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Name
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First Name
Middle Name
Last Name
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Headache Disability Index
*
Yes
Sometimes
No
Because of my headaches I feel disabled.
Because of my headaches I feel restricted in performing my routine daily activities.
No one understands the effect my headaches have on my life.
I restrict my recreational activities (eg, sports, hobbies) because of my headaches.
My headaches make me angry.
Sometimes I feel that I am going to lose control because of my headaches.
Because of my headaches I am less likely to socialize.
My spouse (significant other), or family and friends have no idea what I am going through because of my headaches.
My headaches are so bad that I feel that I am going to go insane.
My outlook on the world is affected by my headaches.
I am afraid to go outside when 1 feel that a headaches is starting.
I feel desperate because of my headaches.
I am concerned that I am paying penalties at work or at home because of my headaches.
My headaches place stress on my relationships with family or friends.
I avoid being around people when I have a headache.
I believe my headaches are making it difficult for me to achieve my goals in life.
I am unable to think clearly because of my headaches.
I get tense (eg. muscle tension) because of my headaches.
I do not enjoy social gatherings because of my headaches.
I feel irritable because of my headaches.
I avoid traveling because of my headaches.
My headaches make me feel confused.
My headaches make me feel frustrated.
I find it difficult to read because of my headaches.
I find it difficult to focus my attention away from my headaches and on other things.
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