HEADACHE DISABILITY INDEX QUESTIONNAIRE LAST NAME: _____________________ FIRST NAME: ___________________ MI: ____ Date: ____________________
Please CHECK the correct response: I have headaches:
1 per month more than 1 but less than 4 per month
My headache is:
Mild
Moderate
Severe
E1
Because of my headaches I feel handicapped.
F2
Because of my headaches I feel restricted in performing my routine daily activities. No one understands the effect my headaches have on my life. I restrict my recreational activities (e.g. sports, hobbies) because of my headaches. My headaches make me angry. Sometimes I feel that I am going to lose control because of my headaches. Because of my headaches I am less likely to socialize. My spouse (significant other), or family and friends have no idea what I am going through because of my headaches. My headaches are so bad that I feel that I am going to go insane. My outlook on the world is affected by my headaches. I am afraid to go outside when I feel that a headache is starting. I feel desperate sperate because of my headaches. I am concerned that I am paying penalties at work or at home because of my headaches. My headaches place stress on my relationships with family or friends. I avoid being around people when I have a headache. I believe my headaches are making it difficult for me to achieve my goals in life. I am unable to think clearly because of my headaches. I get tense (e.g. muscle tension) because of my headaches. I do not enjoy social gatherings because of my headaches. I feel irritable because of my headaches. I avoid traveling because of my headaches. My headaches make me feel confused. My headaches make me feel frustrated I find it difficult to read because of my headaches. I find it difficult to focus my attention away from my headaches and on other things.
E6 Sometimes I feel that I am going to lose control. F7 Because of my headaches I am less likely to socialize. E8 My spouse (significant other), or family and ...
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