HeadAche Checklist™

The Headache Checklist is intended for use as an aid in collecting self-report information on an individual's headache related experiences as part of the assessment of headache complaints.Individual item endorsement and patterns of item endorsement suggest questions that may

be pursued in an assessment interview.

The Headache Checklist consists of 70 items. The items are responded to in a yes / no format. In addition to their individual content, a number of the items can be categorized into symptom

groupings. The groupings highlighted by the checklist are shown on the left, the number of items in each grouping are shown on the back of this sheet.

Answer Yes / No to About 70 Questions

See Results in Graph Format

Symptom Group % Endorsed

Muscle Contraction 50 *****Masseter Involvement, Bruxism or TMJ 25 **Vascular / Migraine 38 ****Classic Migraine 25 **Cluster Headache 0Sinus Headache 0Possible Ophthalmologic 70 *******Possible Organic 33 ***Possible dietary, Medication orWithdrawal Factors 0To Be Considered in a BehavioralAnalysis: 40 ****

See Results in Easy to Understand Full Text& Summary Table Format

The Headache Checklist can be added to an existing NeuroDynamix software system and calledfrom the main software menu or may be purchased as a stand-alone application that does not

require a NeuroDynamix instrument.

Headache Checklist Features:

• Runs on any Windows based PC• Self Administered

Consists of Items Designed to Highlight Possible:

• Muscular Contraction Symptoms (8)• Bruxism or TMJ, etc. (4)• Vascular or Migraine Symptoms (13)• Cluster Headache Symptoms (4)• Sinus Headache Symptoms (4)• Possible Organic Symptoms (10)• Possible Ophthalmologic Symptoms (2)• Classic Migraine Symptoms (6)• Possible Dietary, Medication or Withdrawal Factors (5)• Behavioral Analysis Factors (5)

The Headache Checklist is not a medical device & administration of the checklistis not intended to provide a diagnosis.