Never

(6 points)

Rarely

(8 points)

Sometimes

(10 points)

Very often

(11 points)

Constantly

(13 points)

1) When you have headaches, is the pain intense?

2) Is your ability to carry out your usual daily activities, including household chores, work, school or activities with others, limited because of your headaches?

3) When you have headaches, would you like to be able to lie down?

4) In the past 4 weeks, have you felt too tired to work or carry out your daily activities because of your headaches?

5) In the past 4 weeks, have you experienced a feeling of “ras-le-bol” or annoyance because of your headaches?

6) Over the past 4 weeks, has your ability to concentrate on your work or daily activities been limited because of your headaches?

TOTAL