HEADACHE DISABILITY INDEX Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *Date of Birth *Email Address *Phone Number * headaches. my of I have headache *One per month.More than 1 but less than 4 per month.More than one per week.My headache is *MildModerateSeverePlease read carefully: The purpose of the scale is to identify difficulties that you may be experiencing because of your headache. Please check off “YES”, “SOMETIMES”, or “NO” to each item. Answer each question as it pertains to your headache only.Because of my headaches I feel disabled. *YesSometimesNoBecause of my headaches I feel restricted in performing my routine daily activities. *YesSometimesNoNo one understands the effect my headaches have on my life. *YesSometimesNoI restrict my recreational activities (eg, sports, hobbies) because of my headaches. *YesSometimesNoMy headaches make me angry. *YesSometimesNoSometimes I feel that I am going to lose control because of my headaches. *YesSometimesNoBecause of my headaches I am less likely to socialize. *YesSometimesNoMy spouse (significant other), or family and friends have no idea what I am going through because of my headaches. *YesSometimesNoMy headaches are so bad that I feel that I am going to go insane. *YesSometimesNoMy outlook on the world is affected by my headaches. *YesSometimesNoI am afraid to go outside when I feel that a headaches is starting. *YesSometimesNoI feel desperate because of my headaches. *YesSometimesNoI am concerned that I am paying penalties at work or at home because of my headaches. *YesSometimesNoMy headaches place stress on my relationships with family or friends. *YesSometimesNoI avoid being around people when I have a headache. *YesSometimesNoI believe my headaches are making it difficult for me to achieve my goals in life. *YesSometimesNoI am unable to think clearly because of my headaches. *YesSometimesNoI get tense (eg, muscle tension) because of my headaches. *YesSometimesNoI do not enjoy social gatherings because of my headaches. *YesSometimesNoI feel irritable because of my headaches. *YesSometimesNoI avoid traveling because of my headaches. *YesSometimesNoMy headaches make me feel confused. *YesSometimesNoMy headaches make me feel frustrated. *YesSometimesNoI find it difficult to read because of my headaches. *YesSometimesNoI find it difficult to focus my attention away from my headaches and on other things. *YesSometimesNoSubmit PAIN IS NOT A LIFESTYLE Get your quality of life back today. BOOK APPOINTMENT