CDE Detailed Report
Disease: Headache
Subdomain Name: History of Disease/Injury Event
CRF: Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire
Displaying 1 - 50 of 52
Subdomain Name: History of Disease/Injury Event
CRF: Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire
Displaying 1 - 50 of 52
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C59673 | Headache before traumatic brain injury complete freedom monthly day count | HdchBfrTBICmplFreeMnthDyCt | Count of monthly frequency of complete freedom from headache the participant/subject experienced prior to traumatic brain injury | Count of monthly frequency of complete freedom from headache the participant/subject experienced prior to traumatic brain injury | Prior to the TBI, how many days per month (30 days) did the individual have complete headache freedom | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate number of days |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:22:26.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C19035 | Headache aura symptom other text | HdchAurasSymOTH | The free-text field related to 'Headache aura symptom type' specifying other text. Type of aura (warning) that a headache was going to start | The free-text field related to 'Headache aura symptom type' specifying other text. Type of aura (warning) that a headache was going to start | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.10 | 2023-08-14 20:18:00.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events | 4000 |
Free-Form Entry |
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| C59684 | Aura without headache indicator | AuraWthoutHdchInd | Indicator of whether participant/subject experienced an aura without a headache | Indicator of whether participant/subject experienced an aura without a headache | Aura without headache | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:41:46.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59641 | Headache aura occurrence indicator | HdchAuraOccurInd | Indicator of whether the participant/subject has an aura occur with headache | Indicator of whether the participant/subject has an aura occur with headache | Auras with headaches | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:22:36.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59663 | Headache first date | HdchFirstDate | Date of the participant's/subject's first headache | Date of the participant's/subject's first headache | Date of first headache | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
ISO 8601 - https://www.iso.org/iso-8601-date-and-time-format.html | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:06:19.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C59674 | Headache before traumatic brain injury continuous indicator | HdchBfrTBICntInd | Indicator of whether headaches experienced by the participant/subject were continuous prior to traumatic brain injury | Indicator of whether headaches experienced by the participant/subject were continuous prior to traumatic brain injury | Were headaches prior to the TBI continuous (i.e., no periods of headache freedom) | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:23:51.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59630 | Headache laterality anatomic site | HdchLateralAnatSite | Anatomic site location of the headache | Anatomic site location of the headache | Where were the headaches usually located? | Right;Left;Front;Back;Top;Side/Temples | Right;Left;Front;Back;Top;Side/Temples | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:04:11.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59642 | Headache aura symptom type frequency category | HdchAuraSympTypFreqCat | Category that describes how the aura symptom type effects the participant/subject | Category that describes how the aura symptom type effects the participant/subject | Did the individual experience the following aura types with headaches | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:24:09.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59664 | Headache after traumatic brain injury change indicator | HdchAftrTBIChngInd | Indicator of whether the participant's/subject's headaches after a traumatic brain injury changed followingf the TBI | Indicator of whether the participant's/subject's headaches after a traumatic brain injury changed followingf the TBI | Did the headache that was present prior to TBI change following TBI? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:07:34.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59675 | Headache before traumatic brain injury noncontinuous inadequate treatment duration | HdchBfrTBINnctnInadqTxDur | Duration of participant/subject's inadequately treated noncontinuous headache | Duration of participant/subject's inadequately treated noncontinuous headache | If headaches were not continuous, how long did headaches last if untreated/inadequately treated? | Numeric Values |
Duration is recorded in hours and minutes (HH:MM) |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:24:45.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C59631 | Headache laterality type | HdchLateralTyp | Type of side were headache is located | Type of side were headache is located | What side(s) was the headache(s) usually on | Right only;Left only;Both sides;Alternating sides | Right only;Left only;Both sides;Alternating sides | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:06:04.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59643 | Headache aura experience percent value | HdchAuraExprncPctVal | Value of (the percentage of) headaches the participant/subject experience with auras | Value of (the percentage of) headaches the participant/subject experience with auras | Percentage of headaches experienced with auras | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:25:45.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
0 | 100 | percent | |||||||||
| C15897 | Headache associated symptom type | HdchAssocSymptmTyp | The associated symptoms the participant/subject experienced with headache | Type of symptoms associated with the headache | Symptom | Nausea;Vomiting;Sensitive to light;Sensitive to noise;Neck Pain/Stiffness;Dizziness and/or vertigo;Gait and/or postural imbalance;Difficulty with memory/concentration | Nausea;Vomiting;Sensitive to light;Sensitive to noise;Neck Pain/Stiffness;Dizziness and/or vertigo;Gait and/or postural imbalance;Difficulty with memory/concentration | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59665 | Headache after traumatic brain injury intensity change indicator | HdchAfterTBIIntnseChngInd | Indicator of whether the participant/subject is experiencing more intense headaches following traumatic brain injury | Indicator of whether the participant/subject is experiencing more intense headaches following traumatic brain injury | Are headaches more intense following TBI? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:10:06.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59676 | Nausea without headache indicator | NausWthoutHdchInd | Indicator of whether participant/subject experienced nausea without a headache | Indicator of whether participant/subject experienced nausea without a headache | Nausea | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:31:29.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59632 | Headache maximum pain intensity scale | HdchMaxPainIntstyScl | Rating scale of the maximum headache pain intensity described by the participant/subject | Rating scale of the maximum headache pain intensity described by the participant/subject | Maximum headache pain intensity: 0 (no pain) to 10 (most severe pain) scale | 0;1;2;3;4;5;6;7;8;9;10 | 0;1;2;3;4;5;6;7;8;9;10 | Numeric Values |
"0" = no pain and "10" = most severe pain |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:07:20.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59655 | Headache category | HeadacheCat | Type of headache experienced by the participant/subject | Type of headache experienced by the participant/subject | Headache Type | Migraine;Post Traumatic Headache;Other Headache | Migraine;Post Traumatic Headache;Other Headache | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:50:50.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C15917 | Headache typical pain intensity rate scale | HeadacheTypPainIntstyRateScl | Rating scale for the pain of this headache on a scale of 0 -10 | Rating scale for the pain of this headache on a scale of 0 -10 | Typical headache pain intensity: 0 (no pain) to 10 (most severe pain) scale | 0;1;2;3;4;5;6;7;8;9;10 | 0;1;2;3;4;5;6;7;8;9;10 | Numeric Values |
"0" = no pain and "10" = most severe pain |
Adult;Pediatric | Supplemental | 4.10 | 2023-06-02 10:23:14.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59666 | Headache after traumatic brain injury frequency change indicator | HdchAfterTBIFreqChngInd | Indicator of whether the participant/subject is experiencing more frequenct headaches following traumatic brain injury | Indicator of whether the participant/subject is experiencing more frequenct headaches following traumatic brain injury | Are headaches more frequent following TBI? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:11:06.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59677 | Vomit without headache indicator | VomitWthoutHdchInd | Indicator of whether participant/subject experienced vomiting without a headache | Indicator of whether participant/subject experienced vomiting without a headache | Vomiting | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:32:32.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59634 | Headache worse with neck movement indicator | HdchWorseWthNeckMvmtInd | Indicator of whether the subject's/participant's headaches worsen with neck movements | Indicator of whether the subject's/participant's headaches worsen with neck movements | Headaches worse with neck movements | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:10:43.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59656 | Headache category other text | HeadacheCatOTH | The free-text field related to 'Headache category' specifying other text | The free-text field related to 'Headache category' specifying other text | Other Headache Type | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:52:09.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
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| C15937 | Headache typical severity type | HeadachTypclSevertyTyp | Level of headache intensity described by the participant/subject | Level of headache intensity described by the participant/subject | Intensity | Mild;Moderate;Severe | Mild;Moderate;Severe | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 3.10 | 2023-08-14 08:41:42.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59667 | Headache after traumatic brain injury symptom change indicator | HdchAfterTBISympChngInd | Indicator of whether the participant's/subject's headaches symptoms changed following traumatic brain injury | Indicator of whether the participant's/subject's headaches symptoms changed following traumatic brain injury | Are headaches associated with new characteristics (e.g., changes in quality, location, or 'associated symptoms' i.e., nausea, vomiting, dizziness, vertigo, or photophobia) following TBI? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:13:08.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59678 | Light sensitive without headache indicator | LightSensitvWthoutHdchInd | Indicator of whether participant/subject experienced sensitivity to light without a headache | Indicator of whether participant/subject experienced sensitivity to light without a headache | Sensitivity to light | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:33:42.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59635 | Headache worse with mental activity indicator | HdchWorseWthMentalActvInd | Indicator of whether the subject's/participant's headaches worsen with mental activity | Indicator of whether the subject's/participant's headaches worsen with mental activity | Headaches worse with mental activity (e.g., reading, concentration) | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:11:41.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59657 | Headache type family history indicator | HeadacheTypFamHxInd | Indicator as to whether the participant/subject has a family history of diagnosed headache type | Indicator as to whether the participant/subject has a family history of diagnosed headache type | Family History of Headache Type? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:53:18.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C15950 | Headache typical pain type | HdchTypcPainTyp | Type of pain the participant/subject experiences with the headache | Type of pain the participant/subject experiences with the headache | Quality | Stabbing;Burning;Pressure/Aching;Pulsating/Throbbing | Stabbing;Burning;Pressure/Aching;Pulsating/Throbbing | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59668 | Headache symptom change after traumatic brain injury type | HdchSympChngAftrTBITyp | Type of headache symptoms experienced by the participant/subject following traumatic brain injury | Type of headache symptoms experienced by the participant/subject following traumatic brain injury | If 'Yes', please select associated symptoms | Nausea;Vomiting;Photophobia;Phonophobia;Vertigo;Dizziness (not vertigo);Throbbing pain;Pain with touching the scalp;Worsening of headache with routine physical activity like walking or climbing stairs | Nausea;Vomiting;Photophobia;Phonophobia;Vertigo;Dizziness (not vertigo);Throbbing pain;Pain with touching the scalp;Worsening of headache with routine physical activity like walking or climbing stairs | Alphanumeric |
Choose all that apply. Only answer if 'YES' is answered to 'Did headaches change in other characteristics e.g., changes in quality, location, or 'associated symptoms' i.e., nausea, vomiting, dizziness, vertigo, or photophobia following TBI |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:14:16.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59679 | Sound sensitive without headache indicator | SoundSensitvWthoutHdchInd | Indicator of whether participant/subject experienced sensitivity to sound without a headache | Indicator of whether participant/subject experienced sensitivity to sound without a headache | Sensitivity to sound | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:34:58.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59636 | Headache associated symptom type frequency category | HdchAssocSymptmTypFreqCat | Category that describes how frequently the headache associated symptom type effects the participant/subject | Category that describes how frequently the headache associated symptom type effects the participant/subject | Did the individual experience the following symptoms during headache | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:12:27.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59658 | Relative biological first degree diagnosis headache history indicator | RelatvBioFrstDegrDxHxHdchInd | Indicator of whether first-degree biological relatives of the participant/subject has a history of diagnosed headache | Indicator of whether first-degree biological relatives of the participant/subject has a history of diagnosed headache | First Degree Biological Relative? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:54:17.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C15961 | Headache worse during activity indicator | HeadachWorsDurngActvtyInd | Indicates whether activity or playing makes headache worse | Indicates whether activity or playing makes headache worse | Headaches worse with physical activity | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59669 | Headache before traumatic brain injury monthly frequency | HdchBfrTBIMnthFreq | Frequency of monthly headaches the participant/subject experienced prior to traumatic brain injury | Frequency of monthly headaches the participant/subject experienced prior to traumatic brain injury | Prior to the TBI, how many days per month (30 days) did the individual have a headache of any duration (minutes or hours) of any severity (mild, moderate or severe)? | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate number of days |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:15:11.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59680 | Neck pain stiffness without headache indicator | NeckPainStffnssWthoutHdchInd | Indicator of whether participant/subject experienced neck pain/stiffness without a headache | Indicator of whether participant/subject experienced neck pain/stiffness without a headache | Neck Pain/Stiffness | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:35:53.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59637 | Headache additional symptom type | HdchAddtnlSymptmTyp | Type of additional symptoms the participant/subject experienced with headache | Type of additional symptoms the participant/subject experienced with headache | Headache Symptom | Miosis (i.e., excessive constriction of the pupil of the eye);Aural fullness (i.e., stuffy ears or fluid in the ears);Conjunctival Injection (i.e., white of eye gets red);Tearing;Nasal congestion;Eyelid swelling;Eyelid drooping;Facial sweating | Miosis (i.e., excessive constriction of the pupil of the eye);Aural fullness (i.e., stuffy ears or fluid in the ears);Conjunctival Injection (i.e., white of eye gets red);Tearing;Nasal congestion;Eyelid swelling;Eyelid drooping;Facial sweating | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:13:24.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59659 | Headache before traumatic brain injury history indicator | HdchBfrTBIHxInd | Indicator of whether the participant/subject had experienced headaches prior to traumatic brain injury | Indicator of whether the participant/subject had experienced headaches prior to traumatic brain injury | Headaches prior to TBI | No;Yes | No;Yes | Alphanumeric |
If 'NO', then questionnaire is complete |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:58:17.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C15972 | Headache aura symptom type | HdchAurasSymTyp | Type of aura (warning) that a headache was going to start | Type of aura (warning) that a headache was going to start | Aura | Visual;Sensory;Speech and/or Language;Motor;Brainstem;Retinal;Other, specify | Visual;Sensory;Speech and/or Language;Motor;Brainstem;Retinal;Other, specify | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 3.10 | 2023-08-14 20:18:35.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59670 | Headache mild before traumatic brain injury average monthly frequency | HdchMildBfrTBIAvgMnthFreq | Average monthly frequency of headaches the participant/subject experienced with mild severity prior to traumatic brain injury | Average monthly frequency of headaches the participant/subject experienced with mild severity prior to traumatic brain injury | Prior to the TBI, what was the average monthly headache frequency of any kind with mild severity | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate average number of days |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:17:56.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59681 | Dizziness vertigo without headache indicator | DizzinessVertigoWthoutHdchInd | Indicator of whether participant/subject experienced dizziness and/or vertigo without a headache | Indicator of whether participant/subject experienced dizziness and/or vertigo without a headache | Dizziness and/or vertigo | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:36:54.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59638 | Headache additional symptom type present indicator | HdchAddtnlSympTypPresentInd | Indicator of whether the participant's/subject's headache symptom is present | Indicator of whether the participant's/subject's headache symptom is present | Is Symptom Present? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:15:53.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59660 | Headache prior diagnosis indicator | HdchPriorDxInd | Indicator of whether the participant/subject had a prior headache diagnosis | Indicator of whether the participant/subject had a prior headache diagnosis | Does patient have a prior headache diagnosis? | Yes;No | Yes;No | Alphanumeric |
If 'YES' then answer the following questions regarding characteristics of pre-TBI headaches |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:59:21.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C16207 | Family history medical condition first-degree relative type | FamHistMedclCondFrstDegReltTyp | Relationship of the first-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of the first-degree family member or ancestor with the medical condition or health related event to the participant/subject |
Relationship of first-degree relative(s) to participant/subject |
1;2;3;4;5;6;7;8;9;10 | Biological Mother;Biological Father;Sibling Male;Sibling Female;Non-identical or dizygotic twin Male;Non-identical or dizygotic twin Female;Identical twin Male;Identical twin Female;Full biologic child Male;Full biologic child Female | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59671 | Headache moderate before traumatic brain injury average monthly frequency | HdchModrtBfrTBIAvgMoFreq | Average monthly frequency of headaches the participant/subject experienced with moderate severity prior to traumatic brain injury | Average monthly frequency of headaches the participant/subject experienced with moderate severity prior to traumatic brain injury | Prior to the TBI, what was the average monthly headache frequency of any kind with moderate severity | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate average number of days |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:20:31.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59682 | Gait posture imbalance without headache indicator | GaitPostrImbalncWthoutHdchInd | Indicator of whether participant/subject experienced gait and/or postural imbalance without a headache | Indicator of whether participant/subject experienced gait and/or postural imbalance without a headache | Gait and/or postural imbalance | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:38:30.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59639 | Headache additional symptom laterality type | HdchAddtnlSympLateralTyp | Laterality type of the participant's/subject's headache symptom | Laterality type of the participant's/subject's headache symptom | If 'Yes', is Symptom Unilateral or Bilateral? | Unilateral;Bilateral | Unilateral;Bilateral | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:17:24.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59661 | Headache prior diagnosis type | HdchPriorDxTyp | Type of prior headache history diagnosis | Type of prior headache history diagnosis | If 'Yes', please check all that apply | Migraine with aura;Migraine without aura;Chronic Migraine;Other;Episodic cluster headache;Chronic cluster headache;Cervicogenic headache;Infrequent episodic tension-type headache;Frequent episodic tension-type headache;Chronic tension-type headache | Migraine with aura;Migraine without aura;Chronic Migraine;Other;Episodic cluster headache;Chronic cluster headache;Cervicogenic headache;Infrequent episodic tension-type headache;Frequent episodic tension-type headache;Chronic tension-type headache | Alphanumeric |
Choose all that apply; Only answer if 'YES' is answered to "Does patient have a prior headache diagnosis?" |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:00:18.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C16208 | Family history medical condition second-degree relative type | FamHistMedclCondScndDegReltTyp | Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of second-degree relative(s) to participant/subject | 11;12;13;14;15;16;17;18;19;20;21;22;23;24 | Half-Sibling Male;Half-Sibling Female;Maternal Grandmother;Maternal Grandfather;Paternal Grandmother;Paternal Grandfather;Maternal Aunt;Maternal Uncle;Paternal Aunt;Paternal Uncle;Grandchild Male;Grandchild Female;Nephew;Niece | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C59672 | Headache severe before traumatic brain injury average monthly frequency | HdchSevereBfrTBIAvgMoFreq | Average monthly frequency of headaches the participant/subject experienced with severe severity prior to traumatic brain injury | Average monthly frequency of headaches the participant/subject experienced with severe severity prior to traumatic brain injury | Prior to the TBI, what was the average monthly headache frequency of any kind with severe severity | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate average number of days |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:21:35.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C59683 | Memory concentration difficult without headache indicator | MemCncntrnDffcltWthoutHdchInd | Indicator of whether participant/subject experienced difficulty with memory/concentration without a headache | Indicator of whether participant/subject experienced difficulty with memory/concentration without a headache | Difficulty with memory/concentration | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 22:39:26.0 | Post-traumatic Headache (PTH) - Headaches Prior to TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
