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Headache Index

Headache Questionnaire

Please Read: The purpose of the scale is to identify difficulties that you may be experiencing because of your headaches. Please choose the correct response for the first two items and check ‘Yes’, ‘Sometimes’, or ‘No’ for all of the remaining items. Answer each question as it pertains to your headaches only.

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

With permisison from: Jacobson GP, Ramadan NM, et ai. The Henry Ford Hospital headache disability inventory (HDI). Neurology 1994;44:837-842.