Green Light Migraine Study Participant Application
Share your migraine history, current treatments, safety screening answers, and availability for the 3-week study.
About You
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Have you been diagnosed with migraine by a healthcare professional?
*
Yes
No
Unsure
How long have you experienced migraines?
*
Please Select
Less than 6 months
6 months to 1 year
1 to 3 years
More than 3 years
Unsure
Migraine Frequency and Intensity
Please think about the last 30 days when answering the following questions.
In the last 30 days, on how many calendar days did you have any headache, including migraine days?
*
In the last 30 days, on how many calendar days did you have migraine symptoms?
*
Count calendar days, not separate attacks. Migraine symptoms may include nausea, light/sound sensitivity, or your typical migraine pattern.
Has this frequency been fairly consistent for at least 3 months?
*
Yes
No
Unsure
What is your average migraine pain intensity?
*
No pain
0
1
2
3
4
5
6
7
8
9
Worst imaginable
10
0 is No pain, 10 is Worst imaginable
How long does a typical migraine attack last?
*
Please Select
Less than 1 hour
1 to 4 hours
4 to 12 hours
12 to 24 hours
1 to 2 days
More than 2 days
Varies widely
Unsure
In the last 30 days, on how many calendar days did migraine symptoms significantly interfere with your usual activities?
*
Your Migraine Symptoms
Which symptoms typically occur during your migraines?
*
Sensitivity to light
Sensitivity to sound
Nausea or vomiting
Visual aura (flashes, zigzags, blind spots)
Other aura symptoms
Throbbing or pulsating pain
Pain worsened by normal activity
Pain primarily on one side
Neck pain or stiffness
Dizziness or vertigo
Does exposure to light usually worsen your migraine symptoms?
*
Yes
No
Not sure
Have you ever noticed a particular light color or light therapy making your migraine symptoms better or worse?
Current Treatments
Are you currently using preventive migraine medications or treatments?
*
Yes
No
Current migraine treatments
How many days in the past 30 days did you take medication to relieve a headache or migraine?
*
In the past 30 days, have you started, stopped, or changed any migraine treatments, or do you anticipate changes during the study?
*
No changes
Started treatment
Stopped treatment
Changed treatment
Anticipate changes
Other
Availability and Participation
Can you attend three 15-minute sessions per week for three consecutive weeks?
*
Yes
Possibly, depending on scheduling
No
Which appointment periods generally work for you?
*
Weekday mornings
Weekday afternoons
Weekday evenings
Saturdays
Are you willing to complete short weekly symptom questionnaires and report any changes in migraine treatments?
*
Yes
No
I agree to be contacted by Life Moves Manual Therapies about this study and understand that applying does not guarantee enrollment.
*
I agree
Submit Application
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