Thank you!
Thank you for sharing your story to help others feel less alone and educate our world on what it's like to live with headache like migraine, cluster and/or other type(s). Please plan 15-30 minutes to fill out the form.
Step 1: Consent
In order to share your story, we want to make sure we have your contact information and consent. You will have an opportunity to review your story once it is complete.
First Name
*
Last Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Street Address
*
City
*
State
*
Zip
*
How did you hear about our storytelling initiative?
*
Please Select
NHF Board Member
NHF Staff Member
NHF Volunteer
NHF Website
NHF Social Media
NHF Newsletter/Emails
NHF Social Media
Partner Organization
Event – Conference/Tradeshow
Event - Health Fair
Event – Hosted by NHF
Event – Headache on the Hill
Event - Other
Other
Back
Next
General Information
What type of headache do you have?
How many days a month do you have a headache?
What are your symptoms*? How do you know when you are having an attack?
*Please list up to 10 current or past symptoms. Please prioritize based on those that have most impacted your life.
What are your triggers or contributing factors?
*Please list up to 10 current or past contributing factors. Please prioritize based on those that have most impacted your life.
Of those days, how many do you miss daily activities (i.e. missing work/school/functions)?
How long is each attack?
Are you being successfully managed or in remission?
Back
Next
Your History
Tell us about when your journey began. Do you remember your first attack? Please explain what you remember from that day (i.e. age, where you were, symptoms, etc.). If not, explain in detail what a typical attack looks like for you?
Do you have a diagnosis? If so, what and when were you diagnosed?
Please share your journey or experience in receiving the diagnosis (i.e. how long did it take, how many healthcare professionals did you see, how did you feel when you received the diagnosis).
What has been the most challenging part of living with headache and/or migraine? What has helped you the most to manage or cope (i.e. lifestyle changes, mental wellness, treatments, etc.)?
Back
Next
Living with headache
What support did a family/friend/coworker do that made a difference or helped? What would you say to someone who wants to support their loved one but isn’t sure how to help? What resources, advice, tips, coping skills would you offer?
In detail, please describe a specific time when headache and/or migraine impacted a major event in your life.
What keeps you going while living with a chronic illness? What gives you hope?
Has the National Headache Foundation supported you in your journey? If so, how?
What did we forget to ask? Any additional comments/learnings:
Bring your story to life by sharing photos.
Ex: everyday photos enjoying life, life events (wedding/graduation), your childhood, during an attack, during a treatment, or if you are from the military, include photos in-uniform, while deployed, etc.
By uploading files you provide National Headache Foundation with the permission to use photos:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Demographic Information
This information helps us to ensure we are capturing voices of ALL people we serve.
Location (City, State):
Gender:
Woman
Man
Non-Binary
Transgender
Other
StreRace and ethnicity (select all that apply):
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Generation:
Silent Generation – 1928-1945
Baby Boomers – 1946-1964
Generation X – 1965-1980
Millennials – 1981-1996
Generation Z – 1997-2012
Generation Alpha – 2013-present
I prefer not to answer
Do you have health insurance?
Yes
No
I prefer not to answer
Are you a member of the military (active duty or veteran)?
For the military community, which health insurance do you have? (Select all that apply)
Tricare
VA
CHAMPVA
Other
As member of the military, are you:
Active Duty
Veteran
Family
Other
Name
First Name
Last Name
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about our storytelling initiative?
Submit
Should be Empty: