On which side does your head hurt?
How frequently does your head hurt?
DailyOnce a weekOnce a MonthLess Than Once a Month
Do you feel nauseous or vomit when you get an attack?
Is your vision blurred when you get an attack?
Late nightsTensionBeing out in the sunBad tummy
For the women- When do you do you get an attack?
Before periodsDuring PeriodsAfter periods
Are you already a patient with Dr. Manoj's Homeopathy? If yes then please state your Registration number in the ‘more symptoms’ column at the end of the questionnaire.
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