marked than the 1:2.2–3.1 usually
described elsewhere. Migraineurs in Singapore have a
higher frequency of attacks than the ‘less than once a
month’ described in a recent review (24), but similar to that
found in a German (9) and in an Ethiopian (11) study. In
view of the relatively greater disability from migraines
compared with most other headache types, this finding
may have important socio-economic implications.
The epidemiology of tension-type headache is not as
well studied as that of migraine, and less comparative data
based on the IHS criteria are available. Other investigators
have found a prevalence of 27–78% for the episodic form
(3, 4, 8, 9) and 3% for the chronic form (24), but both types
of tension-type headache in Singapore are relatively less

© Blackwell Publishing Ltd Cephalalgia, 2003, 23, 6–13


common. Some (1, 3, 4, 8, 11, 24) have found a female
predominance in tension headache, but others (9, 21, 25),
like ourselves, have found no significant gender differ-
ences. Unlike the case in migraine, the frequency of tension
headache episodes in Singapore is probably lower than
that found elsewhere (4, 8, 9).
Our findings concur with those of other investigators (1,
3, 11, 20, 26–28) in identifying the chief headache precipi-
tants as mental/emotional stress, physical ever-exertion,
weather and insufficient sleep. These appear to trigger
both migraines and tension-type headaches. Conversely,
menstruation, alcohol and food appear more likely to pre-
dispose to migraine rather than tension-type headache.
The foods rich in bioactive amines (cheese, red wine, choc-
olate) which are usually thought to be important (29) in
triggering migraines are not prominent in the diet of the
majority Chinese population, which may account for the
relatively low importance of food and alcohol as headache
precipitants in Singapore. It is interesting that a number of
headaches are attributed to ‘heaty’ food in which the
‘yang’ (or ‘male’) element predominates over the ‘yin’ (or
‘female’) element. This is a concept found in traditional
Chinese medicine but not in Western dietetics.
The local prevalence of migraine peaks in the fifth
decade, similar to the pattern found in several other pop-
ulation studies (24). The relationship of tension headache
with age is less clear. There is a fall in lifetime headache
prevalence with increasing age, and the markedly different
Appendix: Excerpts from the questionnaire relevant to the IHS classification
• Have you ever had a headache?
• Do you have a headache today (now)?
• At what age do you remember your headaches starting?
• How many headaches of your usual type have you had since then?
• Over the past year, how many days of headache have you had?
• How long do the headaches usually last?
• Where do you usually feel your headache?
• What word best describes the pain?
© Blackwell Publishing Ltd Cephalalgia, 2003, 23, 6–13
Headache diagnosis and prevalence in Singapore 11
mean age of headache onset reported by the oldest popu-
lation subgroup suggests that the most likely cause for this
is poor recall. An increasing tendency for younger cohorts
to have more headaches or for headaches to remit with
advancing age cannot be excluded, and the third alterna-
tive – that headache sufferers die at a younger age – is not
supported by available evidence (30).
Headache is a common symptom in the Singaporean
population, with a prevalence intermediate between that
found in most international community studies and in
studies of other predominantly Chinese populations. The
IHS criteria successfully classified more than two-thirds of
the headaches reported by the respondents in a question-
naire-based study and were associated with minimal diag-
nostic overlap. Failure to meet the criteria with respect to
number of previous similar headache episodes and/or
duration of headache episodes was a common occurrence,
suggesting that a more liberal approach to diagnostic clas-
sification could be taken in community-based prevalence
studies. Our data suggest that tension headache and
migraine are distinct entities with different precipitants
and associated symptoms.
Acknowledgements
This study was supported by a grant from Glaxo-Wellcome
(Singapore).
Yes/No
Yes/No
1–4
5–9
10 or more
<180 (<15/month)
>180
A few seconds
<half an hour
Half an hour to 4 h
24–72 h
Longer
The neck and back of the head
Bitemporal/bifrontal
On one side
The whole head/the top of the head
Throbbing/pounding/pulsating
Tight/heavy
Sharp/stabbing/needle-like
12 K-H Ho & BK-C Ong

• During the headache attack, do you experience the following?

Nausea Yes/no
Vomiting Yes/no
Phonophobia Yes/no
Photophobia Yes/no
• What most often brings on the headaches?
Mental/emotional stress Yes/no
Physical exertion Yes/no
Lack of sleep Yes/no
Change of environment (light, temperature, smell, dust) Yes/no
Perimenstrual/menstruation Yes/no
Illness Yes/no
Certain foods/drinks Yes/no
Other Yes/no
• Which of these makes the pain of the headache worse?
Physical exertion (prefers to rest) Yes/no
Bending forward/straining Yes/no
• With regard to the severity of your headaches
Mild: You can continue work/daily activities with the headache
present
Moderate: Work/daily activities are affected
Severe: You must stop work and lie down
• If you have any warning that a headache is on the way, does it consist of
flashes of
Light/blind spots/lines of colours in the vision Yes/no
Vertigo and/or diplopia Yes/no
Weakness of numbness of one side of the body/face Yes/no
Other Yes/no

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